My Detailed Review of the MiniMed 670G from Medtronic

The MiniMed 670G from Medtronic is an insulin pump coupled with a glucose sensor.  It uses a computer program (called an “algorithm”) to automate certain aspects of insulin delivery.  I decided to try 670G partially out of professional interest (everybody and their great aunt has been asking for my opinion on the system), and partially out of personal interest, as my blood glucose control hasn’t been the greatest the past couple of years.

Let me start out by saying this:

Since I started using 670G, my overall blood glucose control is better.

I have to keep reminding myself of this non-consequential fact, because every day I find things about this system that I don’t particularly like.

To continue reading, click here.

Recap of an exciting month for diabetes and technological innovation

Fall has come with a flurry of new products, FDA approvals, and announcements from the major players in diabetes technology. Don’t miss out by checking out a quick recap of what matters:

1. Tandem Diabetes begins shipping the forward-thinking T:Slim X2

Tandem X2

Thanks to an all-new bluetooth transmitter and its FDA-approved ability to add new features with software updates, the T:Slim X2 unifies and replaces Tandem Diabetes’ outgoing models, the T:Slim and T:Slim G4. (The T:Flex will remain as the primary option for users requiring higher doses of insulin).

While it currently closely resembles the outgoing T:Slim in form and function the T:Slim X2 will soon introduce (via free software update) the long-overdue ability to display data directly from the Dexcom G5 continuous glucose monitor (CGM). In addition to wirelessly receiving information from other devices like the G5, the T:Slim X2 can transmit data to other devices such as the iPhone. This two-way communication opens up the very likely possibility of smartphone apps to display information from (and possibly even control) insulin pumps and CGM’s.

Years down the road, the future-proof X2 platform will be able to incorporate “artificial pancreas” features such as predictive low glucose suspend and eventually fully autonomous closed loop systems.

Current owners of Tandem products can learn about upgrade options here.

2. FDA approves Medtronic 570G, the next step toward the Artificial Pancreas


The same month that the (underwhelming) 630G systems began shipping, the FDA surprised the diabetes community by approving the eagerly anticipated Medtronic 670G Hybrid Closed Loop system, including their next-generation CGM sensor.

The Medtronic 670G’s landmark feature is its SmartGuard HCL (Hybrid Closed Loop) technology, which automatically adjusts the pump’s insulin rate to target a blood sugar of 120. Much like a car with adaptive cruise control, the 670G will increase or decrease the basal rate of insulin delivery but will still require user intervention for notable events such as mealtime boluses. (We explore why this matters in a separate article.)

The 670G also comes with the updated design introduced in the 630G, and includes the new Guardian 3 sensor, featuring better accuracy and a 7 day wear period (up from 6 days).

Although Medtronic won’t ship the 670G until April 2016, the 670G’s FDA approval represents a pivotal step forward toward achieving the goal of a true Artificial Pancreas.

3. FDA Approves Abbott Freestyle Libre Pro System for Short-Term CGM Usage

Freestyle Libre Pro

Although the Abbott Freestyle Libre has been available for personal use in Europe for years, the hybrid-CGM comes stateside with limited functionality as a professional system (rather than for personal use). That means the Libre Pro System would be purchased by health care providers to be worn by their patients for a 14 day period. (This 14 day period improves upon the Medtronic iPro’s 4 day and Dexcom Professional’s 7 day period)

During that 14 day period, the patient will not have to do any calibrations, BUT they would also not have real-time access to their CGM readings. At the end of the period, the patient would review their CGM data with their provider to identify patterns.

While we’re still hoping that the FDA will eventually approve the version of the Freestyle Libre for long-term, personal use found in Europe, the Libre Pro System can still benefit patients in the USA whose insurance only covers short-term CGM trials. Also, the Freestyle Libre Pro System’s 14 day wear period and freedom from calibrations makes it an obvious upgrade over the Medtronic iPro.

4. Medtronic adds Android compatibility to Connect

Medtronic Connect for AndroidThe Connect is Medtronic’s answer to Dexcom’s Share, and comes in the form of a small dongle that helps transmit data to nearby smartphones. Also like the Dexcom’s smartphone connectivity, Medtronic had been limited to the Apple iPhone. Until now… With the release of MiniMed Connect in the Android Play Store, the Connect finally allows data from the 530G to be viewed from your smartphone, Apple or Android. (Dexcom plans to release a G5 app into the app store very soon).

Unfortunately, the Medtronic Connect platform is curiously not compatible with the aforementioned upcoming 670G and their current top-of-the-line 630G.



Why the Medtronic 670G Artificial Pancreas is a huge deal for diabetes

So you’ve read all the headlines about an artificial pancreas and how it’s supposed to change the world for diabetes, but what does it really mean? We understand the skepticism… Remember: Medtronic previously claimed to have released an artificial pancreas system back in 2013.

But this time, the Medtronic 670G actually is a big deal. It’s a major step forward towards the artificial pancreas, and scientific studies back up its bold claims. (Note: it is NOT a true artificial pancreas, though)

But instead of repeatedly saying how important it is, we’re going to tell you exactly why it matters.

An “artificial pancreas” is like a “self-driving car”


The quest toward an “artificial pancreas” closely parallels that of the “self-driving car.” The names do a good job in describing their futuristic vision, so long as you understand that the pancreas is the body organ that produces insulin. (In Type 1 diabetes, the pancreas no longer functions properly and stops making insulin, causing blood sugar to go out of control.)

So continuing the comparison, having Type 1 diabetes is like owning a car with just an engine; no steering wheel or brake. Not good. Thanks to modern medicine, people with diabetes have the opportunity to “drive their car” by checking their blood sugar and injecting insulin appropriately.

Much like a self-driving car, a true artificial pancreas would be an autopilot for navigating the highs and lows of blood sugar. With an artificial pancreas, the user would not have to devote any effort to controlling their blood sugar. It would take care of itself, just as a self-driving car would get you from point A to point B on its own.

But now the next question…

Is the Medtronic 670G an artificial pancreas?

No, but it’s halfway there. If a true artificial pancreas is like an autopilot for self-driving cars, the Medtronic 670G is similar to “adaptive cruise control.” (If you don’t know what that is, adaptive cruise control allows a car to automatically accelerate and decelerate to maintain a safe distance from the car in front of it). If you want to drive on a straight stretch of road without making any lane changes, adaptive cruise control requires virtually no user interaction.


Similarly, the Medtronic 670G’s breakthrough feature adjusts basal insulin delivery (by speeding it up or slowing it down) to maintain a normal blood sugar of 120 mg/dL. It might not be as obvious during the day with meals and periods of exercise, just as adaptive cruise control plays a more subtle role when making many turns during city-driving.

But overnight and between meals is when the 670G’s adaptive cruise control truly shines, when circumstances are relatively stable, without the need to “change lanes” for meals or exercise. And keep in mind, unlike a car that you only use for trips, people with diabetes live with their disease 24 hours a day, 7 days a week. So a significant portion of their day is spent during those in-between and overnight periods.

Medtronic 670G’s “Adaptive Cruise Control” Works

Studies have clearly shown that wearing the 670G improves sugar control by reducing time spent in both high and low blood sugar range and lowered average A1c from 7.4% to 6.9%.

People who have worn insulin pumps with “dynamic cruise control” features particularly rave about its benefits on improved sleep overnight. Restful sleep is a big deal (and why mattress/pillow companies make a killing!), and it’s even more elusive with Type 1 diabetes due to the fear of overnight hypoglycemia or hyperglycemia. It’s not uncommon to be woken up several times a week in the middle of the night to check blood sugar or to have to eat a snack to avoid hypoglycemia. And even when sleep is not interrupted, waking up with higher or lower sugars than desired can start the day off with a thud.

Medtronic 670G Artificial Pancreas

As you can see in the graph above, adults using the 670G algorithm (highlighted in red) had a much narrower range of blood sugars, especially at night, when compared to standard pump users (the shaded grey area). They also headed into their mornings closer to target, and with a more stable glucose trend.

Medtronic 670G is just the beginning…

The top reason we’re excited for April 2017 (when the Medtronic 670G becomes available) is that it is just the first of a wave in the movement towards a true artificial pancreas.

While Medtronic has the advantage of manufacturing both its CGM and insulin pump, many future competing artificial pancreas systems are partnering with Dexcom’s highly rated, iPhone-compatible continuous glucose monitors.


The long list of such artificial pancreas systems includes a variety of approaches such as Bigfoot’s iPhone-based user interface, the more altrustic public benefit company BetaBionics’ iLet, and collaborations between Tandem and TypeZero.

bigfoot-artificial-pancreasThese projects are in various stages of advanced development, most of which are being currently worn and tested in clinical trials and research labs. The initial feedback of test subjects has been exceedingly optimistic, and the future of the “self-driving” artificial pancreas is just around the corner.

No matter which company (or companies) win, the type 1 diabetes community is the biggest winner.

Stay tuned for more coverage of the Medtronic 670G and other artificial pancreas devices…



Devices aren’t drugs: Insurance companies should not dictate diabetes technology

The diabetes community has been set ablaze after UnitedHealthcare announced an agreement for Medtronic devices to be the “preferred” in-network, durable medical equipment (DME) provider of insulin pumps. Starting July 1, 2016, UnitedHealthcare patients will be funneled toward using a Medtronic insulin pump instead of offerings from manufacturers like Tandem and Animas.

Many diabetes advocates have eloquently voiced their outrage and have been rallying under the hashtags #MyPumpMyChoice and #AccessMatters, and I strongly echo their sentiment that this policy puts “profits before patients”. It’s unacceptable, and both UnitedHealthcare and Medtronic deserve any negative publicity that results from such a short-sighted decision.

To add another layer to the discussion, though, what I find particularly insightful about the controversy is that it highlights the distinction between medication and medical technology. I rarely blink an eye when my patient has to switch brands of insulin, so why is it such a big deal when they have to switch brands of insulin pumps?

Technology is Intensely Personal

Whether it’s Apple vs Samsung, Xbox vs Playstation, Nikon vs Canon, or BMW vs Mercedes, fierce loyalties are found among their users. Beautiful photos of phones and smartwatches adorn billboards across the city, evoking emotions such as envy and desire in a way that no medication can.

iphone 6s verizon billboard

When buying a new device, there’s a curious sense of satisfaction when finally choosing a model after poring over reviews and comparing individual specifications. Making that choice creates a personal connection before it even arrives in your hands.

On a personal level, many of my most touching diabetes patient interactions are due to technology. A recently-emigrated woman came to my office and was overjoyed to find that she could obtain an Omnipod pump, as it hadn’t been allowed by her previous nationalized health system. Additionally, I love watching the eyes light up in patients and their family members when they first learn about continuous glucose monitoring (CGM) and the ability to view their blood sugars on their phone.

In diabetes, harnessing technology to manage a chronic condition brings a sense of empowerment that medications alone can never do. Removing the ability to choose medical devices only adds to the sense of helplessness that underlies too many other aspects of diabetes.

Technology is Defined by Interaction

For medications, pharmaceutical companies create chemical compounds that elicit a desired physiologic effect. Their competition will create a slightly different chemical compound with a similar mechanism of action, and these medications are grouped into the same class (eg Humalog and Novolog insulin). For the most part, they are interchangeable to patients and providers, and insurances frequently prefer one over the other. No big deal — just swap out one pill (or pen/vial) for another.


But for devices, focusing on the desired outcome only tells a portion of the picture. For reference, choosing a smartphone is about more than making phone calls and browsing the web. As Apple’s success has shown, the overall user experience of gadgets often matters more than functionality. The iPhone was not the first smartphone (remember Blackberry?), but its intuitive and simple user experience expanded the smartphone audience from working professionals to college students, children, the elderly, and everybody in between.

When using an unfamiliar smartphone or computer operating system, even a simple task like sharing a photo can seem Herculean. With health technology, the stakes are exponentially higher as potentially lethal medications must be managed by complex user interactions with software dashboards and calculators. Being forced to switch between differing interfaces of insulin pumps and other diabetes technology creates confusion/frustration at best, and gaps in diabetes management at worst.

medtronic-tandemPut simply, there are no “class-equivalents” in the world of devices because they encompass a complex interplay between software and hardware. A Medtronic Pump is as similar to a Tandem Pump as a Blackberry (they still exist!) is to an iPhone.

Competition breeds innovation

To be clear, the outrage isn’t regarding the quality of Medtronic’s insulin pumps, or whether they are inferior or superior to the competition. Rather, the issue is that eliminating competition and choice in the insulin pump market stifles creativity and innovation.

We live in such an exciting time for diabetes technology. For insulin pumps alone, there are touch-screen pumps (Tandem), tubeless patch pumps (Omnipod), color screens (Tandem, Omnipod, and Animas), and cartridge-based pumps (Asante). Each of these features are appealing to different types of users. It’s not one size fits all.

Evidenced by Tandem’s 20% decline in stock after the UnitedHealthcare announcement, it’s hard to believe that such product diversity would exist in a world where insurance companies anoint a winner. Would Android and iPhones have come as far as they have if wireless carriers “preferred” Apple and required a prior authorization for any Android phone?


In the above timeline, notice that Medtronic Insulin Pumps did not noticeably upgrade their user interface for over 10 years… until after the 2012 release of the Tandem T: Slim. Now, the upcoming Medtronic 640G incorporates a dramatic redesign that seems to take some design cues from its competition. Had the Tandem never come to market, I suspect that the next Medtronic would look similar to the previous generations.

Deeper implications beyond diabetes

The digital health revolution is underway, and the future of health technology includes fascinating devices like wearable (or even implantable!) sensors and novel drug-delivery mechanisms, affecting specialties from psychiatry to pain management.

I’ve often beaten the drum that diabetes technology has been a harbinger of the future of health technology (continuous glucose monitors preceded the current infatuation with wearable sensors by about 10 years), and this week’s news suggests a bleak future where established, larger device manufacturers can outmaneuver innovative disruption by strategically partnering with insurance companies.

Free markets and capitalism have been serving the best interests of technology consumers for decades, and such interference by insurers would negatively impact health devices in all areas of medicine.

Call to Action

So what should we do? Make your voice heard, and raise awareness of the issue by sharing posts like this on Facebook and Twitter. Reach out to the pump manufacturers, tell your doctor, and vocalize your displeasure to the insurance companies. DiabetesMine has compiled a helpful list of action points here and will continue to cover the issue as it develops along with other advocacy sites like Diatribe.

As the world of glucose meters have shown, it might be a UnitedHealthcare-Medtronic partnership now, but what’s to prevent UnitedHealthcare from switching to a different pump manufacturer when their current agreement expires?

That’s why we must act now and make it clear that we will not take it lightly when insurance companies try to dictate which medical devices we use and prescribe.


New Apple Watch update brings improvements for diabetes

The Apple Watch first arrived to much fanfare exactly six months ago.  Despite some sensational headlines in mainstream press and Dexcom’s bold efforts to fully support the Apple Watch with the Share platform, the overall user experience for people with diabetes was tolerable at best, due to limitations in the aptly-title watchOS (the Apple Watch’s operating system).

In contrast to the lightning-fast, always-visible live CGM views on the Pebble Smartwatch (courtesy of the home-made modifications pioneered by #WeAreNotWaiting/NightScout crew), the Dexcom Share/Follow apps for Apple Watch were clunky, laggy, and not visible at first glance. The few diabetes logbook apps that did support Apple Watch were equally clunky, hindered by the watchOS’s stubborn dependence on the iPhone.

But this past Tuesday, Apple released watchOS 2, giving app creators new abilities such as accessing health sensor data from the watch (e.g. heart rate, activity), downloading data directly from the Cloud via WiFi, and displaying information directly on the watch face. How does this benefit Apple Watch owners with diabetes?

Display diabetes data directly on the watch face!diabetes-apple-watch-complications-smallOne of the Apple Watch’s best feature is the ability to display additional information the Watch Face. These small views are called “complications,” a term reverently taken from the watchmaking world. (Not to be confused with medical complications like neuropathy and blindness). On the original watchOS (pictured on the left), these complications were restricted to displaying data from official Apple apps (e.g. alarm, moon phase, sunset, activity, etc).

With watchOS2, third party developers now can do the same. As pictured above, the CNN app displays the latest headline, and the United Airlines app displays upcoming flight information.

For users of CGM (like the Dexcom Share and Medtronic MiniMed Connect platforms), imagine being able to view your sugar and trend arrow right on the home screen, as pictured in the bottom right in this mockup. In such a scenario, tapping on the icon would take you directly to the app for more detailed information.

For non-CGM users, logbook apps could display complications that show how many sugar checks that remain, as an example. The bottom left of the mockup shows how my app Sugar Streak could show that the user has completed one of the two glucose checks they are trying to complete each day.

So, the summary/zinger: finally, GOOD diabetes complications! =)

Go back in time! (kind of)

See information in the past/futureTime Travel is Apple’s cute name for a clever feature. On the primary watch face, users can wind the digital crown to scroll forward and backwards in time. If appropriate, the complications update to show information that pertains to the displayed time. For example, in the above example, scrolling forward in time shows future appointments and the appropriate hourly forecast.

Continuing the conversation from before, CGM wearers could quickly scroll through their prior CGM readings and trend arrows were throughout the past 12 or so hours. Ridiculously neat!

Speedier Watch Apps That Are Less Dependent on the iPhone


For a variety of reasons, the initial release of watchOS did not allow for apps to be run natively on the Apple Watch. (Don’t forget, the original iPhone did not allow users to install ANY apps). When you launched an app on the Apple Watch, you would see the dreaded loading screen (pictured) while it pinged its iPhone mothership to learn what to do next. As a result, every single Apple Watch app had to essentially function as a second screen, helpless without an iPhone nearby.

With watchOS 2, Apple Watch apps can finally run natively. For example, a Watch calculator app can now run without an iPhone nearby. (Before the update it would require an iPhone, sadly).

But what about Diabetes apps, where most of them rely on data from the Cloud? Natively-run diabetes apps will still load significantly faster because the app can still load graphics and the skeleton of the app  instantaneously. Any data will then be downloaded via nearby iPhone or Wifi. The experience is similar to the Facebook app for iPhone: the app launches instantly, but takes a few split seconds to display status updates/photos. Overall, the process still feels fairly snappy.

Furthermore, downloading from the Cloud no longer requires a nearby iPhone! If the Apple Watch is in range of a known WiFi network, the Watch can download data directly from the Cloud.

Now for the Bad News…

Unfortunately, all these nifty features need to be supported by the developer so these features won’t be available until the companies or app creators release software updates.

Adding new features are easier for well-funded startups and companies like Dexcom and Medtronic, but many diabetes apps are built by individuals or independent developers who might not have the bandwidth to readily roll out new features.

At the time of this article’s publishing, not a single top search result for “Apple Watch diabetes” in the Apple Watch app store supported any of these new watchOS 2 features.

What Can’t WatchOS 2 Do? What’s Left on the Wishlist?

Despite its many advances and upgrades, watchOS 2 represents just one more step in the pathway to Diabetes smartwatch nirvana.


The imminent release of the new Dexcom G5 signifies a HUGE step for CGM users by transmitting glucose data directly to the iPhone (and later, Android). The G5 eliminates the need to carry around the Dexcom receiver, a feature users were begging for from day one.

Unfortunately, the G5 CANNOT directly transmit glucose data directly to the iPhone, even with watchOS 2. Therefore, if you’re going on a run and want to view your CGM data on your wrist, you’ll have to bring along the iPhone as well. Similarly, wireless glucose meters also can’t directly connect to Apple Watches, and will require iPhones as the bridge for communication.

Along those lines, while watchOS 2 allows the Watch to download data over WiFi, we’re not always in range of a friendly WiFi network. Perhaps future version of the Apple Watch will be able to connect directly to cellular networks or bluetooth sensors.

And a final personal pet peeve of mine: the Apple Watch display still doesn’t always stay on. To activate the display, you either have to raise your wrist, tap the screen or press a button. I seem to be a rarity among my friends, but I don’t appreciate having to dramatically lift up my arm in order to check the time or my sugar.

Overall, Apple watchOS 2 introduces powerful new features that will change the way people manage their diabetes. Now it’s up to the developers to do their part.