Our Review of Medtronic’s MiniMed 780G as Both Patients and Providers
We like to try all the new drugs and devices that are approved for people with type 1 diabetes, and since we heard so many good things about the Medtronic MiniMed 780G system, we both went on it for several weeks.
I’ll share my experience as a person who has lived with type 1 diabetes for over 50 years, and my good friend and colleague Dr. Jeremy Pettus will give the healthcare provider perspective. You can also watch a video recap of our experiences here:
The Patient Experience, from Dr. E
First Things First: Pump, Sensor, and App Set-Up
I was already using a hybrid closed-loop system (Looping with Omnipod DASH) when I tried the 780G, so I was coming from a pretty good baseline. This is an important point that you will realize as you read further. I met with a Medtronic pump trainer who was excellent, and she got me set up on the system.
I gave her my current settings and daily insulin usage. She helped me get my pump programed and my MiniMed mobile app set up. I really liked the app because it gave me 24/7 data on how the algorithm managed to keep me in range (basal rate, insulin suspensions, boluses, autocorrections, etc.).
I was also instructed on how to insert the Guardian 4 sensor that communicates with the pump for AID (automatic insulin delivery).
The sensor did not have the best form factor compared to the Dexcom G7 and Eversense sensors I was already wearing, but it was accurate.
Special Features, Time in Range, and Blood Sugar Control
My overall experience was excellent! The MiniMed 780G kept my time in range (TIR) of 70 to 180 mg/dL in the upper 80% to low 90% range, with very few lows (0 to 2% time below range). I really tested the treat to target algorithm to the max. I went on several three-hour bike rides with my good friend Bill Polonsky (I got tired of playing Twister with Jeremy) and I ate a few heavy pasta dinners which, with my gastroparesis, really tested the 780G and what’s called SmartGuard mode (the fully automated system).
For my long bike rides I put in a higher target of 150mg/dL one hour before I started riding, and there was not one beep for highs and not one beep for lows the entire ride! This was so nice, and I appreciated not having to stop and consume a bunch of glucose tabs or GU. A rare event when I am cycling for that long.
Testing the Algorithm with Big Pasta Dinners
My gastroparesis always acts up when I eat too much of a heavy meal like pasta late at night. After my bike rides, I would go to an Italian place with my girlfriend and have a big dinner at 8 pm. I stuffed myself every time (bread, pasta, tiramisu). My blood glucose after dinner would be fairly good in the 150 range, but I knew most of my dinner was in my stomach yet to be propelled into my intestine, broken down to glucose and sent into my bloodstream.
The first time I did this I slept through the night and when I woke up, I looked at my phone app. I was hovering just below the 180mg/dL level throughout most of the night as the 780G was working overtime pumping out correction boluses automatically every five minutes. Not once did my value hit 180, so there were no alarms to wake me up. Normally I would have been well over 250 mg/dL with alarms going off, and the need for my input to give a correction bolus over and above the basal rate of my own HCL system.
Bottom Line: The MiniMed 780G Provided Great Control
I have always thought Looping was the best way to go with the most effective algorithm, but as I was packing up my Medtronic pump to give it back, I thought I clearly had better control on the MiniMed 780G, and this made me adjust my own Loop settings to try and emulate the great control I had for the prior three weeks on the 780G system!
The Provider Perspective, from Dr. P
Ok, it’s my turn now! My job is to comment on the system from a healthcare provider perspective, so here goes.
First, we need to recognize that while Medtronic was the first to have an automated insulin delivery system (the MiniMed 670G), that system was launched about a decade ago. A lot has happened since then, with multiple companies launching their own systems like the Tandem Control-IQ, Omnipod 5, and iLet. These systems were, quite frankly, better than the MiniMed 670G in several ways – they had more aggressive algorithms and they used a better CGM (Dexcom). Medtronic became a system that simply wasn’t used much, and as a provider it wasn’t one I recommended.
Improvements with the 780G
However, with the launch of the MiniMed 780G system, that has all changed. This system has been improved significantly in many ways, as Steve mentioned. One of the most important changes is how well it does controlling blood sugars, thanks to an appropriately aggressive algorithm. Medtronic is back, and the system is a very viable option for many patients.
That said, the most common question my patients ask me is, “Which pump is the best?” That’s a really tough question because each system has its pluses and minuses. The Omnipod doesn’t use tubing, which might be the most important issue for someone. The iLet doesn’t require carb counting, which might be the winning factor for others. So which patients would I recommend use the 780G? The patients who ask, “Which system do you think has the best algorithm and will control my blood sugars the best?” These patients prioritize control over tubing, form factor, etc. So there is no “best” pump, but there may be a “best” pump for you.
Why do I think the MiniMed 780G has the best algorithm? In clinical trials, data showed that patients on this system did extremely well, but there are no head-to-head studies between the 780G and other systems. So a lot of my rationale comes down to personal results and what patients tell me about their own experience.
A Temporary Downside
The major downside to the system, however, is still in the CGM. The CGM lasts for seven days and requires one calibration to start, and it has a separate transmitter that requires charging after each use so it’s just a little more clunky than other CGMs. That being said, the MiniMed 780G has a new CGM that’s already been approved in Europe and is currently under FDA review in the U.S. This updated CGM is much easier to use, so the downside could be eliminated rather soon.
The 780G Offers More Options for More People
The bottom line is your provider should let you know about ALL pump options, and let you choose the one that’s right for you. Also, most pump companies have a free trial period you should utilize. You can try the pump and if you don’t like it, return it. This is a very personal and important decision, so do your research, ask questions, and don’t be afraid to switch pumps if it isn’t working out the way you’d like.
Steve and I thought it was important to write this article to let you know that the pump world has really exploded in a beautiful way. People have more choices and are having better control than ever – AND the field is constantly improving. This is all fantastic news for all of us living with this rollercoaster of a disease!
Unless the pump interfaces with a Dexcom type CGM (i.e., NOT the Medtronic Guardian system) we’re not interested.
The Guardian system just doesn’t work well and it is painful and bloody, and doesn’t have the features of the Dexcom.
I know exactly what you’re talking about and totally agree with you, but that is the old Medtronic sensor. For years I would not try it nor would I prescribe it to my patients. Saying that, the new sensor, which kind of looks like the old sensor, is comfortable and super accurate, and it did not cause bleeding. The last thing I’ll say is they just got their new Simplera sensor approved by the FDA, which means it will be out soon. My big thing is that it has to be accurate, and it goes in easy and lasts seven days. Jeremy also has no problem with it.
August 7th news: Medtronic announces FDA approval of Simplera™ CGM and global partnership with Abbott which means more sensor choices eventually for the Medtronic 780G. The Simplera Sync is in FDA review with the Medtronic 780G while the Simplera has been FDA approved for MDI. Abbott partnership means access with Libre” CGM as another option for extended wear CGM. All great news for Medtronic users.
Agreed! Thanks Ken!
I have the 780g. I love it. It works very hard to keep my BG down overnight. The Guardian 4 CGM is very accurate, compared to finger sticks. It is nice to hear complementary comments about the pump.
Agree…the algorithm is excellent!
I have been on the 780 since Jan and it is the first AID pump I have used. I looove not having overnight lows. Exercise on the pump doesn’t work well for me, and I constantly go low during long and/or strenuous workouts. Hiking and running, I exit Smart guard and cut my basal down manually so I can control it better.
I am also a provider who has Type 1 diabetes. I have not recommended Medtronic for quite some time, but I am happy to say that this system is great and I am now bringing it up again as an option for patients. I use the Tandem pump with DexCom and did think about switching after I was given a trial of the Medtronic 780G. As I write this the new sensor for use with Medtronic 780G has just been FDA approved. Now Medtronic just needs to redesign the pump. It is still a little too clunky for me but am really happy that they have made all the changes to the algorithm. My patients have more good choices again.
Hi, what new Medtronic sensor was just approved? Newer one than Guardian 4? Thank you.
Hi Ellen,
It’s called Simplera. You can read more about it here:
https://news.medtronic.com/2024-08-07-Medtronic-announces-FDA-approval-of-Simplera-TM-CGM-and-global-partnership-with-Abbott
Thank you so much for your note. I feel the same way you do, and I will call the president of Medtronic right away to make sure they address your needs with the pump size! 😉
FINALLY! After all these years of being one of your biggest fans, I get to see you guys finally come around to Medtronic!!! I’ve been waiting for you guys to try it and see the beauty of this 780G system. It is definitely a game changer after 42 years of pumping for me!!! This was a great podcast. Thank you for all you do!!!
Thanks you for your comment Molly! It is an impressive system, and I loved wearing it. Jeremy stole mine, and is wearing it all the time now!
I have had Type1 Diabetes for over 56 years, am an RN, was a CDE and Program Director for large medical facilities and have worn Medtronic pumps since about 1986 … I have used Medtronic pumps since then.
I received a new MiniMed 780G in early July … the part that changed my mind about using the entire system was the sensor … it cannot be put on by one person … Metronic took something simple and made it difficult. Even though my spouse can help me, sometimes he may not home … and what about people that live alone? The sensor only lasts about 6-7 days. I finally decided that I will wait to see if the new sensor is any better but for now I am happily using the 780G pump and a Freestyle Libre 3 that lasts for 14 days and only takes one hour to warm up … so far so good.
Thank you so much for your comment. I totally understand your situation. The new sensor, called Simplera, has a form factor that’s similar to the Dexcom and the Libre. Simplera is not out yet, but it’s FDA approved and it is a huge improvement if you ever want to try it.
RN CDCES here as well; T1D for 26 years. It can absolutely be put on with one hand…as long as you’re willing to either put it in a place other than the arm, or have your tape not looking super pretty. I wear mine on my upper/outer thigh or stomach because it’s super easy to insert on my own. I’ve tried it on the back of my arm as well, but I need more tape to keep it in place (I only use the first tape for thighs and stomach), and my tape tends to bunch a bit due to awkwardness of placing it one handed.
Consider another trial of the Guardian 4. Smartguard is truly amazing. And even when my sensors don’t last the full 7 days (they usually do, but some last 5-6 days), I don’t even care. You get 5 sensors per month and it’s so easy to build up a stockpile. I once went 6 months without reordering because I forgot to put them in my pharmacy order for that long, and still had another 3 month supply. I used to be a huge fan of Dexcom, but seeing the accuracy of Guardian against Dexcom helped me switch. Guardian picks up my lows faster than Dexcom. The algorithm of the 780G makes some of the downsides of the cgm worth it. I don’t care what my cgm looks like as long as it’s accurate and I get an amazing pump algorithm. That said, I’m excited to wear the Simplera Sync when it comes out, and excited to see what develops between Medtronic and Abbott.
Hello! Type one for over 50 years also. Not sure what Susan, above, means – the sensor is easy to put on and I have never, ever required another person to help, even after having one finger operated on. The sensor lasting 7 days (in line with the new extended wear cannula sets!) is a blessing, not a drawback – because it means they can use a glue which does not contain such strong chemicals. There are literally tens of thousands of people allergic to the Dexcom (and Libre) adhesive. Including me – my entire arm swells up and blisters with Dexcom. Strong adhesives contain unpleasant chemicals, and we have enough of those already, with our insulin and its phenol and meta-cresol excipients pumping into us all the time. Safety over that convenience for me is paramount – 7 days is a good amount of time to wait before changing imo. I love the 780, and after many pumps- Many old Medtronics, Deltec Cozmo (my fave for a long time) Tandem T Slim and now the 780, I can honestly say this one blows the others out of the water.
Thanks so much for your comment, and glad you’ve had such a great experience with the 780G. We really did too.
I’ve been on Medtronics pumps and CGMs for about 12 years, and in the past I have NEVER had anything good to say about Medtronic, BUT the 780 pump/CGM are doing a Great job for me and I am really pleased with them. This new algorithm is finally aggressive enough to keep up highs. I’ve been on the new system about 9 months, and it has really made it simpler for me to stay in range 80-90% of the time. It’s a big step forward.
Thank you so much for the comment. We seem to be getting the same positive feedback from others on the 780G system. Agree it’s a big step forward!
I’m thinking of going back to Medtronic after 4yrs on TSlim. But I’ve been using u-200 which only comes in pens. I have searched in vain to see if it is possible to fill the extended infusion set with a pen. Videos look like it is a vial or nothing. Thoughts?
To be honest, I don’t have any experience using U-200 in the 780G. The folks from Medtronic may not be able to answer you due to compliance issues, but I would keep asking around and see if anyone knows how to do it. You could post in our type 1 diabetes Facebook group, or in other type 1 chat forums online.
I use U-200 in my pump, and have for some time. I carefully attach the syringe to the bottom of the pen, inject air, and draw out the insulin. If it’s a full pen, I can only inject smaller amounts of air at a time, but it is easy to fill if you are careful.
I wish it was less cumbersome. I switched to Tandem because the Medtronic pump was always cracking. The weight of it would cause my skirt or pants to hang lopsided.
I thought having a crooked skirt was in fashion! 😉 I hear you. Medtronic is working on making their devices smaller and lighter.
Type 1 for 67+ years, pumping for more than 30 (MM, Disetronic, Deltec, Animas, Tandem, etc.). What is the expected battery life on the 780G? Last MM pump I used was the 523, battery life was 3 days at best. Got tired of walking around with a pack of batteries in my pocket (“Are you using a MiniMed or are you just glad to see me?”;)).
Haha! Better than bananas! The device uses AA batteries, and they last a couple of weeks at least.