Product Review post 1 of 6: The latest insulin pump AID technology
I have worn multiple brands of insulin pumps during the 26 years that I have had diabetes. Each one has been beneficial to my blood glucose (BG) management and has helped me to live life without as many pokes, roller-coaster rides or issues. As the technology has morphed into the AID (automated insulin delivery) territory, the landscape has changed to where we can really consider diabetes technology a big factor in reducing diabetes burden and burnout. I am always wary when trying new technology, however, because while the tech may sound great, it may not work well for MY particular body. If only I could try it...
My 30 day trial of the Medtronic 780G technology started in mid December and I was ready! This particular version of the tech was designed to reduce the pressure of accurate carb counting with what they call "bolus forgiveness." The algorithm in the pump uses the Gaurdian 4 sensor to determine when BG is rising over 120 mg/dl and can give a correction bolus every 5 minutes to help curb hyperglycemia. Tandem CIQ (control-IQ) can give a correction bolus once per hour and Omnipod 5 does not give correction boluses but increases the basal rate when BG is trending high. In other words, if BG is going high, the 780G is going to be the most aggressive tech in helping to bring that BG back down.
I am always wary when trying new technology, however, because while the tech may sound great, it may not work well for MY particular body
Because of this, the holidays seemed like a perfect time for me to trial the tech. After all, that time of year we tend to eat out more and consume more carbohydrates without nutrition labels (hello homemade cookies!!). I always start off wary with new tech - sort of like it's probably too good to be true, but I must say that I was impressed with the 780G and it's ability to improve time-in-range and, for me, reduce the guilt of eating higher carb meals (stay tuned for what happened when I got sushi!).
I also have used the Medtronic 670G and am well aware of the common issues people experienced on that tech. I too experienced being woken up in the middle of the night for yet another sensor calibration and being kicked out of automated mode quickly. But after talking with the lead engineer at Medtronic (fun fact - he used to be a NASA engineer and says human bodies are way more complicated than space!!), I felt more confident that the sensor issues had been resolved with the latest algorithm and Guardian 4 sensor.
My hope was to see better BGs and improved time-in-range (TIR) with less effort and mental burden.
During my trial, my hope was to see better BGs and improved time-in-range (TIR) with less effort and mental burden. The ultimate test for technology for me is if it can do a better job than I can! Of course, each insulin pump needs a bit of time to get to know you and how your body responds to insulin and carbs, so I also tried to approach this trial with a lot of patience.
First Impressions:
On the day of my training, I was excited and hopeful – but was also going to keep on my Dexcom to see how the Guardian compared to it! My trainer showed up to my door with a GIANT box of supplies – new pump, owner’s manual, AA batteries, pump clip, five 7-day-wear insets and 10 cartridges for keeping the insulin in the pump. There was also a box for the sensors, reusable sensor inserter, transmitter charger, charger battery and overtape. One more box contained a Accu-Chek Guide Link glucometer with test strips. Whoa!
The amount of devices needed for the Medtronic was a bit overwhelming! I was expecting more to be included compared to the Omnipod because of the CGM that comes with Medtronic, but there really were a lot to go along with the pump. This wasn’t something I had thought about previously but it became important when I went on a short vacation and forgot the CGM charger which meant I couldn’t connect a new sensor when mine was accidentally removed (darn it!!). I would also say that the Medtronic system takes more brain power to learn because there are multiple steps and multiple devices that are required. For the person that struggles with remembering details or with dexterity issues, this would not be my first choice in pumps for you.
My trainer started by having me connect all of the devices with the Medtronic pump via bluetooth. She also had me download the Medtronic app onto my phone so that I could view my pump data from the phone and automatically upload my data to the Carelink reporting system. The app does not allow for mobile bolusing, yet, so those of you hoping to keep the pump tucked in your bra and bolus from your phone will be disappointment. The download was easy and Carelink set-up was simple once I reset my password (it has been at least 2 years since I’ve last logged in). So, the glucometer, CGM transmitter and phone all were connected with the pump, but mobile bolus is not yet available.
The ultimate test for technology for me is if it can do a better job than I can!
Insulin Pump Comparisons:
Next, we programed the pump and I started to learn more about the system itself and how the algorithm is meant to work. The 780G has the lowest target BG option than any other pump at 100 mg/dl which I believe did help to lower my average target sensor value when wearing the system. The Omnipod 5 allowed me to go as low as 110 mg/dl for the target which is lower than the target range that Tandem CIQ uses that stretches from 112.5-140 mg/dl. Of course, a lower target BG does not necessarily mean a lower BG.
Another interesting difference is Medtronic recommends setting the Active Insulin Time (AIT) to 2 hours, far below Tandem’s 5 hour non-adjustable setting and the recommendations for Omnipod (typically not less than 3 hours). What the heck does that mean? AIT allows you to bolus insulin as often as you want without BG dropping too low because it calculates and subtracts how much insulin is still working in the body to bring sugar from the bloodstream into the cells. A shorter AIT means that the pump will give
more insulin sooner. My expectation was that I would have more low BGs because of this, but, amazingly, it didn’t! When coupled with the lower target range, I thought for sure I would have more lows. During my month on Medtronic 780G, I never exceeded 2% time spent below 70 mg/dl. Strangely, while using Medtronic, the pump was more aggressive with dosing insulin but did not actually cause more low BGs because of that. I honestly don’t know how they’ve managed that!
Strangely, the Medtronic pump was more aggressive with dosing insulin but did not actually cause more low BGs because of that. I honestly don’t know how they’ve managed that!
Initial Impressions:
There was a lot to learn on the first set-up. The buttons of the pump have been redone to make it more user-friendly, but it takes some practice to remember which button leads you where. It felt like there were more steps to complete any one task, but looking back, I'm not sure there actually were, it just felt like it since I was constantly forgetting if I am supposed to press the down or up button. I also needed a good amount of review on how to charge, insert and tape the CGM and I am positive that the CGM requires more time and more steps compared to Dexcom or Libre (more about the CGM in my next postings).
The pump is the same size as previous iterations and has the same cartridge, tube and inset that I used with the 670G. One big difference, however, was the 7-day wear inset (so cool!) and I really like that you just push a button to insert as this makes insertion easier and you are less prone to get kinked cannulas with automated insertion devices.
When you start on the 780G, you spend a couple days in manual mode (includes an options for helping prevent lows similar to Basal-IQ) before you are able to turn on Smartguard (their AID algorithm name). So, I set off with the pump connected, Guardian CGM warming up and my Dexcom attached just for a comparison and waited for the clock to strike 12 on the third midnight to be able to start the fully automated system (Cinderella vibes anyone?).
I set my Omnipod 5 to the side, clipped the 780G pump to my pants and started collecting data! In those first 3 days of wearing the pump, my TIR jumped to 81% (higher than typical) with average SG of 152 mg/dL (typical for me). The stats right before I went into auto mode even better with 86% TIR for the previous 24 hour period. That is much better than I have been able to achieve with any other pump out there! I was AMAZED!!!
But my time with the Medtronic 780G was only starting! I was making plans to test out the system including seeing what happens to BG when I don't bolus before a meal. How would BG do with disconnecting the pump to go to the pool? Where would I keep the pump when I wore dresses or any of my clothes without pockets? Would I remember to reconnect the pump after showering? Would eating Christmas dinner be any easier?
I waited for the clock to strike 12 on the 3rd midnight to be able to start the fully automated system.
Stay tunes for more details on what it was like to wear the Medtronic 780G insulin pump and Guardian 4 sensor. Subscribe below for early access to the latest posts and information on the newest diabetes technology. You can also follow, comment or like on social. Cheers!
For more information of the algorithms for each pump, please click the image below for the Panther Project Comparison sheet.
Resources:
Zhang G, Cohen O, Chattaraj S. Development of the Extended Infusion Set and Its Mechanism of Action. Journal of Diabetes Science and Technology. 2022;0(0). doi:10.1177/19322968221112120.
Panther program, University of Colorado. Barbara Davis Center for Diabetes. https://www.pantherprogram.org/.