Diabetes Mellitus, Type 1
Conditions
Keywords
Diabetes Mellitus, Closed Loop, Artificial Pancreas
Brief summary
Hypothesis: Closed-loop control systems for an artificial pancreas using multi-parametric model predictive control can be developed and evaluated safely in patients with Type 1 Diabetes Mellitus (T1DM) to control blood glucose concentrations. This study seeks to combine real-time continuous glucose sensing with automated insulin delivery in a closed-loop system that will achieve euglycemia in patients with T1DM. The end result of this line of research will be an artificial pancreas that will provide around-the-clock glucose regulation through controlled insulin delivery in response to detected patterns of change in glucose levels.
Detailed description
The goal of the JDRF Artificial Pancreas Project is to produce an autonomous artificial pancreas that can safely and effectively regulate glycemia in people with type 1 diabetes mellitus. In our work, this fully automated closed-loop system combines a subcutaneous continuous glucose monitor (CGM) and a continuous subcutaneous insulin infusion (CSII) pump with a sophisticated control algorithm. This is a proof-of-concept study to demonstrate that the controller could bring the patient back to a relatively normal glucose concentration after an unannounced meal and from mild hyperglycemia. Once the system is initiated, all insulin delivery is calculated automatically. There was no outside intervention either by the subject or medical personnel. An artificial pancreas system that aims at replicating normal beta-cell function by using the subcutaneous-subcutaneous (sc-sc) route needs to address inherent delays in both glucose sensing and insulin delivery. Our strategic approach is that a closed-loop system should operate safely without any knowledge of meals or other disturbances. We have developed the Artificial Pancreas System (APS©) and used it to clinically evaluate a control strategy that allows efficient glycemic control without any a priori meal information. The Artificial Pancreas device uses the Artificial Pancreas System (APS©) platform with the OmniPod insulin pump, the DexCom SEVEN PLUS CGM and a multi-parametric model predictive control algorithm (mpMPC) with an insulin-on-board (IOB) safety constraint.
Interventions
DEVICEClosed-loop session
Subjects will arrive fasting at 7am unless needed for hypoglycemia (glucose \< 70 mg/dL) and no extra bolus insulin after 3am. An IV catheter will be inserted for blood samples and for IV administration of glucose if necessary. Blood samples will be analyzed for glucose by YSI 2300Stat every 30 minutes. Breakfast consisting of 25g of CHO will be eaten at 7:30 am and the subject will bolus for this amount of CHO. The controller is switched on on the down slope of the meal response, and the subject is brought to a basal steady-state by the controller. Target blood glucose is 110 ± 30-mg/dL. After approximately 3 hours a small lunch will be eaten consisting of 25g of CHO (unannounced meal challenge). The subject will be monitored until blood glucose returns to euglycemia.
Sponsors
Juvenile Diabetes Research Foundation
Schneider Children's Medical Center, Israel
Sansum Diabetes Research Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Willing to sign the consent form 2. Type 1 diabetes for at least 1 year prior to the study 3. Using continuous subcutaneous insulin infusion pump 4. Above 21 years of age 5. Willing to follow the study requirements
Exclusion criteria
1. Allergy to the sensor or to one of its components 2. Psychiatric disorders 3. Reported diabetic ketoacidosis within last 3 months 4. Abnormal liver function (Transaminase \> 2 times the upper limit of normal) 5. Heart failure 6. Any carcinogenic disease 7. Any other chronic abnormality 8. Unwilling to perform or to follow the research protocol 9. Participation in any other study concurrent with the proposed study 10. Creatinine concentration above the upper limit of normal for age and sex 11. Active coronary artery disease 12. Active gastroparesis 13. History of uncontrolled seizures 14. Pregnancy 15. Untreated adrenal insufficiency 16. Hypokalemia 17. Uncontrolled thyroid disease. 18. Condition, which in the opinion of the investigator, would interfere with patient safety
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Restoration of Euglycemia | 12 hours | The primary endpoint of this pilot study is successful restoration of euglycemia from the two perturbed conditions using closed loop control with minimal hypo- and hyperglycemia exposure. The first condition involves restoration of euglycemia when the subject is in a hyperglycemic state. The second condition involves restoration of euglycemia following consumption of a meal containing 25g CHO with no insulin bolus. The patients will be followed for the duration of the 12 hour study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average percent-of-time-in-range (80 - 180 mg/dL) | 12 hours | All reported blood glucose values per both CGM and YSI ware analyzed for average percent-of-time-in-range (80 - 180 mg/dL). The participants will be followed for the duration of the 12 hour study. |
Countries
Israel, United States
Outcome results
None listed