Type 1 Diabetes Mellitus in Prepubertal Children
Conditions
Keywords
Type 1 diabetes, Prepubertal children, Closed-loop insulin infusion
Brief summary
The study is a randomized trial preceded by a run-in period and followed by a non-randomized study extension. After 3 weeks of outpatient use of study pump (1 week) and study pump+CGM (2weeks) as run-in period, patient and parents will be admitted for 4-hour training to closed-loop (AP) mode. Following randomization (1:1), patient will be allocated to '24-hour' use of AP or 'dinner and overnight AP mode/day time pump and CGM use' for the next 18-week period. At 18-week visit, a study extension for a further 18-week period will be initiated. AP mode that will be prescribed to all patients will depend from an independent DSMB decision based upon study safety data collected after 6 and 12 weeks from the first 30 included patients. Visits will occur at week 27 (safety follow-up) and 36 (final visit).
Detailed description
The study is a randomized trial preceded by a run-in period and followed by a non-randomized study extension. After 3 weeks of outpatient use of study pump (1 week) and study pump+CGM (2weeks) as run-in period, patient and parents will be admitted for 4-hour training to closed-loop (AP) mode. Following randomization (1:1), patient will be allocated to '24-hour' use of AP or 'dinner and overnight AP mode/day time pump and CGM use' for the next 18-week period. A hotline phone number will be given to the patient and parents so that they can contact the study staff as needed. A logbook will be provided to collect details about hypoglycemic and hyperglycemic episodes, physical activity and noticeable events. Phone calls will be scheduled between investigator and patient+parents 48 hours, 1 week and 2 weeks after AP mode initiation. Potential misbehaviors will be corrected and all questions answered. If needed, AP parameters may be revised and reconfigured. Hospital visits will be scheduled 6, 12 and 18 weeks after AP mode initiation for the same purposes, plus HbA1c measurement at week 12 and 18. At 18-week visit, a study extension for a further 18-week period will be initiated. AP mode that will be prescribed to all patients will depend from an independent DSMB decision based upon study safety data collected after 6 and 12 weeks from the first 30 included patients. Visits will occur at week 27 (safety follow-up) and 36 (final visit).
Interventions
Continuous subcutaneous insulin infusion according to an automated algorithm from continuous glucose monitoring data
Sponsors
University Hospital, Montpellier
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Treatment of diabetes by insulin pump since \> 6 months * HbA1c level \< 10%
Exclusion criteria
* Unwillingness of one parent or the legally responsible party to participate in insulin treatment * Any associated chronic disease or therapy (except insulin) affecting glucose metabolism
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of time spent in the 70-180 mg/dl glucose range assessed on daily CGM data | 18 weeks | % time blood glucose in 70-180 mg/dl range |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of time spent with glucose level > 180 and 300 mg/dl, assessed on daily CGM data | 18 and 36 weeks | Percent time while blood glucose is kept in safe 70-180 mg/dl range |
| Percent of time spent in the 70-140 mg/dl glucose range assessed on daily CGM data | 18 and 36 weeks | Percent time while blood glucose is kept in safe 70-180 mg/dl range |
| Mean glucose level assessed on daily CGM data | 18 and 36 weeks | CGM data will be used to calculate daily glucose mean to assess the efficacy of the algorithm on glucose control. |
| Percent of time spent with glucose level < 70, 60 and 50 mg/dl, assessed on daily CGM data | 18 and 36 weeks | Percent time while blood glucose is kept in safe 70-180 mg/dl range |
| Number of needed interventions by the patients or care providers to treat hypoglycemia | 18 and 36 weeks | A logbook will be used all along the study by patients to record carbs intake in case of hypoglycemia. If patient required further assistance, care provider who will record third parties intervention. |
| Percent of time with AP functional, discriminating between each component failure modes | 18 and 36 weeks | Percent time while blood glucose is kept in safe 70-180 mg/dl range |
| Score of the Artificial Pancreas Acceptance Questionnaire | 18 and 36 weeks | This questionnaire consists of 15 affirmations about the use of AP and patient can answer in a scale from 0 (do not agree) to 6 (totally agree). The global score is calculated by the sum of all answers. A high score means a good acceptation of the system. There is no subscale. |
| HbA1c level measured at week 12, 18, 27 and 36 | 12,18, 27 and 36 weeks | Levels of glycated hemoglobin will be measured at different time intervals to assess the clinical impact of the use of the algorithm on patient diabetes. |
Countries
France
Outcome results
None listed