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Trial · Interventional

CompletedPhase 1Results postedRegistry data

Three Way Crossover Closed Loop Study With Xeris Glucagon

Overview

Status
Completed
Phase
Phase 1
Enrollment
23 participants (actual)
Sponsor
Oregon Health and Science University · Other
Design
Randomized · Open label (no masking)
Countries
1 country

United States

Start
29 Mar 2018
Primary completion
17 May 2019
Completion
17 May 2019
First posted
6 Feb 2018
Last update posted
27 May 2020
Conditions
Type1diabetes

Timeline

1 trial · 1 completed · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
201820192020
  1. Ph 1

    Three Way Crossover Closed Loop Study With Xeris Glucagon

    NCT03424044

    29 Mar 2018 to 17 May 2019

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

Closed-loop systems are an emerging technology that automate hormone delivery. They are quickly paving the way to revolutionize the treatment of type 1 diabetes. Several categories have emerged: dual-hormone (insulin and glucagon) closed-loop systems and closed-loop systems with insulin only, one variety of which is the low glucose suspend safety feature now available from Medtronic (MiniMed640G with SmartGuard). The study described within this protocol is designed to test the efficacy of a new closed-loop algorithm for managing blood glucose in people with type 1 diabetes before and after exercise. The new algorithm will have 3 modes: a single hormone insulin only mode, a dual-hormone insulin and glucagon mode and an insulin only mode with predictive low glucose suspend, all with an exercise detection algorithm. The purpose of this study is to determine whether a dual hormone AP using a stable investigational glucagon with an exercise detection algorithm outperforms both single hormone AP and a low glucose suspend algorithm.

Interventions

  • Artificial Pancreas Controller in Dual Hormone ModeDevice
  • Artificial Pancreas Controller in Single Hormone ModeDevice
  • Artificial Pancreas Controller in Predictive Low Glucose Suspend ModeDevice
  • XeriSol glucagonDrug

Arms3

  • Experimental

    Dual Hormone Closed-loop Arm

    Subjects will undergo a 76 hour study with 9 hours inpatient and 67 hours outpatient using the closed-loop artificial pancreas controller in dual hormone mode and XeriSol glucagon to manage blood sugar that includes an exercise detection component that includes a reduction in insulin delivery and an increase in glucagon delivery upon detection.

  • Experimental

    Single Hormone Closed-loop Arm

    Subjects will undergo a 76 hour study with 9 hours inpatient and 67 hours outpatient using the closed-loop artificial pancreas controller in single hormone mode to manage blood sugar that includes an exercise detection component that includes a reduction in insulin delivery upon detection.

  • Experimental

    Predictive Low Glucose Suspend Arm

    Subjects will undergo a 76 hour study with 9 hours inpatient and 67 hours outpatient using the closed-loop artificial pancreas controller in predictive low glucose suspend mode. The system will run through the closed-loop system but will utilize the patient's optimized basal rates, correction factors and carb ratios as they would normally run on their own insulin pump. But the mode will have the additional safety net of the pump suspending insulin when it predicts a hypoglycemic event.

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Percent of Time With Sensed Glucose < 70 mg/dl

    Time frame · 4 hours post exercise on Day 1

    Registry description

    Assess the percent of time that the Dexcom G5 or G6 reported sensor glucose values less than 70 mg/dl using Dexcom sensor across all three arms.

Secondary outcomes(6)
  1. Percent of Time With Sensed Glucose Between 70-180 mg/dl

    Time frame · entire 76 hour study

    Registry description

    Assess the percent of time that the Dexcom G5 or G6 reported sensor glucose values between 70-180 mg/dl using Dexcom sensor across all three arms.

  2. Number of Carbohydrate Treatments

    Time frame · 24 hours

    Registry description

    Assess the number of rescue carbohydrate treatments across all three arms per day.

  3. Percent of Time With Sensed Glucose < 54 mg/dl

    Time frame · entire 76 hour study

    Registry description

    Assess the percent of time that the Dexcom G5 or G6 reported sensor glucose values less than 54 mg/dl using Dexcom sensor across all three arms.

  4. Percent of Time With Sensed Glucose > 180 mg/dl

    Time frame · entire 76 hour study

    Registry description

    Assess the percent of time that the Dexcom G5 or G6 reported sensor glucose values greater than 180 mg/dl using Dexcom sensor across all three arms.

  5. Mean Amount of Insulin Delivered in One Day

    Time frame · 24 hours

    Registry description

    Assess the mean amount of insulin delivered in units/kg as documented through the artificial pancreas controller across all three arms.

  6. Mean Amount of Glucagon Delivered in One Day

    Time frame · 24 hours

    Registry description

    Assess the mean amount of XeriSol glucagon delivered in mcg/kg as documented through the artificial pancreas controller in dual hormone arm.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeMedian· 4 hours post exercise on Day 1

Percent of Time With Sensed Glucose < 70 mg/dl

GroupValue (percentage 4 hrs post exercise on Day 1)
Dual Hormone Closed-loop Arm0
Single Hormone Closed-loop Arm8.3
Predictive Low Glucose Suspend Arm4.2
Secondary and other outcome results(6)
Secondary outcomeMean· entire 76 hour study

Percent of Time With Sensed Glucose Between 70-180 mg/dl

GroupValue (percentage of 76 hours)Spread
Dual Hormone Closed-loop Arm71.09.2
Single Hormone Closed-loop Arm72.69.2
Predictive Low Glucose Suspend Arm63.416.6
Secondary outcomeMean· 24 hours

Number of Carbohydrate Treatments

GroupValue (number of carbohydrate treatments/day)Spread
Dual Hormone Closed-loop Arm0.60.9
Single Hormone Closed-loop Arm1.72.0
Predictive Low Glucose Suspend Arm1.41.3
Secondary outcomeMedian· entire 76 hour study

Percent of Time With Sensed Glucose < 54 mg/dl

GroupValue (percentage of 76 hours)
Dual Hormone Closed-loop Arm0
Single Hormone Closed-loop Arm0.2
Predictive Low Glucose Suspend Arm0.1
Secondary outcomeMean· entire 76 hour study

Percent of Time With Sensed Glucose > 180 mg/dl

GroupValue (percentage of 76 hours)Spread
Dual Hormone Closed-loop Arm28.29.4
Single Hormone Closed-loop Arm25.19.0
Predictive Low Glucose Suspend Arm34.716.7
Secondary outcomeMean· 24 hours

Mean Amount of Insulin Delivered in One Day

GroupValue (units/kg/day)Spread
Dual Hormone Closed-loop Arm42.316.9
Single Hormone Closed-loop Arm41.116.4
Predictive Low Glucose Suspend Arm44.015.3
Secondary outcomeMean· 24 hours

Mean Amount of Glucagon Delivered in One Day

GroupValue (mcg/kg/day)Spread
Dual Hormone Closed Loop4.51.9

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
Dual Hormone Closed-loop ArmSubjects will undergo a 76 hour study with 9 hours inpatient and 67 hours outpatient. Artificial Pancreas Controller in Dual Hormone Mode: The artificial pancreas controller contains an algorithm for managing blood glucose in people with type 1 diabetes which includes an exercise detection component. XeriSol glucagon: XeriSol glucagon is an investigational drug that is a stable, soluble liquid glucagon formulation that can be injected or administered through an insulin pump. XeriSol glucagon will be used to fill the Omnipod to deliver glucagon for the Artificial Pancreas Controller in Dual Hormone mode.0 / 220 / 227 / 22
Single Hormone Closed-loop ArmSubjects will undergo a 76 hour study with 9 hours inpatient and 67 hours outpatient. Artificial Pancreas Controller in Single Hormone Mode: The artificial pancreas controller contains an algorithm for managing blood glucose in people with type 1 diabetes which includes an exercise detection component.0 / 210 / 213 / 21
Predictive Low Glucose Suspend ArmSubjects will undergo a 76 hour study with 9 hours inpatient and 67 hours outpatient. The system will utilize the patient's optimized basal rates, correction factors and carb ratios as they would normally run but the mode will have the additional safety net of the pump suspending insulin when it predicts a hypoglycemic event. Artificial Pancreas Controller in Predictive Low Glucose Suspend Mode: The artificial pancreas controller contains an algorithm for managing blood glucose in people with type 1 diabetes which includes an exercise detection component.0 / 200 / 203 / 20
Dexcom Training Period ArmSubjects used the Dexcom G6 CGM along with the APC app. Subjects attended a training visit on using the Dexcom G6. Subjects used the G6 at home over the next 7 days.0 / 230 / 230 / 23

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies0

Studies that cite this trial.

No study cites this trial.

Other registry references

References listed at the registry that are not in PepBank. They link to PubMed.

  • DerivedWilson LM, Jacobs PG, Ramsey KL, Resalat N, Reddy R, Branigan D, Leitschuh J, Gabo V, Guillot F, Senf B, El Youssef J, Steineck IIK, Tyler NS, Castle JR. Dual-Hormone Closed-Loop System Using a Liquid Stable Glucagon Formulation Versus Insulin-Only Closed-Loop System Compared With a Predictive Low Glucose Suspend System: An Open-Label, Outpatient, Single-Center, Crossover, Randomized Controlled Trial. Diabetes Care. 2020 Nov;43(11):2721-2729. doi: 10.2337/dc19-2267. Epub 2020 Sep 9. PMID 32907828

Eligibility

Who could join, as posted.

Sex
All
Age
from 21 Years up to 50 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: * Diagnosis of type 1 diabetes mellitus for at least 1 year. * Male or female subjects 21-50 years of age. * Physically willing and able to perform 45 min of exercise. * Current use of an insulin pump. * Lives with another person age 18 or older who will be present while subject exercises at home and that can attend the training on using the system. * Lives within 40 miles of OHSU main campus. * HbA1c \<= 10% at screening. * Total daily insulin requirement is less than 139 units/day. * Current use of a phone or other device so can be contacted by study staff off-campus. * Willingness to follow all study procedures, including attending all clinic visits. * Willingness to sign informed consent and HIPAA documents. Exclusion Criteria: * Female of childbearing potential who is pregnant or intending to become pregnant or breast-feeding, or is not using adequate contraceptive methods. Acceptable contraception includes birth control pill/patch/vaginal ring, Depo-Provera, Norplant, an IUD, the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence. * Any cardiovascular disease, defined as a clinically significant EKG abnormality at the time of screening or any history of: stroke, heart failure, myocardial infarction, angina pectoris, or coronary arterial bypass graft or angioplasty. Diagnosis of 2nd and 3rd degree heart block or any non-physiological arrhythmia judged by the investigator to be exclusionary. * Renal insufficiency (GFR \< 60 ml/min, using the MDRD equation as report by the OHSU laboratory). * Liver failure, cirrhosis, or any other liver disease that compromises liver function as determined by the investigator. * Hematocrit of less than 36% for men, less than 32% for women. * Hypertensive subjects with systolic blood pressure \>= 160 mm Hg or diastolic blood pressure \>= 100 mm Hg despite treatment or who have treatment-refractory hypertension (e.g. requiring four or more medications). * History of severe hypoglycemia during the past 12 months prior to screening visit or hypoglycemia unawareness as judged by the investigator. Subjects will complete a hypoglycemia awareness questionnaire. Subjects will be excluded for four or more R responses. * Adrenal insufficiency. * Any active infection. * Known or suspected abuse of alcohol, narcotics, or illicit drugs. * Seizure disorder. * Active foot ulceration. * Severe peripheral arterial disease characterized by ischemic rest pain or severe claudication. * Major surgical operation within 30 days prior to screening. * Use of an investigational drug within 30 days prior to screening. * Chronic usage of any immunosuppressive medication (such as cyclosporine, azathioprine, sirolimus, or tacrolimus). * Bleeding disorder, treatment with warfarin, or platelet count below 50,000. * Allergy to aspart insulin. * Allergy to glucagon. * Need for uninterrupted treatment of acetaminophen. * Current administration of oral or parenteral corticosteroids. * Any life threatening disease, including malignant neoplasms and medical history or malignant neoplasms within the past 5 years prior to screening (except basal and squamous cell skin cancer). * Beta blockers or non-dihydropyridine calcium channel blockers. * Current use of any medication intended to lower glucose other than insulin (e.g. use of liraglutide). * Diagnosis of pheochromocytoma, insulinoma, or glucagonoma, personal or family history of multiple endocrine neoplasmia (MEN) 2A, MEN 2B, neurofibromatosis or von Hippel-Lindau disease. * History of severe hypersensitivity to milk protein. * Current use of any medication with strong anticholinergic properties, such as antihistamines, sleep aids, and antidiarrheal medications. * Current use of indomethacin. * Conditions that may results in low levels of releasable glucose in the liver and an inadequate reversal of hypoglycemia by glucagon such as prolonged fasting, starvation or chronic hypoglycemia as determined by the investigator. * A positive response to any of the questions from the Physical Activity Readiness Questionnaire with one exception: subject will not be excluded if he/she takes a single blood pressure medication that doesn't impact heart rate and blood pressure is controlled on the medication (blood pressure is less than 140/90 mmHg). * Any chest discomfort with physical activity, including pain or pressure, or other types of discomfort. * Any clinically significant disease or disorder which in the opinion of the investigator may jeopardize the subject's safety or compliance with the protocol.

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