IDS Clinicians Offer Different Perspectives on the Medtronic 670G

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Medtronic MiniMed 630G insulin pumpPoint/Counterpoint: IDS Clinicians Offer Different Perspectives on the Medtronic 670G

Several months ago, Gary posted his thoughts after trying out the Medtronic 670G hybrid closed loop system.

Since then, two other IDS clinicians have given the system a try:

jennifer smith

Jennifer Smith RD/LD/CDE

alicia downs

Alicia Downs RN/MSN/CDE

Both have extensive experience using a variety of insulin pumps and CGM devices.

After several months of using the 670G in “auto-mode,” in which the pump self-adjusts basal insulin delivery based on input from Medtronic’s Guardian continuous glucose monitor, here’s what they had to say.

Q: What were your needs/expectations going into using 670G?

Jenny:

I was optimistic about trying the 670G. I wanted it to make life with diabetes easier as well as safer all around. Given it is the only FDA approved hybrid loop system on the market, it opens the doors for this type of technology to get approved from other pump companies as well. This is very exciting since we all need a “partner” so to speak in our self-management. Up to this point, all the pumps on the market have had smart features, but the PWD is the one who has to make use of the smart features by using their own brain to enable them.  With the variables we each have in our day to day lives, this means constant interaction if we really want to avoid a roller coaster.

Having type 1 for almost 30 years now, I’ve managed to figure out adjustments to many of the variables that affect my management.  But, I would really like a product that has my back – a partner in this 24/7 of management. Essentially, one that can fill in the gaps between the times that I’m not looking at my CGM screen or checking my BG. With 2 kids now (5 years old and 14 months old), that tends to be less often the “looking and evaluating for making changes now”, and more the “oh, I think I see a pattern here, but I’ll have to make an adjustment when my son doesn’t have glue all over the kitchen table, etc”. Anyone with a busy life, regardless of bambinos can understand the desire to have a system that not only tells you that BG is dropping or rising, but offsets that trend right away.  That is what I expect(ed) from a system like 670G.  I’d like a partner that sees what I don’t and doesn’t ask me to make an adjustment, it just does it based on a fancy algorithm that some wonderful mathematician figured out!


Alicia: 

My expectations were pretty low. I was honestly expecting that the system would not keep up with my habits and my widely varied basal needs. My control on “Alicia mode” is where I want it to be, so I was going in a bit skeptical.

Did you find the system easy to learn?

Jenny:

3 user manuals – one for the pump, one for the CGM and one to learn how to use the Automode feature of the system.  Lots of reading, but pretty easy to get set up and learn how to use if you have used an insulin pump before.  There are a lot of menus to look through on the pump itself for using the sensor and the Automode feature and to customize them, and I feel navigating these took longer to actually get used to than the actual set up of the pump/sensor.


Alicia:

I found the principles of the system easy for me, but diabetes is my job and I’ve been pumping close to a decade. I found manuvering the menus of the system a real headache. To this day I keep a flow chart of all the menus taped to my computer monitor because navigating where things are is a headache. I also found it hard because, for me, diabetes is about learning to see things coming before they happen. Anticipation makes life move more smoothly. But as much as I learned about the system I was never able to learn to anticipate its demands.

Once you began using AutoMode, how did your life change?

Jenny:

I’d love to say that using Automode changed my life for the better – honestly, I would.  However, for me, it actually made things more annoying and variable. I believe a major part of this is the fact that the Guardian Sensor was just not as accurate for me as the Dexcom that I’ve come to use and love in the past 7 years (prior to that I used the Abbott Freestyle Navigator, which was fantastic and I still miss it!). The Guardian sensor was accurate most often for me when I was literally sitting and not doing much – so office work time seemed to stay pretty on target with my fingersticks and with Dexcom (especially if I wasn’t eating anything). However, I’m not a sedentary person and I eat food!

** A side note here in that when I was in Manual mode using the Guardian CGM, it was more accurate for me than when I was in Automode. It seemed like all the request for confirmation of BG and calibrations in Automode made it less accurate and more variable.

I love exercise and with 2 little boys who are busy, I’m not sitting very much after I’m done with work. This is where things would get very off with the sensor. It lagged in noting a drop in my BG as well as a rise in my BG compared to my Dexcom – especially during exercise and after meals. I also found that overnight, while it kept things stable, I’d wake to find my straight line was not an accurate value – hovering at 122 all night via Medtronic would have been fine, but when I tested upon waking and found a fingerstick of 196 instead and then looked at my Dexcom (I turned alarms off on my Dexcom so as to not get so many notifications overnight) I saw I had a rise in my BG and then stabilized at 170-195 all night – bah!! Not where I want to start my morning.

The other parts of not loving the system are the alarms and requests for blood. Seriously, a nice flat line overnight should mean a system isn’t asking for more information to confirm it is doing what it is supposed to do. If I calibrate before bedtime that should suffice in my mind. It is great to have a nice flat line overnight – which should mean I sleep all night without waking up for alarms.  Argh – I got alerts overnight for false low BG, then the system would tell me to add a BG to stay in Automode, or to calibrate again, etc, etc and on and on. The things it asked for and the alarms made me a bit crazy about where my BG was at any point in time.  I had more roller coaster in BG as well as more low BG (and false low BG) then I had when I was doing all of this with my own mental power and self-adjustment on my own pump.


Alicia:

My first few days on auto mode were VERY frustrating as the post meal curve I have come to anticipate for years changed. I was going higher than I had anticipated later after meals. In my pre670 world that typically spells disaster! It means I’m going to be bolusing to bring blood sugars down for hours, so I was really upset to see that. I spent a number of afternoons and evenings griping to my husband and showing him sensor graphs that he pretended to care about.

But I forced myself to do what Medtronic tells patients and “Trust the system” And over the course of the week the numbers spoke. I was spending the same, if not a little bit more time in range over all, that time had just shifted from what I was used to seeing. And my average had remained the same. So I let it do its thing. I even pushed it into what I thought would break the system, a steak house dinner, and a trip to Disney World! But it handled both without kicking me out of automode! I was impressed. But I still had this constant nagging feeling of not knowing what was going on with my management. meal timing was off, reactions to exercise were off, the predictability I’d come to wrap up in like a blanket was gone, and it made me more tentative in my day to day living.

shortcut

Is there anything you wish Medtronic did differently in designing this system?

Jenny:

A) The system needs to allow the target BG to be adjusted based on user preference. Honestly, I target a BG lower than the 120 preset value in this pump and my corrections target a lower BG than this system targets too. The current targets restrict use of this pump to those who are NOT considering pregnancy or are NOT pregnant, as the current default target is too high for pregnancy management.  This is a fair percent of the population of women with type 1 diabetes.

B) The alarms, alerts and requests for information need to be changed. I know it is built in as a safety feature of checks and balances to ensure the system is working, but this was a big part of why it was annoying to me.

C) Allow the system to work with known advanced features on current pumps like extended bolus, temporary basal, and the ability to adjust the pump’s recommended bolus based on the need of the PWD (ie – if you know you are going for a run in an hour and you are eating/bolusing now, you should be able to adjust the suggested bolus down to avoid having so much IOB for the run –without having to exit Automode to adjust!)

D) Better menu system – there are too many steps and too many screens to look through to find what is needed quickly (or at 2am when it is requesting you do something to stay in Automode).

E) Better sensor accuracy with less interaction needed by the user to keep it accurate.


Alicia:

MENUS! Wow my thumbs were aching from that pump! Things that you interact with 5 times a day are buried 4 menus deep, and features I don’t think I ever used are right on the home screen! The buttons themselves are even tough to push and awkwardly placed. Nothing about the menu set up is in the least way intuitive. In a time where any 3 year old can pick up most any technology and maneuver the interface without any instruction; these menus feel like something out of the DOS prompt era of menus listed under sub menus that only make sense to the engineers who built them. (And were often the source of an inside joke rather than any kind of user driven logic) I found myself wondering if Medtronic ever put this system through any kind of user focus group during the design phase, because it sure doesn’t feel like it.
I also really wish they’d given me a way to temp basal for things that I know are coming rather than waiting for the fall out. I know I’m going to work out, so let me use what I know!! I’ve kept myself alive quite well for quite some time with my knowledge and skills. Eliminating them is tantamount to taking a bicycle away from a child because it is dangerous to ride in busy traffic. But i’m not a child, I’m a professional cyclist, let me use what I know to get where I want to be more effectively!! Let me keep the anticipatory skills that serve me so well rather than forcing me to be reactive, as if I had no idea a workout was coming. I never did get the chance to put this system through my personal workout challenge, summer heat! Advance temp basal and bolus adjustments literally save my life all summer long. The idea of going without those features through a Maryland summer is daunting at best, and may spur me to give the system a more high stakes trial in a few more months.

question

Do you plan to continue using 670?  Why or why not?

Jenny:

I do not plan to continue wearing the system. For me it brought variables to my management and made me wary of where my BG was headed. I did not like to have to respond to so many requests through the day (and I’m one who tests via finger-stick a lot already even though I wear a CGM 24/7) and I felt like I had to keep wearing my Dexcom to stay on top of where 670 was saying I was.

I prefer lower targets than the system allows and my need to use features like extended bolus or temporary adjustments for exercise are not met by the Automode system.

In full disclosure I had been using a LOOP insulin pump prior to starting use of the 670G and I feel that the 670 was a step back from what the LOOP system was doing for me and my management.


Alicia:

The system did its job, but it’s not for me. My average and in-range time showed a statistically insignificant improvement over “Alicia mode” but took a LOT more effort to get there. “Alicia mode” does not wake me up at night to enter blood sugars, it does not require me to lie to the system to safely workout, or to get the corrections I want. I’m not an early adopter by nature. I don’t do an update on my phone until I notice performance issues from the outdated system, and I will drive a car until it costs more to repair it than to purchase another. I only update pumps every 4 years because my insurance will cover it and I want to get my money’s worth! I think that the next couple of years is going to bring us some great options in hybrid closed loop systems from other pump developers, so I will wait to see what they bring to the table before wading into the HCL life full time.

About the Author:

26 Comments

  1. Deb k March 23, 2018 at 8:06 pm - Reply

    As a T1d for 52 years, pumper for nearly 20 years, I was SO looking forward to the wonderful 670g…. but like the ones at Gary’s business, it has frustrated me more than helped. My A1c went up. I’ve tried auto mode for months, quit, and keep trying again, but usually end up lasting less than 24 hrs in auto. I really dislike being woke at night. The 120 target might be ok if sensor was accurate, but sensor averages 20 below actual…. even on manual mode, carelink estimated my a1c at 6.3; it’s 6.9…. I cant see how it’s possible to get down to 6.0 or below…. I’m really disappointed, but feel ashamed to complain…

    • alicia downs March 29, 2018 at 5:02 pm - Reply

      Thanks for sharing,
      Mathematically it’s close to impossible to get an A1C that low on the 670G since it shoots for a target of 120 which means in a magical 670 dream world you’d have an A1C of 5.8, but since we eat, get sick, have stress, and move about, the more realistic outcome is a high 6 to low 7

  2. Robin J Suarez March 28, 2018 at 3:48 pm - Reply

    I have been on the 670G since July 2017 and my experience is completely different than these 2 stories. I do not know how long these people were on the 670G to give their experience but I do not have all the alarms and alerts going off as they do. My in range time has gone from 53% of the time prior to the 670G to consistently 80% and above since on the 670G. My HbA1c has dropped a full percent. My correction boluses have gone from 83% of the time to only 30%. The 670G has been life changing for me.

    • alicia downs March 29, 2018 at 4:57 pm - Reply

      Every user experiences is certainly different. There are candidates for whom the system is highly effective, and there are others for whom it is a step backward. Thanks for sharing your experience.

  3. Sina Piers April 11, 2018 at 11:25 am - Reply

    I would not have expected the 670G to be as good as the LOOP or “Alicia Mode”. However, for me, someone who still works at Diabetes on a part time basis, instead of the full time job it always is, I like sharing the work load!!! That being said, I completely agree that the sensor needs to be more accurate with less input from the user, and that the menu is not user friendly.

    I have been wearing the 670 since November.

  4. Kat May 2, 2018 at 3:52 pm - Reply

    I just got the 670G about 3 mo ago and have pretty much hated it from the start. I want my old dex and omnipod back! But since I just got it…I will not be eligible to change. =( I randomly try going back into auto mode but my BG is under better control in manual honestly.
    Also I am just now starting to delve into the pregnancy prep world (about 2 years out from actual pregnancy) but need to start practicing tighter control! I guess manual mode is the way to go. Too bad, such a great idea, I thought I’d get to float on a sort of cloud knowing it will help keep me in better control, but really things just got worse and now I’m bouncing back on my own.

    • alicia downs May 16, 2018 at 6:14 pm - Reply

      Hi Kat,
      Your experience is , unfortunately, not uncommon.
      Feel free to give us a call for a consultation. We have been able to work with a number of 670G users to improve their manual management and settings and go into a 670G use with much better outcomes and much less stress. We also offer pregnancy preparation and pregnancy specific education and support.

  5. MarC May 11, 2018 at 2:16 pm - Reply

    After reviewing this article I finally feel redeemed! I feel a kinship with Jenny as my issues were exactly the same overnight. I have a straight line, it says (in automode) that my BG is 101 but in actuality on waking it’s > 170 very often! I have called Medtronic to see if others have said the same thing and was told no. It also will not calibrate unless the sensor is in the back of my arm! Nothing on my abdomen works, totally frustrating going into summer with a big old sensor in my arm with short sleeves on?! 🙁
    I also can relate to Deb K in her response, I am ashamed it’s not working for me like I thought it would. I have been on it since December and feel like the sensor isn’t nearly as accurate as the Dexcom was for me. The ONLY positive I can say about the 670G is my hypoglycemia is almost non-existent now which is a plus. My A1C is almost one percentage point higher though. The alarm fatigue is over the top, most days I input more than 8-10 BG’s on top of calibration. Perhaps they rushed this device before allowing algorithms to be updated? Not sure but I want my Dexcom back!!!!

  6. Dins890 June 6, 2018 at 8:18 pm - Reply

    As a 670G user I just want to make sure that I commented regarding a couple of the issues that were stated above, 1st, at least on my 670G I am able to set the target range below 120 (located under Options, Delivery Settings, Bolus Estimate Setup, BG Target; 2nd) there is a temp basal mode that allows you to temporarily decrease your basal doses for workouts, you tell it how long to basal in this temporary mode (this function is located under the Basal Option on the first menu under Temp Basal and you always have the option to suspend delivery; and 3rd) the dual/wave option allows you to bolus for big meals that include fast and slow digesting carbs, it gives you your immediate normal bolus followed by a Square Wave bolus where the square wave portion is delayed evenly over a period of time so you can remain level. I have to agree that the menus are terrible and need to be fixed, if I didn’t have someone to help me I would be lost. I have been on this pump for a year and still have a hard time navigating them but lucky for me I have a great rep who is very knowledgeable. I also was having issues with sensors failing regularly but I was recently notified that the CGM has been approved for wear on your arms. Since I have moved the sensors I have experienced 6-7 day of use on each sensor where before I was only getting about 3 day average.

    • alicia downs June 18, 2018 at 5:50 pm - Reply

      Just wanted to elaborate that the features listed above are not available in automode. In automode the only option available is to use a temp target set higher for exercise and other times of reducing hypo risk.
      A savy user can bounce between manual mode and automode to make use of features, but it is time consuming.

  7. Eileen Burke July 21, 2018 at 2:02 pm - Reply

    Wow, I am shocked and completely discouraged. I came upon this website in my search to find professional help for my daughter, who is struggling with control and diabetes burnout. I am the mother of a 24 yr old, who was “gifted” with diabetes when she was three. She started pumping at age 8 and switched to the 670 about 9 mos. ago. All I’ve heard since then is problems: lack of options, wild alarms, false readings, etc. I thought it couldn’t be true; she must be overlooking proper protocols. So, it was all true…everything she expressed. I am so disturbed at this moment I cannot complete my thoughts.

    • alicia downs August 29, 2018 at 2:02 pm - Reply

      Hi Eileen,
      Sounds like you could definitely use some added support. We would love to work with you and your daughter to help you find some answers and encouragement. Feel free to reach out to our office for an appointment anytime. We work with patients across the country and around the world.

  8. Jill M Benti August 10, 2018 at 3:44 pm - Reply

    I have had diabetes for 28 years. I purchases the 670G. I I am on an Animas currently. I picked up the pump. Several boxes and instruction manuels. Couldnot figure out any of it. I called the pharmacy, the diabetic educator to help me. They told me Medtronic would have to train me for this. I never got a follow up call on the pump after purchased. I called Medtronic to see if we could set up an appointment to have someone show me how to use. The associate I spoke to told me he would check to see if I have an endo appointment. Also, told me sometimes it can take up to 14 days for an appointment for someone from Medtronic to show me how to use the pump. Very disappointed how they are so quick to see. But after all is said and done. No one wants to help and the buck is always being passed. In the mean time I sit here with an Animas pump that I can barely read the screen and the attachment for it to stay on my pants falls off and pulls the tubing out.

    • alicia downs August 29, 2018 at 3:21 pm - Reply

      Hi Jill,
      We work with a lot of Medtronic patients whoa re unable to get their training needed in a timely way. if you have the ability to do remote education, reach out to our offices and we will work with our local reps to see if we can be a resource to get you the training you need.
      It is really unfortunate that medtronic’s sales force so greatly outstripped their training force with this product launch.

  9. Bruce August 11, 2018 at 3:34 pm - Reply

    Hi I have been using the 670 g for 1 year. I use all the features. First the guardian sensors are inaccurate. Usually 30 to 50 points off. So your target is way off. I have had the worst a1cs of my diabetic time. 7.3. Interestingly Medtronic said a1c is not a good measure anymore. Next the alarms. Even with all alarms silenced. Driving ,sleeping getting louder and louder until it’s an air raid siren. Eat the correct carbs for correction. Alarm going off every 3minutes far too long..Saying low 40 or whatever. Finger stick says 95. Alarm makes you want to eat and eat. I would not recommend this system. I think the future is going to provide great pumps. This is a step.

    • alicia downs August 29, 2018 at 3:18 pm - Reply

      Bruce, your struggles are very common. We find that most of our patients on 670 are able to get better results with more in depeth education. Still, others find that they use automode in a modified way to improve their quality of life rather than the focus on continual use for A1C management.
      The Medtronic systems have always been far more alert heavy than other systems. We are waiting to see how Dexcom based systems might differ.

  10. Mike September 6, 2018 at 1:22 am - Reply

    With as much money spent on the 670G pump itself, I would have thought Medtronics had a 24 hour hotline. This is the only major flaw I have had so far. 8am-6pm, I personally work longer than that. So checking the status or ordering more after 6pm is out of the question. Very disappointing. However, shipping is very fast.

  11. Nancy September 11, 2018 at 8:16 pm - Reply

    I have been diabetic for 34 years and on a Medtronic pump since 2001. (Currently a Paradigm). I have been using the recommended Dexcom CGM for a little over a year and like it. I am completely discouraged at what I’ve read here. I was looking forward to finding out about this new pump that can actually get wet at my next endo. appointment next week!
    In addition to a pump that only communicates with the same brand CGM, I’ve heard nothing but bad things about Medtronic’s GGM – inaccurate readings/predictions and a HUGE amount of tape that leaves a residue along with damaged skin. What if the newest pump could work with whatever CGM the user desires? Really, how many are there to choose from anyway? I’d like to keep using Dexcom and fear that my Paradigm will fail and I’ll be forced to get a new pump… then have the bad experiences I am reading here with both pump and CGM. Very discouraging. I hope for changes in the Medtronic Pump and CGM future!!

  12. David Workman September 24, 2018 at 3:31 am - Reply

    I’m trying to return this unit as it has major software issues. The major one is falling off the auto mode and the start of basal when in low BG situations. I just wanted this system to stop pumping insulin when my BG was low. This is not happening. The lawyers have really screwed this system up. Can’t get a full nights sleep because it keeps alerting me. I’m 58 years into this game I don’t need this.

  13. Dustin September 26, 2018 at 3:53 am - Reply

    I went from dexcom g5 and pens to the 670g. I love the way the auto adjustments work. Problem is when the cgm is t working correctly which seems to be a lot. It’s almost always off by at least 20. End up checking my blood sugar at least 5 times a day. I have had quite a few sensors that failed. Very disappointed. My dexcom was almost always with in 5-10. Almost never needed re-calibration and was just easier to use. I think I just want to send this back and get the tslim and dexcom combo.

  14. Rhonda October 7, 2018 at 10:42 pm - Reply

    I just switched out of auto mode after 4 days of use. I wasn’t as concerned about alarms as I was the large rise in blood glucose levels and the large amount of time that the pump took to correct. I feel like I’m on a bad roller coaster ride and my muscles ache from all the fluctuation.
    I am also a very low carb eater and feel bad for those who actually eat carbs!!!? the CGM that comes with the pump is also very inaccurate, usually around 25 points higher!!
    I’m going to go in manual mode for now and maybe auto at bed time and see how that works for awhile.

  15. Rhonda October 8, 2018 at 12:21 am - Reply

    I’ve been a type 1 for 30 years with no complications. I was really looking forward to this new smart pump. I started in manual mode and now I have been in auto mode for four days.
    The sensor has been very inaccurate. It ranges about 25 points higher than my meter.
    I am also a low carb eater and I have found that I have been very high on glucose with this new pump. 12-15 grams of carbs brings a steady long climb uphill with a slow decent. It seems to always be chasing itself rather than maintaining.
    My muscles hurt because of the radical change in glucose so I have decided to put my pump in manual mode except for at night. Maybe I will go back to Auto Mode during the day but not for now.

  16. Karen October 10, 2018 at 9:13 pm - Reply

    I worked so hard to get the new 670g system and paid for it myself. I was really excited to start . Now I have nicknamed it my torture device. The alarms, the calibrations , the Finger sticks , the lows everyday , the lack of sleep , the accusations that I am not doing it right, the weight gain , the inability to perform my job , all have me so stressed I came here to look for a better system , I found there are many others experiencing the same problems, now the question is what do I do about it ?

  17. Josh November 1, 2018 at 2:34 pm - Reply

    My doctor swears by this system, but it has made my life so much more stressful and I really have not seen an improvement. It alerts me multiple times a night for no reasons and it is not very accurate. I had one incident recently where it said I was in the 40’s. After checking with my glucose monitor I found I was actually at 180. Who knows what would have happened if I had just trusted what my sensor said.

  18. Steve Swiger November 2, 2018 at 2:35 am - Reply

    I was blessed with type 1 at age 23, and I’m now nearly 66. After years of using needles I felt blessed to get my first pump about 20 years ago, and have done my best to maintain control. I got a Medtronic 670 about a month ago, and I seem to become more one with it almost daily. It takes a lot of tweaking and learning, but my control is improving albeit slowly. I’m retired so have more time to fool with it I’ll admit but I’m optimistic about my future results. I encourage everyone to stop and take a breath, be patient and understand that this is a lifelong journey. Only by patiently working to master the system can you have a smoother ride.

  19. Linda I. Collier November 9, 2018 at 1:11 am - Reply

    I’ve been pumping since 2012 and it does make my life better. When I went to the 670G I was hoping for some peace and balance. The Guardian sensor is a super improvement and is close enough to reality to use its reading to alleviate some finger sticking. The Auto Mode (AM) is an entirely different problem. I’m pretty experienced with computers and recognized that when you have 2 separate programs inside the same database, the pump must be primary and AM should work with it.. AM grossly overlooks the pump actions (by me). There is no question my sugars are far better, but AM kicks in and demands BGs/calibrations after I’ve just done it (up to 2-5 times) and sometimes in the middle of the night. I told Medtronic the same thing when I was taking their surveys. Anyway, I’ve kept trying AM and have stopped it altogether now. I can’t take the stress!

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