The main objective of this study is to determine whether 24/7 hybrid closed-loop insulin delivery under free living conditions applying faster insulin aspart (FiAsp) is superior to 24/7 hybrid closed-loop insulin delivery applying standard insulin aspart in very young children with type 1 diabetes. The closed-loop system consists of three components: the continuous glucose monitor (CGM), the insulin pump and a smartphone Application, or App, that translates, in real-time, sensor glucose levels received from the glucose monitoring device and calculates the amount of insulin to be delivered by the coupled insulin pump. This is a double-blind, multi-centre, randomised, crossover design study, involving a run-in period followed by two 8-week study periods during which glucose levels will be controlled by a hybrid closed-loop system using either standard insulin aspart or faster insulin aspart in random order. Participants aged 2-6 years with type 1 diabetes on insulin pump therapy will be recruited through paediatric diabetes outpatient clinics at participating clinical centres. Enrolment will target up to 30 children (aiming for 6-14 participants per centre) to allow for dropouts during run-in. Prior to the use of study devices, participants and parents/guardians will receive appropriate training by the research team on the safe use of the study pump and CGM device, and the hybrid closed-loop insulin delivery system. Parents/guardians at nursey/school may also receive training by the study team if required. Participants will have regular contact with the study team during the study including 24/7 telephone support. Parents/guardians will be asked to complete validated questionnaires at the start and end of the study to assess quality of life measures including sleep. The primary outcome is the between group difference in time spent in target range between 3.9 and 10.0 mmol/l as recorded by CGM during the study. Secondary outcomes are time spent with glucose levels above and below target, as recorded by CGM, and other CGM-based metrics. Safety evaluation comprises assessment of the frequency and severity of hypoglycaemic episodes and diabetic ketoacidosis (DKA).
Purpose of clinical trial: To compare hybrid closed-loop applying faster insulin aspart to hybrid closed-loop applying standard insulin aspart over 8 weeks. Study objectives: The study objective is to compare hybrid closed-loop glucose control using faster insulin aspart with hybrid closed-loop control using standard insulin aspart in very young children with type 1 diabetes. 1. EFFICACY: The objective is to assess the ability of a hybrid closed-loop system applying faster insulin aspart to maintain CGM glucose levels within the target range from 3.9 to 10.0 mmol/l, in comparison to a hybrid closed-loop system applying standard insulin aspart in very young children with type 1 diabetes. 2. SAFETY: The objective is to evaluate the safety of closed-loop glucose control using faster insulin aspart compared to standard insulin aspart in terms of episodes and severity of hypoglycaemia, frequency of diabetic ketoacidosis (DKA) and nature and severity of other adverse events. 3. UTILITY: The objective is to determine the acceptability and duration of use of the closed-loop system. 4. HUMAN FACTORS: The objective is to assess emotional and behavioural characteristics of parents/guardians and their response to the closed-loop system and clinical trial using validated surveys. Participating clinical centres: 1. Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge 2. John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford 3. Nottingham Children's Hospital, Nottingham 4. Alder Hey Children's Hospital, Liverpool Sample Size: 24 children randomised (6-14 participants per centre). Maximum duration of study for a subject: 6 months Recruitment: Participants will be recruited through the paediatric diabetes outpatient clinics at participating clinical centres (see above). Enrolment will target up to 30 participants (aiming for 6-14 participants per centre), to allow for dropouts during run-in. Consent: Written informed consent will be obtained from all parents/guardians. Screening and baseline Assessment: Eligible participants will undergo a baseline assessment including a blood sample for the measurement of HbA1c. Height and weight will be recorded. Validated questionnaires will be completed by parents/guardians. Pre-Study Training and Run-in: Training sessions on the use of the study CGM, insulin pump and hybrid closed-loop insulin delivery will be provided by the research team. During the closed-loop training session, parents/guardians will operate the system under the supervision of the clinical research team. Participants and parents/guardians will use the study CGM, insulin pump, and hybrid closed-loop insulin delivery during a 2-4 week run-in period. For compliance and to assess the ability of the participant to use the study devices safely, at least 8 days of CGM data need to be recorded and safe use of study insulin pump and hybrid closed-loop insulin delivery demonstrated during the last 14 days of the run-in period. The CGM data will also be used to assess baseline glucose control and may be used for treatment optimisation as necessary. Competency Assessment: Competency on the use of study pump,study CGM and hybrid closed-loop insulin delivery will be evaluated by the research team. Training may be repeated if required. Randomisation: Eligible participants will be randomised using randomisation software to the initial use of faster insulin aspart with the hybrid closed-loop system or to standard insulin aspart with the hybrid closed-loop system for 8 weeks before crossing over to the other treatment arm. 1. Faster insulin aspart with hybrid closed-loop: Participants and their parents/guardians will use the hybrid closed-loop system with faster insulin aspart for 8 weeks at home. The participant, parents/guardians and the research team will be blinded to the intervention. Crossover assessment: At the end of the first study arm, validated questionnaires will be completed by the parents/guardians. 2. Standard insulin aspart with hybrid closed-loop: Participants and their parents/guardians will use the hybrid closed-loop system with standard insulin aspart for 8 weeks at home. The participant, parents/guardians and the research team will be blinded to the intervention. Study contacts: Participants and parents/guardians will be contacted 24 hours after starting each study arm to ensure there are no concerns regarding the study devices. Participants will be contacted by the study team (email/phone) 2 and 4 weeks after the start of each study arm in order to record any adverse events, device deficiencies, and changes in insulin settings, other medical conditions and/or medication. In case of any problems related to the technical devices or diabetes management, participants and parents/guardians will be able to contact a 24-hour telephone helpline to the local research team. The local research team will have access to central 24 hour advice on technical issues. End of study assessments: Height and weight will be recorded. Validated questionnaires will be completed by parents/guardians. Participants will resume usual care using their pre-study insulin pump. Procedures for safety monitoring during trial: Standard operating procedures for monitoring and reporting of all adverse events will be in place, including serious adverse events (SAE), serious adverse device effects (SADE) and specific adverse events (AE) such as severe hypoglycaemia. A data safety and monitoring board (DSMB) will be informed of all serious adverse events and any unanticipated serious adverse device effects that occur during the study and will review compiled adverse event data at periodic intervals. Criteria for withdrawal of subjects on safety grounds: A participant and parent/guardian may terminate participation in the study at any time without necessarily giving a reason and without any personal disadvantage. An investigator can stop the participation of a participant after consideration of the benefit/risk ratio. Possible reasons are: 1. Serious adverse events 2. Serious protocol violation 3. Non-compliance 4. Failure to satisfy competency assessment 5. Decision by the investigator, or the Sponsor, that termination is in the participant's best medical interest 6. Allergic reaction to insulin
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
27
CamAPS FX closed loop system comprises: * Dana insulin pump (Diabecare, Sooil, Seoul, South Korea) * Dexcom G6 real-time CGM sensor (Dexcom, Northridge, CA, USA) * An Android smartphone hosting CamAPS FX app with the Cambridge model predictive control algorithm and communicating wirelessly with the insulin pump and glucose sensor * Cloud upload system to monitor CGM/insulin data
CamAPS FX closed loop system comprises: * Dana insulin pump (Diabecare, Sooil, Seoul, South Korea) * Dexcom G6 real-time CGM sensor (Dexcom, Northridge, CA, USA) * An Android smartphone hosting CamAPS FX app with the Cambridge model predictive control algorithm and communicating wirelessly with the insulin pump and glucose sensor * Cloud upload system to monitor CGM/insulin data
University Department of Paediatrics
Cambridge, Cambridgeshire, United Kingdom
Wellcome Trust-MRC Institute of Metabolic Science University of Cambridge
Cambridge, Cambridgeshire, United Kingdom
Time in target (3.9 to 10.0mmol/L) (70 to 180 mg/dL)
Time spent in the target glucose range from 3.9 to 10.0 mmol/l based on subcutaneous glucose monitoring (CGM)
Time frame: 8-week intervention
Time spent above target glucose (10.0 mmol/L) (180 mg/dL)
Percentage of time spent with sensor glucose readings above target glucose (10.0mmol/L) (180mg/dL)
Time frame: 8-week intervention
Mean glucose
Average of sensor glucose levels
Time frame: 8-week intervention
Time spent below target glucose (3.9 mmol/L) (70 mg/dL)
Percentage of time spent with sensor glucose readings below target glucose (3.9mmol/L)(70mg/dL)
Time frame: 8-week intervention
Standard deviation of glucose
Standard deviation Standard deviation of sensor glucose levels
Time frame: 8-week intervention
Coefficient of variation of glucose
Coefficient of variation of sensor glucose levels
Time frame: 8-week intervention
Time spent below target glucose (3.0 mmol/L) (54 mg/dL)
Percentage of time spent with sensor glucose readings below target glucose (3.0mmol/L)(54mg/dL)
Time frame: 8-week intervention
Time with glucose levels in significant hyperglycaemia (glucose levels > 16.7 mmol/L) (300 mg/dL)
Percentage of time spent with glucose levels in significant hyperglycaemia (glucose levels \> 16.7mmol/L) (300mg/dL)
Time frame: 8-week intervention
BMI SDS
Time frame: 8-week intervention
Total, basal, and bolus insulin dose
Time frame: 8-week intervention
Number of episodes of severe hypoglycaemia
Safety evaluation
Time frame: Through study completion, an average of 5 months
Frequency of diabetic ketoacidosis
Safety evaluation
Time frame: Through study completion, an average of 5 months
Frequency and nature of other adverse events or serious adverse events
Safety evaluation
Time frame: Through study completion, an average of 5 months
Closed-loop use
Percentage of time of closed-loop is operational (Utility evaluation)
Time frame: Through study completion, an average of 5 months
CGM use
Percentage of time CGM is available (Utility evaluation)
Time frame: Through study completion, an average of 5 months
Human factors assessment
Assessment of emotional and behavioural characteristics of parents/guardians, their response to the closed-loop system and information about parent/guardian sleep will be assessed through validated surveys.
Time frame: 8-week intervention and 8-week control period
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.