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Type 1 DiabetesDCLP4NCT04436796

The International Diabetes Closed Loop (iDCL) Trial: Protocol 4

A study testing interoperable Artificial Pancreas System (iAPS) and Sensor-Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS) in people with Type 1 Diabetes, run by Sansum Diabetes Research Institute at 5 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The investigators aim to compare the efficacy and safety of an AID system using an adaptive MPC algorithm versus SAP (which may or may not include PLGS; to be referred to as SAP) in people with type 1 diabetes. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Type 1 Diabetes
What is being tested?
interoperable Artificial Pancreas System (iAPS) and Sensor-Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
35 participants
Where
5 sitesUnited States
Study dates
5 Aug 2020to 10 May 2021
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Clinical diagnosis, based on investigator assessment, of type 1 diabetes for at least one year and using insulin for at least 1 year
  • Using an insulin pump for at least 3 months (which may include use of automated features)
  • Familiarity and use of a carbohydrate ratio for meal boluses
  • Age ≥18.0 years old
  • For females, not currently known to be pregnant. If female and sexually active, must agree to use a form of contraception to prevent pregnancy while a participant in the study. A negative serum or urine pregnancy test will be required for all females of child-bearing potential. Participants who become pregnant will be discontinued from the study. Also, participants who during the study develop and express the intention to become pregnant within the timespan of the study will be discontinued.
  • If using a personal CGM, willingness to use a Dexcom G6 CGM and discontinue personal CGM use during the study
Show all 10Show fewer
  • Willing not to begin use of, or not to continue use of if currently using, a personal AID (closed loop control) system during the study; note if the system offers an open-loop mode or can be switched to a PLGS mode that is compatible with the Dexcom G6, the system may be used during the study in these modes only
  • Willingness to switch to lispro (Humalog) or aspart (Novolog) if not using already, and to use no other insulin besides lispro (Humalog) or aspart (Novolog) during the study
  • Willingness not to start any new non-insulin glucose-lowering agent during the course of the trial, and not to use Afrezza during the trial
  • Investigator believes that the participant can successfully and safely operate all study devices and is capable of adhering to the protocol

Who cannot join

  • Use of Afrezza or any non-insulin glucose-lowering agent other than metformin (including GLP-1 agonists, DPP-4 inhibitors, SGLT-2 inhibitors, sulfonylureas) unless participant is willing to discontinue during the trial.
  • Two or more episodes of DKA requiring an emergency room visit or hospitalization in the past 6 months
  • Two or more episodes of severe hypoglycemia with seizure or loss of consciousness in the last 6 months
  • Hemophilia or any other bleeding disorder
  • A medical or other condition that in the opinion of the investigator could create a safety concern for the participant or put the study at risk. History of frequent severe hypoglycemia or history of frequent severe hyperglycemia and/or ketosis, without emergency room visit or hospitalization, due to poor diabetes self-management may be disqualifying per investigator judgment
  • Participation in another pharmaceutical or device trial at the time of enrollment or during the study

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

United States5 sites
  • Joslin Diabetes Center

    Boston, Massachusetts, 02215

  • Icahn School of Medicine at Mount Sinai

    New York, New York, 10029

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • Sansum Diabetes Research Institute

    Santa Barbara, California, 93105

  • Stanford University

    Stanford, California, 94304

Other trials in United States

About this study

Official title: The International Diabetes Closed Loop (iDCL) Trial: A Randomized Crossover Comparison of Adaptive Model Predictive Control (MPC) Artificial Pancreas Versus Sensor Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS) in the Outpatient Setting in Type 1 Diabetes (DCLP4)

The investigators aim to compare the efficacy and safety of an AID system using an adaptive MPC algorithm versus SAP (which may or may not include PLGS; to be referred to as SAP) in people with type 1 diabetes.

Read the detailed description

A randomized crossover trial will compare the efficacy and safety of an automated insulin delivery (AID) study system using an adaptive Model Predictive Control (MPC) algorithm versus SAP (which may or may not include PLGS; to be referred to as SAP) therapy in people with type 1 diabetes for 13 weeks in each arm of the study. A Pilot Phase using the study system for 10-14 days will be conducted prior to the crossover trial.

Conditions
Type 1 Diabetes
Being tested
interoperable Artificial Pancreas System (iAPS), Sensor-Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS)
Keywords
Artificial Pancreas, Automated Insulin Delivery, Closed Loop Control, Continuous Glucose Monitor (CGM), interoperable Artificial Pancreas System (iAPS)
Medical subject headings
Diabetes Mellitus, Type 1

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • interoperable Artificial Pancreas System (iAPS)Device

    Use of the iAPS at home for 13 weeks, with weekly adaptation of insulin delivery settings occurring automatically in the iAPS.

  • Sensor-Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS)Other

    Use of personal pump with study CGM \& glucometer at home for 13 weeks.

Study groups in NCT04436796
Study groupRoleWhat they receive
Artificial PancreasExperimentalSubjects will be provided the Interoperable Artificial Pancreas System (iAPS) which includes the iAPS phone platform, a study insulin pump, study continuous glucose monitor (CGM), and a study glucometer. This iAPS is designed to help control blood sugar in people living with type 1 diabetes.
Receives: Device: interoperable Artificial Pancreas System (iAPS)
Sensor Augmented Pump/Predictive Low Glucose SuspendActive comparatorSubjects will continue use of home insulin pump with a study continuous glucose monitor (CGM) and study glucometer. Subject may use home pump in PLGS mode if this is supported and compatible with the study sensor.
Receives: Other: Sensor-Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percent CGM Time in Range 70-180 mg/dL

    This results shown is mean percent time in range 70-180 mg/dL.

    Measured: 13 weeks

  2. Non-inferiority for CGM Time <54 mg/dL

    Superiority for time in range 70-180 mg/dL and non-inferiority for time <54 mg/dL measured with CGM will be considered primary endpoints, analyzed using a hierarchical gatekeeping testing procedure

    Measured: 13 weeks

Secondary outcomes (22)
  1. CGM Mean Glucose

    CGM-measured mean glucose (mg/dL)

    Measured: 13 weeks

  2. CGM Time > 180

    CGM time > 180 mg/dL

    Measured: 13 weeks

  3. CGM Time > 250

    CGM time > 250 mg/dL

    Measured: 13 weeks

  4. CGM Time < 70

    CGM time < 70 mg/dL

    Measured: 13 weeks

  5. CGM Time < 54 (Superiority)

    CGM time < 54 mg/dL (Superiority)

    Measured: 13 weeks

  6. Coefficient of Variation

    CGM measured glucose variability measured with the coefficient of variation (CV)

    Measured: 13 weeks

  7. CGM Time in Range 70-140 mg/dL

    CGM-measured % in range 70-140 mg/dL

    Measured: 13 weeks

  8. Standard Deviation

    CGM measured glucose variability measured with the standard deviation (SD)

    Measured: 13 weeks

  9. CGM Time < 60

    CGM time < 60 mg/dL

    Measured: 13 weeks

  10. LBGI

    Low blood glucose index (LBGI) by CGM with higher index indicating higher risk of hypoglycemia. LBGI ≤ 1.1 is associated with minimal risk of hypoglycemia, 1.1 < LBGI ≤ 2.5 is associated with a low risk of hypoglycemia, 2.5 < LBGI ≤ 5.0 is associated with a moderate risk of hypoglycemia, and LBGI > 5.0 is associated with high risk of hypoglycemia.

    Measured: 13 weeks

  11. CGM Time > 300

    CGM time > 300 mg/dL

    Measured: 13 weeks

  12. HBGI

    High Blood Glucose Index (HBGI) is a measure of Hyperglycemic Risk based on frequency and severity of hyperglycemic events. HBGI < 4.5 is associated with lower risk of hyperglycemia, 4.5 < HBGI < 9 is associated with a moderate risk of hyperglycemia and HBGI > 9 is associated with high risk of hyperglycemia

    Measured: 13 weeks

  13. HbA1c at 13 Weeks

    Hemiglobin A1c measured after completing each study arm

    Measured: 13 weeks

  14. Number of Participants With HbA1c <7.0% at 13 Weeks

    Number of participants HbA1c <7.0% after completing each study arm

    Measured: 13 weeks

  15. Number of Participants With HbA1c <7.5% at 13 Weeks

    Number of participants HbA1c <7.5% after completing each study arm

    Measured: 3 months

  16. Diabetes Distress Scale at 13 Weeks - Total Score

    Diabetes Distress Scale for adults has 28 items rated on a 6 point Likert scale that ranges from 1 (not a problem) to 6 (a very serious problem). The total score is the mean of the sum of responses and ranges from 1 to 6 where a higher score indicates greater degrees of diabetes distress.

    Measured: 13 weeks

  17. Glucose Monitoring Satisfaction Survey (Total Scale)

    The GMSS for Type 1 Diabetes contains four subscales as well as a total scale. For this measure, total scale is reported. To calculate the total scale (higher scores indicate greater satisfaction): Mean of all items 1-15 (reverse code items: 2-7, 9, 11-13, and 15) which are all scored on a 5 point scale (1-5) (Minimum Total Scale Score is 1, Maximum Total Scale Score is 5)

    Measured: 13 weeks

  18. Hypoglycemia Confidence Scale

    Hypoglycemia Confidence Scale has 20 items which are rated on a 4-point Likert Scale ranging from 1 (not confident at all) to 4 (very confident) with higher scores indicating higher confidence in dealing with hypoglycemia. A single score is computed by calculating the mean of the sum of all items and ranges from 1 to 4.

    Measured: 13 weeks

  19. INSPIRE Survey Scores - Following Study System Period Only

    The INSPIRE questionnaire assesses user expectations and experiences with Insulin Delivery Systems: Perceptions, Ideas, Reflections, Expectations (INSPIRE). Survey total scores are computed by calculating the mean of the sum of all item ratings then multiplying the mean by 25 to scale the score to a range from 0 to 100. Higher scores indicate a more positive perception of insulin delivery systems. Items are rated on a 5 point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). The Adult survey has 22 items, the Teens/Adolescents survey has 17 items and the Parent survey has 21 items.

    Measured: 13 weeks

  20. SUS Survey Scores - Following Study System Period

    System Usability Scores (SUS)-composite score from 0 to 100 with higher scores indicate better perceived usability

    Measured: 13 weeks

  21. Total Daily Insulin

    Total Daily Insulin (units)

    Measured: 13 weeks

  22. Basal: Bolus Insulin Ratio

    Basal: bolus insulin ratio

    Measured: 13 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Jun 2020
  2. Study start5 Aug 2020
  3. Primary completion10 May 2021
  4. Study completion10 May 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
None (open label)
Enrolment
35 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04436796
Sponsor's protocol ID
G200047
Other IDs
UC4DK108483
Acronym
DCLP4
Status last verified
Nov 2022
First submitted
16 Jun 2020
Last updated
2 Dec 2022
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: NIH's Data Sharing Policy on sharing research resources for research purposes to the scientific community will be followed. Data will be stored in a Data Archive Database includes CGM-insulin delivery time series \& boluses, will be deidentified \& retrievable only by subject ID number. Individual patterns of demographic \& insulin treatment parameters leave open a remote possibility of deductive disclosure of subjects with unusual characteristics. Thus, data will be made available only under a Data-Sharing Agreement that includes: (1) a commitment to using the data only for research purposes \& not to identify participants; (2) a commitment to securing the data using appropriate computer technology; \& (3) a commitment to destroying or returning the data after analyses are completed.

Publications

  • Pinsker JE, Dassau E, Deshpande S, Raghinaru D, Buckingham BA, Kudva YC, Laffel LM, Levy CJ, Church MM, Desrochers H, Ekhlaspour L, Kaur RJ, Levister C, Shi D, Lum JW, Kollman C, Doyle FJ; iDCL Trial Research Group. Outpatient Randomized Crossover Comparison of Zone Model Predictive Control Automated Insulin Delivery with Weekly Data Driven Adaptation Versus Sensor-Augmented Pump: Results from the International Diabetes Closed-Loop Trial 4. Diabetes Technol Ther. 2022 Sep;24(9):635-642. doi: 10.1089/dia.2022.0084. Epub 2022 Jun 2.

    PubMed 35549708

Questions about this trial

What is this clinical trial studying?

A study testing interoperable Artificial Pancreas System (iAPS) and Sensor-Augmented Pump (SAP)/Predictive Low Glucose Suspend (PLGS) in people with Type 1 Diabetes, run by Sansum Diabetes Research Institute at 5 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 Dec 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 2 Dec 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percent CGM Time in Range 70-180 mg/dL (time frame: 13 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04436796, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Dec 2022.

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DCLP4 Clinical Trial NCT04436796 | AzTrials