Jewels Doskicz is a registered nurse, freelance writer, patient advocate, health coach, and long-distance cyclist. Jewels is the moderator of Diabetic Connect’s weekly #DCDE Twitter chat, and she and her daughter both live healthfully with type 1 diabetes.
By allowing a constant peek at our blood sugars, the continuous glucose monitor (CGM) has become one of the most powerful, life-changing pieces of technology people with diabetes have ever seen.
With the Food and Drug Administration (FDA) speeding the approval process for diabetes technology, Medtronic’s MiniMed 670G hybrid closed-loop system got the go-ahead to hit the market in April, 2017.
The 670G has a CGM and insulin pump speaking to one another, doing vital, behind-the-scenes work.
"You get almost normalized overnight blood glucose. For people with type 1 diabetes, that's massively important," Aaron Kowalski, chief mission officer for the Juvenile Diabetes Research Foundation (JDRF), told NPR. He added, "The diabetes isn't gone, but [wearers] can think about it less . . . this is a historic milestone.”
How does a hybrid closed-loop system work? First, let’s remind you how the CGM that’s part of it works. A CGM provides real-time glucose values from a sensor that sits under the skin, changed weekly by the user. A transmitter shares the information with a smartphone, insulin pump, or another device.
A closed-loop system, in simplest terms, enables a CGM and insulin pump to interact with one another, providing adjustments to blood sugars without constant user input.
The MiniMed 670G hybrid closed-loop system:
• Is not a hands-off, fully automatic system/artificial pancreas. The user still counts carbs and adjusts for exercise.
• The pump uses a bolus wizard feature, making suggestions when a blood sugar value (not a CGM result) is entered into the system.
• It is approved for people 14 years of age and older (but might be obtainable with an off-label prescription for those who are younger).
• The insulin pump target is 120 mg/dl with its adjusting basal rate.
• There are two modes: manual and auto, allowing the user to revert to a system that is user driven.
• It is a bit larger than previous pumps, uses an AA battery, and has a larger reservoir size, an automatic shutoff for lows, and a new horizontal orientation.
• It uses a Guardian 3 CGM sensor, approved for up to seven days of wear.
Meanwhile, conventional CGMs continue to advance and provide greater benefits.
CGM pros and cons
Advancements, especially over the past decade have been encouraging. But while some have welcomed CGMs with open arms, others freely admit, “They aren’t for me.”
Why not? The constant feedback. The beeps. The bleeps. The midnight awakenings. The minute-by-minute information on how diabetes is playing out is a never-ending flow of too much information for some.
It’s ironic that this privileged access to the numbers may provoke fretfulness and worry. But the life-saving value of CGMs supersedes such concerns for most people.
There are currently 2 CGM brands on the market: Dexcom and Medtronic.
Dexcom’s newest CGM product is the G5 Mobile System. Easy insertion, a long sensor life, accuracy, data sharing, and real-time glucose readings every five minutes make for happy customers.
Those who prefer Dexcom will have to wait for tech that incorporates this CGM into a combination system.
Medtronic’s latest CGM systems use the new Enlite sensor that’s claimed to provide virtually pain-free insertion. The new insertor, interactions with SmartGuard tech on their 530G insulin pump (stopping insulin during hypoglycemia), improved reliability, data sharing, and glucose readings every five minutes have drawn a loyal crowd.
Although Medtronic is in the market lead with the 670G, there are a host of closed-loop systems under development in other companies.
Bigfoot is passionately driven by CEO Jeffrey Brewer, former chief executive officer of JDRF, and father of a child with type 1 diabetes (T1D). “Life with T1D using today’s tools is unreasonable,” he says. “Therapies are too expensive, too complex, and require intense focus and attention with little support.”
Bigfoot’s smartloop automated insulin delivery system will have a smartphone interface. Medtronic’s 670G does not provide remote monitoring (a step backwards to many users).
Bigfoot’s system uses Asante pump technology and Dexcom’s G5 CGM. All the math happens behind the scenes, but the user can override it. Bigfoot hopes to submit the system for FDA approval by the end of 2017.
Keep your eye on these other big players because they are working on closed-loop systems of their own. By the end of 2018 they will all enter the market with their products (incorporating Dexcom’s CGM tech).
A dual-hormone pump from Beta Bionics, called the iLet, can administer both glucagon and insulin. It could hit the market in 2019 as an insulin-only product, with glucagon added later.
Doing it yourself
With all of the do-it-yourself systems for remote CGM monitoring in place from Nightscout and others, I can only suppose that our diabetes community ingenuity has put the pedal to the metal for the FDA—which can’t be terribly excited to have lost its ability to regulate devices being used by the public to control their diabetes.
To sum up, diabetes technology is better than ever—and the future looks even brighter.
Have you tried any of the technologies mentioned in this article? We’d love to hear what you think. Add a comment below.