Safety Evaluation of the Advanced Hybrid Closed Loop (AHCL) System

Not Applicable

Completed

Conditions: Type 1 Diabetes Mellitus

Interventions: Device: AHCL insulin pump system

Registration Number: NCT03959423

Lead Sponsor: Medtronic Diabetes

Brief Summary: This study is a Safety Evaluation of the Advanced Hybrid Closed Loop (AHCL) System in Type 1 Adult and Pediatric Subjects.

Detailed Description: The purpose of this study is to evaluate the safety of the Advanced Hybrid Closed Loop system (AHCL) in type 1 diabetes adult and pediatric subjects in a home setting. The main objective in conducting this research is to collect data from patients who use the AHCL system at home, at work, at school and everywhere else. Subjects will use 670G 4.0 system with Guardian Sensor 3 (GS3) during study period, and will be allowed to participate in continued access phase, and use 670G 4.0 system with GS3 and 780G system with Guardian 4 Sensor (G4S).

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 288

Inclusion Criteria

Subject is age 7-75 years at time of Screening
Subjects 14-75 years of age: A clinical diagnosis of type 1 diabetes for 2 years or more as determined via medical record or source documentation by an individual qualified to make a medical diagnosis
Subjects 7-13 years of age: A clinical diagnosis of type 1 diabetes for 1 year or more as determined via medical record or source documentation by an individual qualified to make a medical diagnosis Study-specific inclusion criteria
Subject is willing to perform ≥ 4 finger stick blood glucose measurements daily
Subject is willing to perform required sensor calibrations
Subject is willing to wear the system continuously throughout the study
Subject must have a minimum daily insulin requirement (Total Daily Dose) of greater than or equal to 8 units
Subject has a Glycosylated hemoglobin (HbA1c) less than 10% (as processed by Central Lab) at time of Screening visit Note: All HbA1c blood specimens will be sent to and tested by a NGSP certified Central Laboratory. HbA1c testing must follow National Glycohemoglobin Standardization Program (NGSP) standards.
Subject has TSH in the normal range OR if the TSH is out of normal reference range the Free T3 is below or within the lab's reference range and Free T4 is within the normal reference range.
Pump therapy for greater than 6 months prior to screening (with or without CGM experience)
Subject must have a companion or caregiver available at night for the duration of the study period who resides (or will live) in in the same building (or home). A companion or caregiver should also be available during exercise challenges in the same building, home or location (if not at home). This requirement may be verified by subject report at screening visit.
Subject willing to upload data from the study pump, must have Internet access and a computer system that meets the requirements for uploading the study pump
If subject has celiac disease, it has been adequately treated as determined by the investigator
Subject is willing to take one of the following insulins and can financially support the use of either of the 2 insulin preparations throughout the course of the study (i.e. co-payments for insulin with insurance or able to pay full amount)
- Humalog™* (insulin lispro injection)
- NovoLog™* (insulin aspart)
Subjects with history of cardiovascular event 1 year or more from the time of screening must have an EKG within 6 months prior to screening or during screening. If subject has an abnormal EKG, participation is allowed if there is clearance from a cardiologist
Subjects with the 3 or more cardiovascular risk factors listed below must have an EKG within 6 months prior to screening or during screening. If subject has an abnormal EKG, participation is allowed if there is clearance from a cardiologist

a. Cardiovascular risk factors include:
- Age >35 years
- Type 1 diabetes of >15 years' duration
- Presence of any additional risk factor for coronary artery disease
- Presence of microvascular disease (proliferative retinopathy or nephropathy, including microalbuminuria)
- Presence of peripheral vascular disease
- Presence of autonomic neuropathy
Subjects with history of cardiovascular event 1 year or more from the time of screening must have a stress test within 6 months prior to screening or during run in period. If subject fails stress test, participation is allowed if there is clearance from a cardiologist

Exclusion Criteria

Subject has a history of 1 or more episodes of severe hypoglycemia, which resulted in any the following during the 6 months prior to Screening:
1. Medical assistance (i.e. Paramedics, Emergency Room (ER) or Hospitalization)
2. Coma
3. Seizures
Subject has been hospitalized or has visited the ER in the 6 months prior to Screening resulting in a primary diagnosis of uncontrolled diabetes
Subject has had Diabetic Ketoacidosis (DKA) in the 6 months prior to Screening.
Subject has Hypoglycemia Unawareness, as measured by the Gold questionnaire (Gold, MacLeod et al. 1994) at Screening
Subject is unable to tolerate tape adhesive in the area of sensor placement
Subject has any unresolved adverse skin condition in the area of sensor placement (e.g., psoriasis, dermatitis herpetiformis, rash, Staphylococcus infection)
Women of child-bearing potential who have a positive pregnancy test at Screening or plan to become pregnant during the course of the study
Females who are sexually active and able to conceive will be excluded if they are not using an effective method of contraception and do not agree to continue using an effective method of contraception for the duration of the study as determined by investigator.
Subject has had any of the following cardiovascular events within 1 year of screening: myocardial infarction, unstable angina, coronary artery bypass surgery, coronary artery stenting, transient ischemic attack, cerebrovascular accident, angina, congestive heart failure, ventricular rhythm disturbances or thromboembolic disease
Subject is being treated for hyperthyroidism at time of Screening
Subject has a diagnosis of adrenal insufficiency
Subject has taken any oral, injectable, or intravenous (IV) glucocorticoids within 8 weeks from time of Screening, or plans to take any oral, injectable, or IV glucocorticoids during the course of the study
Subject is actively participating in an investigational study (drug or device) wherein he/she has received treatment from an investigational study drug or investigational study device in the last 2 weeks
Subject is currently abusing illicit drugs
Subject is currently abusing marijuana
Subject is currently abusing prescription drugs
Subject is currently abusing alcohol
Subject is using pramlintide (Symlin), DPP-4 inhibitor, liraglutide (Victoza or other GLP-1 agonists), metformin, canagliflozin (Invokana or other SGLT2 inhibitors) at time of Screening
Subject has a history of visual impairment which would not allow subject to participate in the study and perform all study procedures safely, as determined by the investigator
Subject has elective surgery planned that requires general anesthesia during the course of the study
Subject has a sickle cell disease, hemoglobinopathy; or has received red blood cell transfusion or erythropoietin within 3 months prior to time of Screening
Subject plans to receive red blood cell transfusion or erythropoietin over the course of study participation
Subject diagnosed with current eating disorder such as anorexia or bulimia
Subject has been diagnosed with chronic kidney disease that results in chronic anemia
Subject has a hematocrit that is below the normal reference range of lab used.
Subject is on dialysis
Subject has serum creatinine of >2 mg/dL.
Research staff involved with the study.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Subjects 7-75 years of age	AHCL insulin pump system	Subjects who have been diagnosed with type 1 diabetes

Primary Outcome Measures

Name	Time	Method
Change in HbA1c	Baseline to End of 3-Month Study Period	The overall mean difference of the change in HbA1c from baseline to end of 3-month Study Period.
Change in Percentage of Euglycemia	Baseline to End of 3-Month Study Period	The overall mean change in % of time in euglycemia (70-180 mg/dL) from baseline to end of 3-month Study Period will be estimated.

Secondary Outcome Measures

Name	Time	Method
Number of Severe Hypoglycemic Event	3-month Study Period	Number of severe hypoglycemic events occurred during 3-month Study Period
Number of Diabetic Ketoacidosis (DKA) Event	3-month Study Period	Number of Diabetic Ketoacidosis (DKA) event occurred during 3-month Study Period
Change in Percent of Time in Hypoglycemic Range (<70 mg/dL)	Baseline to End of 3-Month Study Period	The overall mean change in % of time in hypoglycemic range (\<70 mg/dL) from baseline to end of 3-month Study Period will be estimated.

Trial Locations

Locations (17): Scripps Whittier Diabetes Institute
🇺🇸
La Jolla, California, United States
University of South Florida
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Tampa, Florida, United States
Yale Diabetes Research Program
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New Haven, Connecticut, United States
Diabetes and Glandular Disease Clinic
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San Antonio, Texas, United States
AM Diabetes & Endocrinology Center
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Bartlett, Tennessee, United States
Rocky Mountain Diabetes Center
🇺🇸
Idaho Falls, Idaho, United States
Rainier Clinical Research
🇺🇸
Renton, Washington, United States
International Diabetes Center
🇺🇸
Minneapolis, Minnesota, United States
Seattle Children's Hospital and Medical Center
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Seattle, Washington, United States
Atlanta Diabetes Associates
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Atlanta, Georgia, United States
Arkansas Diabetes and Endocrinology Center
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Little Rock, Arkansas, United States
Barbara Davis Center - Pediatric
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Aurora, Colorado, United States
SoCal Diabetes
🇺🇸
Torrance, California, United States
Southeastern Endocrine
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Roswell, Georgia, United States
Barbara Davis Center - Adults
🇺🇸
Aurora, Colorado, United States
Diablo Clinical Research
🇺🇸
Walnut Creek, California, United States
Texas Endocrinology
🇺🇸
Austin, Texas, United States