Type 1 Tech: What's new in 2019
Type 1 tech is constantly advancing, improving the ways in which we can manage blood glucose levels, reduce long-term complications risks and reduce the overall burden of type 1 tasks. In order to select the most appropriate insulin delivery device in such a rapidly-changing landscape, it’s important to understand and compare their different technical features, costs and capabilities. Here's a rundown of three new insulin pumps released, or due to be released, to the Australian market this year.
Medtronic 670G The Medtronic MiniMed 670G system with SmartGuard Auto Mode is the first ‘hybrid closed-loop’ system on the market, integrating with Continuous Glucose Monitoring (CGM) to adjust basal insulin automatically. For dealing with lows and highs, the system incorporates the predictive low glucose suspend function of the current 640G, whereby insulin delivery is shut off when low blood glucose is predicted, and it also calculates and offers correction boluses if glucose levels exceed 8.3mmol/L. The pump has an inbuilt target glucose of 6.7mmol/L, and it continually adjusts the basal rate and calculates corrections that the user must accept to maintain target glucose. The pump needs fingerstick calibration at least three times a day. If the user fails to respond to alerts or to calibrate, the pump's auto mode is temporarily shut down, and the pump reverts to a stored basal pattern until the user responds and re-enters auto mode. This vital feature keeps the system running optimally. As with all pumps in Australia, the 670G pump is covered by private health insurance: generally speaking, ‘Gold’ level policies include pumps but some providers may offer them under different policy tiers. However, running the 670G as a hybrid closed-loop system requires CGM, and therefore a paid subscription to the Guardian 3 Link transmitter and sensors which will cost anyone over the age of 21 around $3000 per year. People under 21 have access to government-subsidised CGM – a benefit I hope will be extended to people with type 1 of all ages soon. My take: The patients who love the 670G generally had average blood glucose levels above the 6.7mmol/L target prior to getting the pump, and are now hitting the target without having to make drastic changes to their management. Other patients are hesitant to adopt this technology because they’re not comfortable with 6.7mmol/L as a target glucose level and want to run their glucose levels at a different target. Users must be aware that the 670G is not a ‘set and forget’ system – the user must be prepared to respond to correction notifications and calibrate regularly. Finally, the 670G currently is only approved for children aged 7+, and the CGM that integrates with the 670G cannot be viewed on a phone or shared by others, and so remote monitoring – a feature that many parents feel is vital for their peace of mind - is not possible with this system. Image credit: https://www.medtronic-diabetes.com.au/
Tandem t:slim X2 The t:slim has a touch screen, is rechargeable via USB and the operating system on the device can be updated remotely, similar to a phone. These features, along with its slim and sleek design, have made the t:slim a very popular choice amongst my clinic patients. The Tandem t:slim currently links to the Dexcom G5, the only CGM that has TGA approval for dose decisions without a confirmatory fingerprick. Right now, t:slim does not have predictive low glucose suspend or automatic basal adjustment, but with the introduction of the updated Dexcom G6 imminent in Australia, the ‘Basal-IQ’ and ‘Control-IQ’ functions that allow for the pump to suspend on low and automatically adjust basal rates are in the pipeline for Australians too. The beauty of the t:slim is that you need not wait four years to get a new pump – when updates are released, you simply upload the new software onto your pump. The t:slim is covered under private health. There is no requirement for a CGM to run all the current features of this pump, but anyone over the age of 21 wishing to integrate it with the Dexcom G5 will need to purchase sensors and transmitters at a cost of approximately $6600 a year. The t:slim is approved for patients aged 6+. My take: I have set-up many patients on the tslim and their reports have been overwhelmingly positive. They love the small size, intuitive system, and modern look of the device, and the ability to upgrade the system without having to wait for a new device. They also like that with t:slim CGM integrates with both the pump and a phone simultaneously, allowing for remote glucose monitoring. Patients note, that having to recharge the pump via USB regularly is yet another diabetes task you have to do, and there is a lack of accessories (such as bra clips and pump cases) available for this new pump - although it will only be a matter of time before this changes. Image credit: https://amsldiabetes.com.au/item/tslim-x2-insulin-pump/
Coming soon: Roche Solo Although not yet available in Australia, the Rocho Solo micropump is a small, tube-free insulin delivery system that received TGA approval this year. The Solo has three components: a disposable cannula patch which has a 200-unit reservoir, the reusable pump body and battery which click into the cannula patch and have a four-month lifespan, and a touchscreen handheld device used to run the pump via Bluetooth. The system offers users the choice to bolus directly from the pump or from a handheld device. My take: I think that patients who play sport or don’t like the tubing required with other pumps will love the Solo as it is a patch pump, although a 200 unit reservoir may exclude some users who require more insulin over the three-day cannula wear. While the Solo does not currently integrate with any CGM systems, it's worth noting that Roche has partnered up with Senseonics to use their implantable Eversense CGM, so we can expect to see that at some point down the road. People with type 1 have more options than ever before with the advanced new devices and technology we can now access. If you’re interested in a pump start or to know more, contact the Family Centre today! Image credit: http://www.solowaitinglist.com/de