mini-med

My Detailed Review of the MiniMed 670G from Medtronic

The MiniMed 670G from Medtronic is an insulin pump coupled with a glucose sensor.  It uses a computer program (called an “algorithm”) to automate certain aspects of insulin delivery.  I decided to try 670G partially out of professional interest (everybody and their great aunt has been asking for my opinion on the system), and partially out of personal interest, as my blood glucose control hasn’t been the greatest the past couple of years.

Let me start out by saying this:

Since I started using 670G, my overall blood glucose control is better.

I have to keep reminding myself of this non-consequential fact, because every day I find things about this system that I don’t particularly like.

To continue reading, click here.

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DIY Looping

Steve and I had the pleasure of going to Vienna, Austria together two weeks ago for the diabetes technology meeting, and while there definitely was some cool stuff presented in the artificial pancreas world, my update comes from my own AP world.

As I’ve mentioned before, I started on LOOP about 4 months ago, and I think I’m finally ready to give an update on it.  So first off, what is LOOP?  Basically, it’s an AP system that uses:

  1. An old Medtronic pump
  2. An Iphone
  3. Your CGM (Dexcom or Medtronic)
  4. And a device called a “RileyLink” that connects them all together

The founder of Loop has a daughter with T1D named Riley, and thus, RileyLink!

So what does it do?  Basically, it uses an app to determine what basal rate adjustments should be made on your pump, and uses the RileyLink to hack the pump and tell it what to do.  You still have to bolus as you would for meals, and correct, and all that garbage, but the system does a great job of giving you more or less insulin as a basal rate.  Basically, it does what the 670g system does, but with a lot less hassle.  So what do I like about it?  Well here it is:

THE UPSIDE:

I SLEEP BETTER

I could probably just drop the mic after this one and walk away and I would be fine with that.  I simply don’t get low at night anymore.  And I don’t really get high either.  Nighttime went from my most frustrating time, to my most consistent.  My wife told me the other day, “Hey you don’t sleep with apple juice by your bed anymore.”  And I was like- she’s right.  Now I’m just spending time thinking about what I’m going to do with all this juice money.  Seriously though, I don’t wake up to alarms, and I wake up every day with a really, really good blood sugar.  It took going on LOOP to realize how crappy I was sleeping before…  Low.  Eat.  High.  Insulin.  Repeat.

I’M A LITTLE LAZY WITH MY DIABETES

Yeah that’s right.  Loop lets me slack off a little, and I kinda like that.  I know if I don’t nail my bolus, the basal rate will kick in to help minimize the damage of me drastically underestimating my carbs…. again.  So I think I worry a little less about the fluctuations and my time in range is better.

LESS LOWS

Not a lot to add here.  I get low less.  Less at night, less during the day, and less with exercise.  Less lows means fewer texts from Steve telling me to get my shit together.  I really like that feature a great deal.

SOME TECH FEATURES

The pump is completely controlled from your phone through a pretty slick-looking app.  So if you don’t want to, you never really have to touch your pump.  You can adjust your target to whatever you want- including an exercise target.  It gives you a predicted glucose curve and its fun to see it shift when you enter carbs or insulin.  It’s not always right, but it looks cool.  You can tell the app if you’re eating a high carb meal (lolly pop), a mixed meal (taco), or high fat (pizza).  All well thought out stuff.

THE DOWNSIDE:

So what don’t I like about it?  Well it’s really when it just doesn’t work.  Sometimes it drops the Dexcom signal or isn’t picking up the pump for some reason.  So I do spend a fair amount of time looking at the app to make sure I’m still “looping”.  Carrying the RileyLink around is kinda annoying and I’ve broken 3 of them.  Yes 3.  All water related.  So more “fried” them then broke them.  But this is all minor stuff.

SO HOW DO YOU GET ONE?

How do you or your patients get on the system?  To be honest it’s a little complicated to set up, but I actually did it myself (the second time) without any problems.  There are VERY good instructions here:

https://loopkit.github.io/loopdocs/

I didn’t mention before that this is a complete Do It Yourself (DIY) system so is NOT FDA APPROVED, you won’t find it in any CVS, and your doctor can’t prescribe it for you.  You have to do it your damn self (DIYDS).  And to do that you’ll need all those things I mentioned at the top, several hours to spend, and about 130 bucks to buy a RileyLink.

I didn’t realize how much LOOP had really been helping me until I was in Vienna, and I only packed one European electrical converter and ended up charging my phone more than my RileyLink.  So my LOOP would drop out when the RileyLink didn’t charge, and I was back to the dark ages.  Champagne problems for sure, but hey, it made me realize what a big advance this type of technology is.  So while we are waiting for systems to get better and better, for now, go out and DIYDS.

 

This post originally appeared on weareonediabetes.org. If you are a diabetes professional and also have type 1,  sign up for the WeAreOne online diabetes community here!

3D illustration of Pancreas - part of digestive system, medical concept.

Coming Soon: The Artificial Pancreas

Can you imagine wearing an artificial pancreas in the year 2018? Well, we have the panel of all panels regarding all the current developments in the artificial pancreas space. These worldwide leaders and superstars who are on the cutting edge represent and have done research on the multiple AP systems in development: Animas, Tandem, Bigfoot, Medtronic, etc. What the heck will we do with all of our free time if we don’t have to think about our diabetes and being in the zone all day? This technology is so close we can taste it, and it’s delicious!

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The shifting paradigm of a “cure” for type 1 diabetes: Is technology replacing immune-based therapies?

Nearly 50 years after the autoimmune nature of type 1 diabetes was discovered, no therapy has been approved to alter the course of the disease at any stage. However, during that same period, technology has been delivering tools to help patients achieve better glycemic control and reduce the burden of the disease. With the imminent arrival of fully automated artificial pancreas systems that will continue to improve control and quality of life, it appears that we are on the verge of a major technological breakthrough that will significantly impact diabetes care. These devices have such a high degree of potential that they are, at times, mentioned as a virtual cure for the disease—a first for technology in this space. As such, these devices will undoubtedly alter the research landscape in a field that has predominantly been occupied by immunotherapies. This article reviews the history of type 1 diabetes and compares and contrasts the advancements that have come from the world of technology and immunology alike at this important crossroads in care that we are currently in.

View the full article here.

Recap of an exciting month for diabetes and technological innovation

Fall has come with a flurry of new products, FDA approvals, and announcements from the major players in diabetes technology. Don’t miss out by checking out a quick recap of what matters:

1. Tandem Diabetes begins shipping the forward-thinking T:Slim X2

Tandem X2

Thanks to an all-new bluetooth transmitter and its FDA-approved ability to add new features with software updates, the T:Slim X2 unifies and replaces Tandem Diabetes’ outgoing models, the T:Slim and T:Slim G4. (The T:Flex will remain as the primary option for users requiring higher doses of insulin).

While it currently closely resembles the outgoing T:Slim in form and function the T:Slim X2 will soon introduce (via free software update) the long-overdue ability to display data directly from the Dexcom G5 continuous glucose monitor (CGM). In addition to wirelessly receiving information from other devices like the G5, the T:Slim X2 can transmit data to other devices such as the iPhone. This two-way communication opens up the very likely possibility of smartphone apps to display information from (and possibly even control) insulin pumps and CGM’s.

Years down the road, the future-proof X2 platform will be able to incorporate “artificial pancreas” features such as predictive low glucose suspend and eventually fully autonomous closed loop systems.

Current owners of Tandem products can learn about upgrade options here.

2. FDA approves Medtronic 570G, the next step toward the Artificial Pancreas

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The same month that the (underwhelming) 630G systems began shipping, the FDA surprised the diabetes community by approving the eagerly anticipated Medtronic 670G Hybrid Closed Loop system, including their next-generation CGM sensor.

The Medtronic 670G’s landmark feature is its SmartGuard HCL (Hybrid Closed Loop) technology, which automatically adjusts the pump’s insulin rate to target a blood sugar of 120. Much like a car with adaptive cruise control, the 670G will increase or decrease the basal rate of insulin delivery but will still require user intervention for notable events such as mealtime boluses. (We explore why this matters in a separate article.)

The 670G also comes with the updated design introduced in the 630G, and includes the new Guardian 3 sensor, featuring better accuracy and a 7 day wear period (up from 6 days).

Although Medtronic won’t ship the 670G until April 2016, the 670G’s FDA approval represents a pivotal step forward toward achieving the goal of a true Artificial Pancreas.

3. FDA Approves Abbott Freestyle Libre Pro System for Short-Term CGM Usage

Freestyle Libre Pro

Although the Abbott Freestyle Libre has been available for personal use in Europe for years, the hybrid-CGM comes stateside with limited functionality as a professional system (rather than for personal use). That means the Libre Pro System would be purchased by health care providers to be worn by their patients for a 14 day period. (This 14 day period improves upon the Medtronic iPro’s 4 day and Dexcom Professional’s 7 day period)

During that 14 day period, the patient will not have to do any calibrations, BUT they would also not have real-time access to their CGM readings. At the end of the period, the patient would review their CGM data with their provider to identify patterns.

While we’re still hoping that the FDA will eventually approve the version of the Freestyle Libre for long-term, personal use found in Europe, the Libre Pro System can still benefit patients in the USA whose insurance only covers short-term CGM trials. Also, the Freestyle Libre Pro System’s 14 day wear period and freedom from calibrations makes it an obvious upgrade over the Medtronic iPro.

4. Medtronic adds Android compatibility to Connect

Medtronic Connect for AndroidThe Connect is Medtronic’s answer to Dexcom’s Share, and comes in the form of a small dongle that helps transmit data to nearby smartphones. Also like the Dexcom’s smartphone connectivity, Medtronic had been limited to the Apple iPhone. Until now… With the release of MiniMed Connect in the Android Play Store, the Connect finally allows data from the 530G to be viewed from your smartphone, Apple or Android. (Dexcom plans to release a G5 app into the app store very soon).

Unfortunately, the Medtronic Connect platform is curiously not compatible with the aforementioned upcoming 670G and their current top-of-the-line 630G.

 

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Why the Medtronic 670G Artificial Pancreas is a huge deal for diabetes

So you’ve read all the headlines about an artificial pancreas and how it’s supposed to change the world for diabetes, but what does it really mean? We understand the skepticism… Remember: Medtronic previously claimed to have released an artificial pancreas system back in 2013.

But this time, the Medtronic 670G actually is a big deal. It’s a major step forward towards the artificial pancreas, and scientific studies back up its bold claims. (Note: it is NOT a true artificial pancreas, though)

But instead of repeatedly saying how important it is, we’re going to tell you exactly why it matters.

An “artificial pancreas” is like a “self-driving car”

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The quest toward an “artificial pancreas” closely parallels that of the “self-driving car.” The names do a good job in describing their futuristic vision, so long as you understand that the pancreas is the body organ that produces insulin. (In Type 1 diabetes, the pancreas no longer functions properly and stops making insulin, causing blood sugar to go out of control.)

So continuing the comparison, having Type 1 diabetes is like owning a car with just an engine; no steering wheel or brake. Not good. Thanks to modern medicine, people with diabetes have the opportunity to “drive their car” by checking their blood sugar and injecting insulin appropriately.

Much like a self-driving car, a true artificial pancreas would be an autopilot for navigating the highs and lows of blood sugar. With an artificial pancreas, the user would not have to devote any effort to controlling their blood sugar. It would take care of itself, just as a self-driving car would get you from point A to point B on its own.

But now the next question…

Is the Medtronic 670G an artificial pancreas?

No, but it’s halfway there. If a true artificial pancreas is like an autopilot for self-driving cars, the Medtronic 670G is similar to “adaptive cruise control.” (If you don’t know what that is, adaptive cruise control allows a car to automatically accelerate and decelerate to maintain a safe distance from the car in front of it). If you want to drive on a straight stretch of road without making any lane changes, adaptive cruise control requires virtually no user interaction.

adaptive-cruise-control

Similarly, the Medtronic 670G’s breakthrough feature adjusts basal insulin delivery (by speeding it up or slowing it down) to maintain a normal blood sugar of 120 mg/dL. It might not be as obvious during the day with meals and periods of exercise, just as adaptive cruise control plays a more subtle role when making many turns during city-driving.

But overnight and between meals is when the 670G’s adaptive cruise control truly shines, when circumstances are relatively stable, without the need to “change lanes” for meals or exercise. And keep in mind, unlike a car that you only use for trips, people with diabetes live with their disease 24 hours a day, 7 days a week. So a significant portion of their day is spent during those in-between and overnight periods.

Medtronic 670G’s “Adaptive Cruise Control” Works

Studies have clearly shown that wearing the 670G improves sugar control by reducing time spent in both high and low blood sugar range and lowered average A1c from 7.4% to 6.9%.

People who have worn insulin pumps with “dynamic cruise control” features particularly rave about its benefits on improved sleep overnight. Restful sleep is a big deal (and why mattress/pillow companies make a killing!), and it’s even more elusive with Type 1 diabetes due to the fear of overnight hypoglycemia or hyperglycemia. It’s not uncommon to be woken up several times a week in the middle of the night to check blood sugar or to have to eat a snack to avoid hypoglycemia. And even when sleep is not interrupted, waking up with higher or lower sugars than desired can start the day off with a thud.

Medtronic 670G Artificial Pancreas

As you can see in the graph above, adults using the 670G algorithm (highlighted in red) had a much narrower range of blood sugars, especially at night, when compared to standard pump users (the shaded grey area). They also headed into their mornings closer to target, and with a more stable glucose trend.

Medtronic 670G is just the beginning…

The top reason we’re excited for April 2017 (when the Medtronic 670G becomes available) is that it is just the first of a wave in the movement towards a true artificial pancreas.

While Medtronic has the advantage of manufacturing both its CGM and insulin pump, many future competing artificial pancreas systems are partnering with Dexcom’s highly rated, iPhone-compatible continuous glucose monitors.

 

The long list of such artificial pancreas systems includes a variety of approaches such as Bigfoot’s iPhone-based user interface, the more altrustic public benefit company BetaBionics’ iLet, and collaborations between Tandem and TypeZero.

bigfoot-artificial-pancreasThese projects are in various stages of advanced development, most of which are being currently worn and tested in clinical trials and research labs. The initial feedback of test subjects has been exceedingly optimistic, and the future of the “self-driving” artificial pancreas is just around the corner.

No matter which company (or companies) win, the type 1 diabetes community is the biggest winner.

Stay tuned for more coverage of the Medtronic 670G and other artificial pancreas devices…