Overview

Safety of Overestimation of a Meal Insulin Bolus in the Context of Dual-hormone Closed-loop Operation - Part 2

Status:
Completed
Trial end date:
2017-03-01
Target enrollment:
0
Participant gender:
All
Summary
In previous studies, investigators have studied if a pre-meal insulin bolus based on estimated carbohydrate meal size would alleviate the burden of carbohydrate counting without a significant degradation in postprandial glucose control. With this strategy, the patient would only have to evaluate the size of the meal in terms of carbohydrate (snack, regular, large or very large). It is however important to establish the safety of this simplified meal bolus approach. The safety of overestimating a meal insulin bolus in the context of closed-loop strategy needs to be assessed. For ethical reasons, only dual-hormone closed-loop will be tested. Investigators hypothesize that dual-hormone closed-loop with overestimated meal size bolus will not increase time below 4.0 mmol/L compared to dual-hormone closed-loop with an adequately estimated meal size bolus.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Institut de Recherches Cliniques de Montreal
Treatments:
Glucagon
Glucagon-Like Peptide 1
Hormones
Insulin
Insulin, Globin Zinc
Criteria
Inclusion Criteria:

1. Males and females ≥ 18 years old.

2. Clinical diagnosis of type 1 diabetes for at least one year.

3. The subject will have been on insulin pump therapy for at least 3 months and currently
using a fast acting insulin analog (Lispro, Aspart or Glulisine).

4. Last (less than 3 months) HbA1c ≤ 10%.

5. Currently using carbohydrate counting as the meal insulin dose strategy.

Exclusion Criteria:

1. Clinically significant microvascular complications: nephropathy (estimated glomerular
filtration rate below 40 ml/min), neuropathy (especially diagnosed gastroparesis) or
severe proliferative retinopathy as judged by the investigator.

2. Recent (< 3 months) acute macrovascular event e.g. acute coronary syndrome or cardiac
surgery.

3. Pregnancy.

4. Severe hypoglycemic episode within 1 month of screening.

5. Agents affecting gastric emptying (Motilium®, Prandase®, Victoza®, Byetta® and
Symlin®) as well as oral anti-diabetic agents (Metformin, SGLT-2 inhibitors and DPP-4
inhibitors) if not at a stable dose for 3 months. Otherwise, these medications are
acceptable and will be kept stable during the entire protocol.

6. Oral steroids unless patients present a low stable dose (e.g. 10 mg or less of
prednisone per day or physiological doses, less than 35 mg/day, of hydrocortisone
Cortef®). Inhale steroids at stable dose in the last month are acceptable.

7. Other serious medical illness likely to interfere with study participation or with the
ability to complete the trial by the judgment of the investigator (e.g. unstable
psychiatric condition).

8. Failure to comply with team's recommendations (e.g. not willing to change pump
parameters, follow algorithm's suggestions, etc).