Medtronic’s Hybrid Closed Loop System: Getting More Bang For Your Buck By, Gary Scheiner MS, CDE, Jennifer Smith RD, LD, CDE, Alicia Downs RN, MSN, CDE, Annette Valle RN, CDE It’s been about a year and a half since we started using and training/managing patients on the Medtronic 670G “hybrid closed loop” system. And we’ve learned a lot. We’ve learned that 670G is beneficial for some, but it clearly isn’t for everybody. Yes, for the “average” person with diabetes, it can produce improvements in glucose control while helping reduce the risk of dangerous hypoglycemia. But there are limits to the degree of glucose control that can be achieved, and there are many hassles and extra tasks involved with using the system. There are other hybrid closed loop systems that are already in use, despite not being on the “FDA approved” list of systems. Loop and OpenAPS systems are highly effective for improving glucose control, but they require special equipment and an “app build” to get them up and running. Tandem’s T:Slim with Basal IQ is easy-as-pie to use, but it only turns off basal insulin to help prevent lows. Other systems are coming to market soon: Tandem’s Control IQ, OmniPod’s Horizon, Tidepool Loop and BigFoot Biomedical’s system are all slated to make automated basal adjustments (similar to Medtronic’s 670G, but with less work on the part of the user), but until the pre-launch studies are completed and the FDA signs off, all we can do is picture them in our daytime fantasies. So for those who want 24-hour automated basal adjustment NOW that is FDA approved, that really leaves just one option: 670G. Medtronic has taking steps to cut down on some of the [...]
IDS Clinicians Offer Different Perspectives on the Medtronic 670G after 10 days of use. Read what they have to say...
Pros & Cons of the Tandem t:slim X2 and t:flex Insulin Pumps Unique Advantages: Pros X2 has software/features updatable through download from website Bright, full-color touch screen Modern, high-tech appearance Compact, thin dimensions Rapid number entry/fastest bolus entry 2-Way Bluetooth (X2) allows full integration with multiple devices, including smartphones & CGM X2 displays data from Dexcom G5 T:flex holds up to 480u Charges; No disposable batteries Can calculate boluses up to 50 units (60u with t:flex) Site-change reminder w/customizable day & time Graphic on-screen history display Carb counting calculatorTemp basal up to 250%, 72 hrs IOB & time remaining displayed on home screen Missed bolus reminders customizable by day of week Alert for high temperatures Secondary basal programs can be linked with secondary bolus formulas Limited unintended insulin movement with changes in pump position X2 with G6 and Basal IQ – Low prediction, basal suspend feature (suspends on prediction of BG 80 or lower, restarts basal with 1mg/dl rise in BG in suspension) Potential Drawbacks: CONS Hybrid closed loop features pending Small buttons can be difficult to activate; screen goes blank if buttons missed 3x Unlock procedure required to perform any programming No attached clip (must put in a case that has a clip) Tubing connector looks “medical,” can snag on clothing Proprietary tubing connection, cannot use third party infusion sets. Basal & bolus settings in same time slots; may take several steps to edit Extra confirmation steps with all programming Weak vibrate mechanism No meter link Company’s long-term viability is uncertain; pump is their only product Requires charging 1-2x/week
Pros & Cons of the Medtronic MiniMed 670G with Guardian Our 2018 review Unique Advantages: Pros Large, secure, long-established company Industry leader in R & D Data from Medtronic Guardian CGM displayed on-screen Automatic basal shutoff when low glucose detected by sensor (may help prevent severe hypos) Hybrid closed loop(Automode) basal adjustment based on CGM readings and predictive algorithms High-contrast full-color screen Slim attachable clip Integrated meter serves as remote control for bolusing Frequently used boluses & temp basals can be stored as “presets” Downloadable to online Carelink program Choice of slow or fast bolus delivery Generates insulin/carb/BG statistics Potential Drawbacks: CONS “Airplane Mode” option CGM and Automode require additional finger sticks for calibration and safety checks. Maintaining Automode requires a higher level of technical acumen and interaction with the pump. Frequent system alerts in Automode may become intrusive Attached clip is upside-down Must pay for loaner/backup pumps Screen and text are relatively small Insulin-on-board only deducted from correction boluses Downloading restricted to Carelink program Multiple menus and programming can be complex to master Many button-presses and confirmation steps in basic programming Delay in getting pumps, supplies and training to new users Company’s marketing can be overly aggressive Diabetes educator, Dr Gary Scheiner gives an in-depth review of his own experience using the Medtronic MiniMed 670G Insulin Pump.Read Review of MiniMed 670G
Pros & Cons of the Medtronic MiniMed 630G with Enlite Unique Advantages: Pros Large, secure, long-established company Industry leader in R & D Data from Medtronic Enlite CGM displayed on-screen Automatic basal shutoff when low glucose detected by sensor (may help prevent severe hypos) High-contrast full-color screen Optional “Connect” feature for sharing CGM data on smartphones Slim attachable clip Integrated meter serves as remote control for bolusing Frequently used boluses & temp basals can be stored as “presets” Easily downloadable to online Carelink program Choice of slow or fast bolus delivery Generates insulin/carb/BG statistics Potential Drawbacks: CONS “Airplane Mode” option CGM accuracy, longevity, transmission range, ease-of-use considered inferior to competitors Automatic low-suspend feature may be disruptive and counter-productive Must pay for loaner/backup pumps Insulin-on-board only deducted from correction boluses Attached clip is upside-down Downloading restricted to Carelink program Screen and text are relatively small Multiple menus and programming can be complex to master Lots of button-pushing and confirmation steps with basic programming Company’s marketing can be overly aggressive
Pros & Cons of the Insulet OmniPod Insulin Pump Unique Advantages: Pros Reduced up-front costs Can program through clothing from a few feet away Discrete pump size No tubing (minimizes wasted insulin, no tangling/snagging, less awkward, no siphon effects) No disconnecting/reconnecting means no missed/lost insulin Simple, automated cannula insertion (minimizes discomfort, reduces “human errors”, creates more site options) Forced pod change reduces chances of lipodystrophy & absorption problems Pump is fully watertight Temp basals and boluses can be customized/preset Freestyle meter built into handheld programmer Large color screen w/text and graphing capability Only 2 parts; simple for travel DASH – New Android-based PDM expected after January 2019 Basal rate of 0.0u/hr will be an option with DASH PDM The Omnipod DISPLAY™ app allows for a convenient display of Personal Diabetes Manager (PDM) data on the user’s smartphone as well as a “Find My PDM” feature. The Omnipod VIEW™ app lets up to 12 care partners view their loved one’s Omnipod DASH™ System data on their iOS smartphone remotely. Potential hybrid closed loop pump with Dexcom - ? Potential Drawbacks: CONS Low-suspend, hybrid closed loop features in development No integrated CGM Bulky programmer New DASH PDM will NOT have BG monitor within device – must use Contour Next BG monitor for Bluetooth connection of BG data to PDM Pod creates a “bulge” on the skin Cannot enter boluses or make setting changes without programmer Cannot do programming or editing while bolus is delivering Only one cannula orientation/length Max reservoir volume 200u; minimum fill amount 85u Pod stops working after 72 hours (plus grace period) Handheld will not calculate bolus if BG < 50 Dislodged/clogged cannula or pod error requires complete pod [...]