Comparison of Day and Night Closed-loop With Faster-acting Insulin Aspart With Insulin Aspart

Not Applicable

Completed

• Conditions: Diabetes Mellitus, Type 1
• Interventions: Device: Insulin aspart (standard of care insulin) + closed loop device; Device: FIASP + closed loop device

• Registration Number: NCT03579615
• Lead Sponsor: Manchester University NHS Foundation Trust

Brief Summary

The main objective of the study is to determine whether automated closed-loop using faster-acting insulin aspart will improve glucose control and reduce the burden of hypoglycaemia over a 23-hour period compared to insulin aspart under conditions mimicking under-estimation of meal carbohydrate content or missed meal bolus. Faster-acting insulin aspart (FIASP) is a novel formulation of insulin aspart in which two additional excipients (L-arginine and Niacinamide) have been added, resulting in accelerated initial absorption and more than double the glucose lowering effect in the first 30 minutes after subcutaneous administration using insulin pump. To date, no closed-loop study has been performed to evaluate the benefit of faster-acting aspart over insulin aspart during closed-loop system use.

Detailed Description

This is an open-label, single-centre, two-period, randomised, cross over study. The study involves a screening visit to assess participant eligibility and two 24 hour in-patient stays at the clinical research facility during which day and night glucose levels will be controlled by the closed-loop system with either faster-acting insulin aspart or insulin aspart.

Up to 22 adults with type 1 diabetes and treated with continuous subcutaneous insulin infusion will be recruited, aiming for 16 completed participants. Recruitment will take place at Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester, UK. Participants will attend the Manchester Clinical Research Facility (MCRF), Manchester, on two occasions. In random order, they will undergo two closed-loop study days using either faster-acting insulin aspart or insulin aspart. During the study days, the closed-loop control algorithm will automatically modulate d insulin infusion rate based on real-time subcutaneous glucose sensor measurements. Participants will receive standardised meals with half usual meal bolus for the evening meal and no meal bolus for lunch time meal during each study day.

Study Timeline

• Study First Submitted: 2018-06-25
• Study First Submitted QC: 2018-07-05
• Study First Posted: 2018-07-06
• Study Start: 2020-12-23
• Primary Completion: 2022-02-24
• Status Verified: 2022-08
• Study Completion: 2022-08-01
• Last Update Submitted: 2022-08-19
• Last Update Posted: 2022-08-22

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 18

Inclusion Criteria

1. The subject is 18 years and older
2. The subject has type 1 diabetes, as defined by WHO for at least 1 year or is confirmed C-peptide negative
3. The subject will have been an insulin pump user for at least 3 months
4. The subject is treated with any of the rapid acting insulin analogues
5. The subject is willing to adhere to study procedures
6. HbA1c ≥ 7.0% (53 mmol/mol) and ≤ 10 % (86mmol/mol) based on analysis from local laboratory or equivalent within 3 months prior to enrolment
7. The subject is literate in English

Exclusion Criteria

• 1. Non-type 1 diabetes mellitus including those secondary to chronic disease 2. Any other physical or psychological disease likely to interfere with the normal conduct of the study 3. Untreated celiac disease or hypothyroidism 4. Current treatment with drugs known to interfere with glucose metabolism, e.g. systemic corticosteroids, Metformin, SGLT2 inhibitors, non-selective beta-blockers and MAO inhibitors etc.

  2. Known or suspected allergy against insulin 6. Subjects with clinical significant nephropathy, neuropathy or proliferative retinopathy as judged by the investigator 7. Total daily insulin dose > 2 U/kg/day 8. Total daily insulin dose < 10 U/day 9. Pregnancy, planned pregnancy, or breast feeding

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Insulin aspart (standard of care insulin) + closed loop device	Insulin aspart (standard of care insulin) + closed loop device	Subjects randomised to insulin aspart (standard of care insulin) and closed loop device will be invited to have blood samples taken at baseline, CGM training, competency assessment, and optimisation of treatment. This is followed by inpatient stay where patients will be using insulin aspart (standard of care insulin) + closed loop intervention for 24 hours.Participants will be advised to change their usual insulin to the corresponding study visit insulin formulation, 24 hours prior to admission. (For example; if the participant is on insulin aspart, this will be changed to faster-acting aspart 24-hour prior to the admission for closed loop with faster-acting aspart and vice versa).
FIASP + closed loop device	FIASP + closed loop device	Subjects randomised to FIASP and closed loop device will be invited to have blood samples taken at baseline, CGM training, competency assessment, and optimisation of treatment. This is followed by inpatient stay where patients will be using FIASP + closed loop intervention for 24 hours. Participants will be advised to change their usual insulin to the corresponding study visit insulin formulation, 24 hours prior to admission. (For example; if the participant is on insulin aspart, this will be changed to faster-acting aspart 24-hour prior to the admission for closed loop with faster-acting aspart and vice versa).

Primary Outcome Measures

Name	Time	Method
Time spent in the target glucose range	23 hours	Time spent in the target glucose range between 3.9 to 10.0 mmol/l (70 to 180mg/dl) based on sensor glucose levels between the hours of 19:00 on day 1 and 18:00 hours on day 2 of the inpatient stay.

Secondary Outcome Measures

Name	Time	Method
Time spent in the target glucose range within 4 hours of each meal	4 hours	Time spent in the target glucose range between 3.9 to 10.0 mmol/l (70 to 180mg/dl) based on sensor glucose levels during the first 4 hours following each meal
The time with sensor glucose levels <3.0 (54mg/dl)	23 hours	The time with sensor glucose levels \<3.0 (54mg/dl)
AUC of glucose below 3.0mmol/l (54mg/dl)	23 hours	AUC of glucose below 3.0mmol/l (54mg/dl)
Incremental area under the curve of sensor glucose level within 4 hours of each meal	4 hours	Incremental area under the curve of sensor glucose level during the first 4 hours after each meal
Time spent below target glucose	23 hours	Time spent below target glucose (\<3.9mmol/l) (\<70mg/dl)
Time spent above target glucose	23 hours	Time spent above target glucose (10.0 mmol/l) (180 mg/dl)
Average, coefficient of variation and standard deviation glucose levels	23 hours	Average, coefficient of variation and standard deviation glucose levels
The time with sensor glucose levels < 3.5 mmol/l (63 mg/dl)	23 hours	The time with sensor glucose levels \< 3.5 mmol/l (63 mg/dl)
The time with sensor glucose levels <2.8 mmol/l (50 mg/dl)	23 hours	The time with sensor glucose levels \<2.8 mmol/l (50 mg/dl)
The time with sensor glucose levels in the significant hyperglycaemia	23 hours	The time with sensor glucose levels in the significant hyperglycaemia (glucose levels \> 16.7 mmol/l) (300mg/dl)
Total, basal and bolus insulin dose	23 hours	Total, basal and bolus insulin dose

Trial Locations

Locations (1)

Manchester University Hospitals NHS Foundation Trust; 🇬🇧 Manchester, United Kingdom