Next Generation Advanced Insulin Delivery System in Adults With Diabetes and Advanced Renal Disease
- Conditions
- HemodialysisDiabetes Mellitus, Type 2Peritoneal DialysisChronic Kidney DiseaseDiabetes Mellitus, Type 1Dialysis
- Interventions
- Device: 2nd Generation Automated Insulin Delivery (AID) system
- Registration Number
- NCT06330194
- Lead Sponsor
- Steno Diabetes Center Copenhagen
- Brief Summary
The goal of this this randomized, clinical trial is to test an automated insulin delivery system (AID) in people with type 1 or type 2 diabetes who are on hemodialysis, peritoneal dialysis, or have advanced chronic kidney disease (CKD).
The main objective is:
• To test if the AID is superior in regulating blood sugar levels compared with usual care in patients with advanced renal disease
Secondary objectives are:
• To evaluate the impact on life quality, incidence of low blood sugar, and if the treatment is feasible in this population
Participants will be randomized to receive either eight weeks with the AID System (780G from Medtronic) or eight weeks of Control (usual care) with cross over at the end of the first eight weeks.
Researchers will compare blood sugar levels between the AID group and the Control group to determine if the AID system is superior in regulating blood sugar levels.
- Detailed Description
Dialysis patients with diabetes have a very short life expectancy likely caused by a high incidence of co-morbidities combined with an increased risk of hypoglycaemia and poor glycaemic control. In the past decades various diabetes technologies have revolutionised treatment, primarily in type 1 diabetes, but have also shown effect in type 2 diabetes. The Automated Insulin Delivery (AID) system combines continuous glucose monitoring (CGM) with an insulin pump that automatically infuse short-acting insulin subcutaneously and has shown remarkable results in improving glucose levels. We hypothesise that the AID system can lead to a substantial improvement in glycaemic control for patients receiving haemodialysis (HD), peritoneal dialysis (PD) and patients with chronic kidney disease (CKD) stage 3b to 5 (not on dialysis).
The primary objective is to determine if the AID system is superior in regulating glucose levels, in people living with type 1 and type 2 diabetes, receiving HD, PD or having advanced CKD, compared with usual care. Secondary objectives are to evaluate the impact on life quality, incidence of hypoglycaemia and if this treatment is feasible for this population
This prospective, open-label, two-stage randomized-crossover study is conducted at the Department of Nephrology, Rigshospitalet Copenhagen and Steno Diabetes Center Copenhagen. The study is performed in collaboration with six Australian centres (St Vincent's Melbourne, Royal Melbourne, Austin, Cairns Base, Flinders, and Canberra Hospitals).
A total of 15 participants will be recruited in Copenhagen, with participants evenly distributed across the three disease categories (HD, PD, and advanced CKD). Data collected from Copenhagen will be pooled with data obtained from the Australian centers.
Participants entering the study will have a four-to-six-week run-in phase with diabetes education (carbohydrate counting, inserting of CGM etc). Training will consist of three sessions of 2-4 hours with a dedicated diabetes nurse. During the run-in phase three weeks of unblinded CGM will be performed to assess baseline glucose levels. All participants will be randomized 1:1 to receive either eight weeks with the AID System (780G from Medtronic) or eight weeks of control (usual care) with cross over at the end of the first eight weeks.
The trial will be conducted in compliance with the Good Clinical Practice (GCP) guidelines, and written informed consent will be obtained before any trial activities are performed. The project including a plan for the handling of personal information will be approved by the Danish Data Protection Agency before initiation. If necessary, the Danish Medicines Agency and the responsible GCP unit will be granted access to journals, documents, and other materials relevant to the project. All participants will be assigned with a subject number and will be recorded on data sheets. Only tubes will appear with subject number and trial ID. Information on full name and social security and subject numbers will be stored separately.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 15
- Written informed consent obtained before any trial-related procedures are performed
- Type 1 diabetes of at least 1-year duration or insulin requiring type 2 diabetes (Total insulin dose should be below 200 IE per day)
- Maintenance HD, PD, or CKD stage 3b-5 (not on dialysis).
- Subject must be willing and able to comply with trial protocol
- HbA1c <91 mmol/mol (10.5%)
All participants will require to have internet or mobile phone access enabling upload of the AID system data to cloud based software.
- History of ketoacidosis within the past 6 months
- Moderate to severe cognitive impairment
- Major allergy to tape/ adhesives
- Women who are pregnant or planning pregnancy
- Life-expectancy to <6 months
- Major psychiatric history
- Treatment with sulphonylureas in pre-dialysis participants (SGLT2 inhibitors, metformin, and GLP1 analogues may be used within regulatory guidelines)
- Treatment with non-insulin glucose lowering therapies may not be used on dialysis participants (with the exception of GLP1 agonists used in preparation for transplantation)
- Systemic steroid treatment within 4 weeks (stable doses of steroids >8 weeks allowed)
- Visual impairment
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Intervention Group 2nd Generation Automated Insulin Delivery (AID) system 2nd Generation Automated Insulin Delivery system (Medtronic MiniMed 780G)
- Primary Outcome Measures
Name Time Method Percent time in sensor glucose target range (3.9-10.0 mmol/L) End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
- Secondary Outcome Measures
Name Time Method Glucose variability (SD and coefficient of variation) End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Serious Adverse Event Week 0-22 Proportion of time spent >10.0 mmol/L End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Proportion of time spent >16.7 mmol/L End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Mean glucose End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
HbA1c Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Blood sample
Potassium pre-dialysis Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Blood sample. Only measured in patients from the HD-group
Sleep diary Week 6-22 Fear of hypoglycaemia Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Questionnaire: Hypoglycaemia Fear Survey \[HFS-II\]
Proportion of time spent <3.0 mmol/L End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Proportion of time spent <3.9 mmol/L End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Proportion of time spent >13.9 mmol/L End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Urine albumine-to-creatinine ratio Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Urine sample. Only measured in patients from the CKD-group
Proportion of time spent 3.9-7.8 End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
eGFR (estimated glomerular filtration rate) Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Based on serum creatinine measurements, using the CKD-EPI equation. Only measured in patients from the CKD-group
Proportion of time Automode is active Weekly assessed: week 6-22 Registered through uploads from insulin pump in the intervention arm
Diabetic ketoacidosis Week 0-22 Severe hypoglycemia Week 0-22 Requiring third party assistance
Diabetes distress Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Questionnaire: Problem Areas in Diabetes \[PAID\]
Proportion of time spent <2.8 mmol/L End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Proportion of time spent <3.3 mmol/L End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Episodes of CGM time in < 3.0 mmol/L range lasting >15 minutes End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Assessed by 3 continuous weeks of CGM
Diabetic ketoacidosis og Hyperosmolar non-ketotic hyperglycemia Week 0-22 Hospital presentations with either of the above
Unanticipated Serious Adverse Device Event Week 0-22 Satisfaction with diabetes treatment End of phase 1: week 14; end of phase 2: week 22 Questionnaire: The Diabetes Treatment Satisfaction Questionnaire control version \[DTSQc\]
Cognitive function Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Questionnaire: Montreal Cognitive Assessment (MOCA)
Actigraph Metrics for sleep architecture End of run in phase: week 3-5; end of phase 1: week 11-13; end of phase 2: week 20-22 Used concurrently with the CGM
Hypoglycaemia awareness Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Questionnaire: Gold Score and Clarke Score
Health-related quality of life Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Questionnaire: EQ-5D
Frailty End of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Questionnaire: Fried Frailty
Sleep Quality Enrollment visit: week 0; end of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 Questionnaire: Pittsburgh Sleep Quality Index \[PSQI\]
Semi-structured interview End of phase 1: week 14; end of phase 2: week 22 Influence of kidney disease on diabetes management and experience with the AID. Only performed in intervention arm.
Sarcopenia End of run in phase: week 6; end of phase 1: week 14; end of phase 2: week 22 SARC-F questionnaire
Trial Locations
- Locations (1)
Tobias Bomholt
🇩🇰Copenhagen, Denmark