Evaluation of Accu-Chek DiaPort, a Port System for Continuous Intraperitoneal Insulin Infusion, in Patients With Type I Diabetes
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 12
- 试验地点
- 1
- 主要终点
- Percentage of Participants With Signs of Redness/Swelling in the Tissue Around the Port
研究概览
简要总结
The Accu-Chek DiaPort system enables continuous intraperitoneal insulin infusion (CIPII): that is, infusion of insulin into the peritoneal cavity using an Accu-Chek insulin pump and an infusion set. The Accu-Chek DiaPort consists of a metal body with a catheter that is placed in the abdomen. The opening of the port is raised above the surface of the skin about 5 millimeters, while a flower-shaped plate is placed under the skin, providing stability for the port. The port has been designed for those diabetics who cannot benefit fully from subcutaneous insulin infusion. The primary objective of the study is to assess the suitability of Accu-Chek DiaPort to perform continuous intraperitoneal insulin delivery. The data collection focuses on the condition of tissue around the port after the implantation, possible peritoneal reactions to the port system, and the peritoneal delivery of insulin. Secondary objectives are the assessments of therapeutic performance and successful implementation of design requirements. In total 12 Patients will participate in this open, mono-centre, single-arm, interventional clinical trial. The study lasts 9 months (without run in period of 3 to 1 week) separated in two parts. Phase I last 12 weeks. Phase II last 6 month until the end of the study. During the study, seven visits are planned. The screening visit can take place up to 3 weeks before study start. At the implantation visit which can last up to 5 days the port will be implanted. After the implantation insulin therapy will be adjusted for CIPII and the patients will be trained for handling and daily care of the Accu-Chek DiaPort system. To check the functionality of the system, the first control visit will take place 2 weeks and the second control visit 6 weeks after the implantation. At the week 12 visit, the most important parameters will be collected for the phase I report. The following visits take place 6 and 9 months after the implantation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Diagnostic
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients, >= 18 years of age at the time of the screening visit
- •Type 1 diabetes mellitus
- •On CSII therapy for at least 6 months prior to the screening visit
- •Has been unsuccessfully treated with standard subcutaneous insulin therapy including CSII therapy, as defined by frequent (defined as handicapping in daily life) or severe (needing help from a third party) hypoglycemia and/or HbA1c above 8.5%, and/or other medical indication for CIPII therapy
- •Presence of at least one of the following indications for CIPII therapy: - Frequent (defined as handicapping daily life) hypoglycemia during CSII therapy - Severe hypoglycemia (needing help from a third party) during CSII therapy - HbA1c above 8.5% during CSII therapy - Hypoglycemia unawareness during CSII therapy - Real subcutaneous insulin resistance - Insulin-induced lipoatrophy - Insulin-associated lipohypertrophy not controlled by site rotation - Other skin disorders interfering with the subcutaneous route of administration - Marked fluctuations of glucose levels and insulin requirements during CSII therapy- History of allergies to materials required for subcutaneous insulin therapy
- •Performs usually self-management of blood glucose at least 4 times per day
- •Willing to adhere to the study visit schedule and motivated to undergo the therapy
排除标准
- •Presence of marked peritoneal adhesions or scarring after abdominal surgery
- •Disorders of the gastrointestinal tract, respectively the digestive system potentially interfering with the intraperitoneal route of administration (e.g. presence of marked peritoneal adhesions, or colonic disease)
- •Known high levels of anti-insulin antibodies
- •History of allergy to materials used for the Accu-Chek DiaPort (titanium, polyethylene)
- •Severely impaired immune response
- •Uses systemic oral or inhaled steroids for > 14 days within the last 3 months
- •Pregnant or lactating women, or women currently planning a pregnancy
- •Previous history of severe chronic liver disease defined as signs of portal hypertension and/or Quick's value below 50% in spite of vitamin K administration
- •Subject is treated for malignancy (chemotherapy, radiation or other treatment) (self-reported)
- •Positive for HIV infection
- •Is under CAPD treatment
- •Suffers from severe eating disorders like bulimia or anorexia
- •Alcohol or drug abuse
- •Serious psychological disorders like schizophrenia, depression, Münchhausen's syndrome etc.
- •Presence of known or suspected infections, bacteremia, septicemia or peritonitis
- •Participation in a clinical trial (medicinal, medical device) within the last 30 days prior to screening
结局指标
主要结局
Percentage of Participants With Signs of Redness/Swelling in the Tissue Around the Port
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Signs of Redness/Swelling was determined by the physician and was categorized as follows: Category 1= None; 2= Minor, negligible; 3= Some, noticeable; 4= Major; 5= Severe. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Persistent Dull Pain Due to Catheter
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Pain due to catheter was determined by a participant questionnaire and categorized as follows: Category 1= No pain; 2= Minor, negligible; 3= Some, noticeable; 4= Major, cumbersome; 5= Severe, almost unbearable. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Signs of Infection/Allergic Reaction at the Site of Implant
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Signs of infection/allergic reaction at the site of implant was determined by the physician and categorized as follows: 1= No problems; 2= Minor problems; 3= Some problems; 4= Major problems and/or replacement of catheter necessary; 5= Severe problems and/or explanation of port necessary. The percentage of participants in each category for the specified time point is presented.
Suitability of the Device - Overall Suitability Score
时间窗: Week 12
Suitability of the device was assessed by the investigator using a questionnaire that determined the following: 1) condition of the tissue around the port: tight connection between port and skin (mechanical stability, dislocation of port, signs of redness/swelling, infection, or pain), 2) peritoneal reactions (persistent dull pain due to catheter, signs of infection/allergic reaction) and ability to deliver insulin intraperitonally at every visit after implantation. Suitability score was determined using participant's responses to a questionnaire where 1 equals (=) no problem, 2=minor/negligible problems, 3=some/noticeable problems, 4=major/cumbersome and 5=severe/almost unbearable problems. Each question was scored and an average across the questions was determined as an overall score. The scores ranged from 1 (not at all suitable) to 5 (completely suitable).
Percentage of Participants With Problems Involving the Tight Connection Between Port and Skin
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Mechanical stability of the device was determined by the stability of the ingrowth surrounding the port as determined by the physician. The ingrowth problems are categorized as follows: Category 1= complete stable Ingrowth, 2= Ingrowth working with negligible problems, 3= Ingrowth working with some problems, 4= Ingrowth working with major problems and 5= Ingrowth resulting in almost non-functional port. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Signs of Infection in the Tissue Around the Port
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Signs of infection were determined by the physician and categorized as follows : Category 1= None; 2= Minor, negligible; 3= Some, noticeable 4= Major; 5= Severe. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Signs of Pain in the Tissue Around the Port
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Signs of pain was determined from the participant questionnaire which was categorized as follows: category 1= No pain; 2= Minor, negligible; 3= Some, noticeable; 4= Major, cumbersome; 5=Severe, almost unbearable. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants With Dislocation of Port
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Position of the port was determined by the physician and was categorized as follows: Category 1= No dislocation; 2= Minimal dislocation; 3= Clearly visible dislocation, with minimal impairment of function; 4= Dislocation impairs functions; 5= Dislocation results in disabling functions. The percentage of participants in each category for the specified time point is presented.
Percentage of Participants Categorized by Ability of the Port to Deliver Insulin Intraperitonally
时间窗: Weeks 2 and 12 and Months 6, 9, 12 and 15
Problems in ability to deliver insulin intraperitoneally was determined by the physician and categorized as follows: 1= No problems; 2= Minor problems; 3= Some problems; 4= Major problems and/or replacement of catheter necessary; 5= Severe problems and/or explanation of port necessary. The percentage of participants in each category for the specified time point is presented.
次要结局
- Glycemic Variability: Percent Coefficient of Variation in Blood Glucose(Screening, Week 12 and Months 6, 9 and 12)
- Insulin Doses Dispensed From Insulin Pump(Screening, Week 12 and Months 6, 9 and 12)
- Hemoglobin A1c Levels(Screening, Week 12 and Months 6, 9 and 12)
- Continuous Glucose Measurement (CGM) - Glucose Levels(Screening, Week 12 and 6 Months)
- Percentage of Participants Achieving Target Glucose Levels(Screening, Week 12 and 6 Months)
- Design Validation Participant Questionnaire - Percentage of Participants With a Positive Response(Week 12)
- Self Monitored Blood Glucose Levels(Screening, Week 12 and Months 6, 9 and 12)