A Fully Automated Lyumjev and Pramlintide Delivery System for Adults With Type 1 Diabetes

Phase

2/3

Condition

Diabetes And Hypertension

Diabetes Prevention

Diabetes Mellitus, Type 1

Treatment

Pramlintide

Lyumjev

Insulin aspart

Clinical Study ID

NCT06046417

2023-9373

Ages > 18
All Genders

Study Summary

The aim of this clinical trial is to investigate whether a fully automated Lyumjev-and-pramlintide delivery system improves glycemic outcomes in adults with type 1 diabetes. The main question we aim to answer is whether a Lyumjev-pramlintide fully closed loop system improves time in range compared to a hybrid closed loop system with carbohydrate counting. We also aim to find the optimal insulin to pramlintide ratio for glycemic control in the fully automated system.

In this cross-over study, patients will undergo the following three interventions in a random order:

(i) fully automated Lyumjev insulin-and-pramlintide (8 μg/u) (ii) fully automated Lyumjev insulin-and-pramlintide (10 μg/u) (iii) rapid automated Lyumjev insulin-and-placebo with carbohydrate-matched boluses

For all interventions, participants will be required to wear two Ypsomed pumps programmed by our developed EuGlide system.

Eligibility Criteria

Inclusion

Inclusion Criteria:

Individuals ≥ 18 years of age.
A clinical diagnosis of type 1 diabetes for at least 12 months. The diagnosis of type 1 diabetes relies on the investigator's judgment; C peptide level and antibodydeterminations are unnecessary.
Using insulin pump therapy for at least three months.
Individuals of childbearing potential using an effective birth-control method. Anindividual of childbearing potential must agree to use a highly effective method ofbirth control.

Exclusion

Exclusion Criteria:

Current or recent use of antihyperglycemic agents other than insulin (≤ 2-week use ofsodium-glucose cotransporter-2 inhibitor (SGLT2I), Metformin, etc.; ≤ 1-month forglucagon-like peptide-1 receptor agonists (GLP1-RA)).
Current use of glucocorticoid medication (except low, stable doses and inhaledsteroids).
Individuals with confirmed gastroparesis.
Use of medication that alters gastrointestinal motility (ex: domperidone).
Use of hydroxyurea.
Planned or ongoing pregnancy.
Breastfeeding individuals.
Severe hypoglycemia requiring hospitalization in the past month. Severe hypoglycemiais defined as requiring the assistance of another person, due to alteredconsciousness, to administer carbohydrates, glucagon, or other resuscitative actions.
Diabetic ketoacidosis episode in the past month.
Clinically significant nephropathy, neuropathy, or retinopathy as judged by theinvestigator.
Recent (< 6 months) acute macrovascular event, e.g., acute coronary syndrome.
Other serious medical illnesses which are likely to interfere with study participationor the ability to complete the trial by the investigator's judgment.
Known hypersensitivity to the study drugs or their excipients.

Study Design

Pramlintide

2/3

November 30, 2023

June 30, 2025

Study Description

The aim of this study is to conduct an outpatient, randomized, crossover clinical trial to compare the glycemic outcomes of a fully automated Lyumjev-pramlintide delivery system to a hybrid automated Lyumjev-placebo delivery system with carbohydrate counting in 26 adults with type 1 diabetes.

Design-

All participants will undergo three interventions in a random order:

(i) Fully automated Lyumjev insulin-pramlintide delivery system. Ratio of 1 unit of inulin for 8μg of pramlintide.

(ii) Fully automated Lyumjev insulin-pramlintide delivery system. Ratio of 1 unit of insulin for 10μg of pramlintide.

(iii) Hybrid automated Lyumjev insulin-placebo delivery system with carbohydrate-matched boluses.

Study drugs-

Lyumjev is a Health Canada insulin for treatment of type 1 diabetes. Participants who do not currently use Lyumjev will be switched to it for the duration of the study.

Pramlintide is an FDA-approved drug used in the treatment of type 1 diabetes. It contributes to regulating glucose levels by delaying gastric emptying, suppressing nutrient-stimulated glucagon secretion and increasing satiety. It is not approved for commercial use by Health Canada, but has been approved for the purpose of the study.

Study Devices-

For the duration of the study, participants will use a Dexcom G6 Continuous Glucose Monitor (GCM), two YpsoPumps (for insulin and pramlintide) as well as a study smartphone with the Euglide application installed. The automated insulin delivery (AID) system will integrate these sets of devices to automate insulin (and pramlintide) delivery in response to an individual's glucose levels.

Treatment Period-

Each intervention will last three weeks and be preceded by a 5-day at-home run-in period. After both the second and third interventions, there will be a 14-45 day washout period. Participants will be followed-up with remotely on days 2 (+/-1) and 5 of each run-in and on days 2(+/-1), 3(+/-1) and 7(+/-2) of each intervention. Remote contact can be performed via phone, email, text message or another reasonable communication channel. After each intervention, participants will be interviewed and asked to complete questionnaires assessing diabetes control and quality of life. Participants will need approximately 15-30 weeks to complete the study.

The study will enroll up to 4 pilot participants, as well as 26 main study participants who meet the eligibility criteria.

Connect with a study center

Research Institute of the McGill University Health Center
Montreal, Quebec H4A 3J1
Canada
Active - Recruiting

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