Me and 780G – an in-depth assessment of Medtronic’s newest Automated Insulin Supply system

I went into this with a totally open thoughts.  Regardless of Medtronic’s latest disappointments with regards to their pump, sensor and algorithm, it’s only honest to provide them a possibility to indicate what they’ve realized. 

So I abdicated my OmniPod Sprint pumps, Dexcom G7 sensors and DIY “Loop” algorithm, a minimum of quickly, in an effort to give Medtronic’s 780G a attempt.  And I’m glad I did.

All the setup was pretty intuitive, a minimum of for somebody like me who has appreciable pump expertise.  I used to be capable of program all the things I wanted to program with out as soon as referring to the person information.

Taking a better have a look at the Medtronic 780G

The {Hardware}…

The primary a number of days, whereas the algorithm was in “information assortment” mode and never really making any automated changes, I used to be reminded of among the downsides related to earlier variations of Medtronic’s automated insulin supply (AID) programs.  The pump stays cumbersome and heavy – largely because of the AA battery and cylindrical insulin reservoir.  And the clip remains to be backwards!  When the pump is clipped to at least one’s waistband (as most individuals do), lifting the pump to see the display screen positions it upside-down and the reservoir cap pokes your intestine.  There may be merely no technique to flip the clip orientation or flip it sideways.  The pump additionally stays awkward to program, regardless of the alternative of lengthy lists of overlapping menus with a collection of 9 on-screen icons.  Actually, I do a lot better with phrases!  I nonetheless battle realizing which icon to click on on for accessing lots of the lesser-used programming options. 

On the flip facet, the brand new MiniMed Cellular app makes an excessive amount of info accessible at a fast look.  Sadly, the app doesn’t permit for any pump programming – simply visualization of latest information/standing, technology of notifications, and information sharing.  And the app won’t perform except you will have the “display screen lock” and passcode characteristic activated in your telephone.

The pump’s person interface depends on buttons for navigation quite than a touchscreen, making numeric entries (for issues like carbs, glucose ranges and bolus doses) considerably time-consuming. Programming boluses, which is the one factor pump customers do routinely all through the day, stays gradual and sloppy. The method of getting into carbs and glucose for a bolus calculation, after which delivering the bolus, can take 2 rounds of scrolling and upwards of 14 button presses!

The pump’s show, whereas smaller than that of different pumps (and cell telephones), gives a pleasant visible of CGM information together with icons indicating when carbs, boluses, calibration values and temp targets have been entered.  The system’s smartphone app permits the information to sync with Medtronic’s Carelink software program – a free on-line program that generates stories and is shareable with healthcare suppliers.  Carelink could be advanced to navigate and the report codecs want some critical work, however it’s good having the ability to see the information multi functional place with out having to plug something in.

I ought to point out that along with syncing with Medtronic’s (and ONLY Medtronic’s) CGM, the pump additionally syncs with a Roche fingerstick blood glucose meter known as AccuChek Information Hyperlink. The meter is fast and compact (even the strip vial is compact – they constructed it in an oval form to save lots of house. good!), however the sign transmission into the pump is ungodly gradual.  So in case you’re relying on utilizing the meter worth for a bolus calculation, you’d higher have one thing readily available to maintain your self busy whereas the studying transmits into the pump.  Fortunately, the CGM readings populate within the bolus calculation display screen mechanically in Sensible Guard mode, so solely carb entries are required when bolusing.

The Disposables…

Having used an OmniPod for therefore a few years, I forgot how inconvenient tubing could be.  Maybe its not the tubing, however the LENGTH of the tubing.  Like many individuals, I would like lengthy (43”) tubing in order that I don’t need to unclip the pump from my pants when going to rest room, lest the pump (and my pants) dangle precariously from my infusion web site.  Sadly, the brand new “Prolonged Put on” infusion units are solely accessible with 23” or 32” tubing.

Talking of infusion units, this can be a particular vivid spot.  The Prolonged Put on units, are designed equally to the Mio Advance: smooth, compact, and a snap to insert.  They characteristic higher adhesive to attenuate canula motion and a filter and preservative-protecting tube lining to make sure insulin is pure and potent when it will get below the pores and skin.  These enhancements actually do make “Prolonged Put on” units last more than conventional infusion units, and produce fewer web site/absorption issues.  The set is extraordinarily straightforward to insert and has a safe join/disconnect mechanism.  I undoubtedly see a distinction in pores and skin well being and glucose stability with this set.

Now let’s talk about the sensor.  Medtronic’s Guardian 4 is sort of an identical to the corporate’s earlier sensors, however with one main distinction:  Calibration is optionally available.  However it’s nonetheless essential to carry out occasional fingersticks, as the accuracy comes up a bit brief in comparison with Dexcom G7 and Libre 3.  It additionally has a comparatively brief life (7 days), lengthy warmup (2 hours), and a transmitter that requires charging between sensor classes.  However the insertion course of remains to be what offers me the creeps.  Possibly it’s as a result of I attempted to insert my first sensor on a turbulent flight from Philly to Phoenix, however the quantity components, steps, and adhesive layers is past comprehension.  In comparison with inserting a Dexcom or Libre sensor, inserting a Medtronic Guardian sensor is like taking part in the sport “Operation” in the course of a hurricane.

Nonetheless, I used to be capable of get all of it up and operating.  I need to admit, it’s good not having to hold my telephone (or a controller) in every single place, because the CGM information exhibits up proper on the pump, the algorithm is constructed into the pump, and all programming is carried out straight on the pump itself.  I can’t let you know what number of instances my telephone battery died and I used to be dumped out of closed-loop mode whereas utilizing the DIY Loop system.  Now I simply have to ensure the battery within the Medtronic pump doesn’t drain fully.

Glucose Administration…

I spent the primary 2 ½ days utilizing 780G in “handbook” mode utilizing my very own basal and bolus settings whereas the system measured my day by day insulin necessities.  It does this to estimate my insulin sensitivity and decide a flat basal charge to make use of as a baseline.  Then, with none actual fanfare, “Sensible Guard” – Medtronic’s automated insulin adjustment algorithm – kicked in.

I’ve to confess.  I’ve been impressed with the algorithm. And this comes from somebody who has spent years utilizing the DIY Loop algorithm, thought of by most to be probably the most refined hybrid closed loop expertise.  The changes made by Sensible Guard have been smart and largely efficient, though I want it will permit me to make use of my very own basal settings as a place to begin.  Like many individuals, I require considerably extra basal insulin throughout sure hours of the day and fewer at others.  Having a flat “adjusted” profile implies that – even with the system making changes on my behalf – I see a modest drop within the early a part of the night time and an increase within the night.  Nonetheless, I’ve seen fairly good glucose management since Sensible Guard went into impact.  My time-in-range and common have been glorious – one thing I didn’t see with earlier variations of Medtronic AID programs.  Even had my first “no-hitter” in fairly a while.  Maybe that is attributable to the brand new system’s customizable glucose goal and skill to ship automated correction boluses as typically as each hour.

One characteristic of the 780G that I used to be very skeptical about was its capacity to compensate and hold glucose ranges inside an affordable vary even in case you neglect to bolus for a meal – what they name “missed bolus forgiveness.”  So I put it to the take a look at.  Twice.  With average quantities of high-glycemic-index meals.  And each instances, it carried out past my expectations.  My glucose “peak” following the non-bolused meals was under 200 mg/dl, and it settled again to regular just a few hours later.  Granted, I might have had even much less of a post-meal peak had I given a bolus earlier than consuming, however this was nonetheless much better than what most of us expertise when forgetting to provide a meal bolus.

I do miss sure options when utilizing Sensible Guard, reminiscent of the flexibility to increase boluses (Tandem nonetheless permits this, and Loop permits customers to set longer carb “absorption instances”) and alter the system’s algorithm for conditions when I’m kind of delicate to insulin than typical (Tandem permits the person to change insulin supply “profiles”, and Loop permits for limitless short-term/customized overrides).  It merely takes too lengthy for Medtronic’s algorithm to “catch on” to short-term modifications in insulin wants for issues reminiscent of train, sickness, very high-fat meals, stress, inactivity, alcohol, steroid drugs, and menstrual cycles.  It does have a “short-term goal” choice that modifications the goal glucose to 150 (conceivably for bodily exercise), however even when set nicely upfront, it typically comes up brief at stopping hypoglycemia with aggressive types of train.

Entry…

780G is FDA-approved for ages 7 and up.  Customers should take a minimum of 8 items of insulin per day, however not more than 250 items per day.  The pump and accompanying sensors and disposables are coated by most medical insurance plans, together with Medicare. Those that at the moment use the 770G can improve for free of charge with a software program patch, and customers of different Medtronic pumps can improve for a nominal payment primarily based on the guarantee remaining on their present pump.

In Conclusion…

To summarize, 780G is a little bit of a combined bag.  I just like the effectiveness of the Sensible Guard algorithm, and the Prolonged Put on infusion set is a particular plus.  So from the standpoint of pure glucose administration, I give this method an B+.  Medtronic appears to consider that everybody desires as little involvement with their diabetes administration as doable, and that merely isn’t true.  Many individuals need to stay engaged if it means higher glucose management.  Give us the flexibility to make use of our personal basal settings, lengthen boluses, and make short-term changes and maybe it’s going to earn a stable “A”. 

In fact, high quality of life additionally issues.  We now have to reside with these gadgets and all their idiosyncrasies 24/7.  In 780G, Medtronic did a pleasant job of eliminating pointless alarms/alerts and calibration necessities, in addition to simplifying the method of utilizing the system’s AID options.  However the pump stays cumbersome, clunky and awkward to program.  The Carelink software program is in want of an improve.  And the sensor, whereas offering higher efficiency than earlier generations of Medtronic sensors, stays a bear to vary out – even while you’re not on a airplane going by means of turbulence.  We now have each motive to anticipate higher product high quality and value from an organization like Medtronic. Hopefully we are going to see this within the not-too-distant future.