Medtronic Minimed 670G hybrid closed loop insulin pump


leap of faith - for so long users have been

encouraged to run their own diabetes,

blood testing, carb-counting, bolusing.

Diabetes is a very hands-on experience,

and requires constant attention. The

MiniMed 640G is both similar but

different. With the MiniMed 670G you

have to take direction from the system as

it will tell you to test your blood glucose

and when to calibrate, and on occasion

it will suggest that you do a bolus. The

best thing you can do, is to do what it

tells you to, and don't do anything beyond

that. Understandably, it is hard to give

over control to a bit of technology, but it

does adapt to you and to your version of

diabetes. Don't try and second-guess it.

You have to trust it and take your hands

off the wheel a bit."

Work experience

So how does it work? The components

of the system are: The all new Guardian

Sensor 3 glucose sensor, the Guardian

Link 3 transmitter; an infusion set; a blood

glucose meter; Carelink software; and the

MiniMed 670G pump with SmartGuard


Simple things are set up in the pump

at the start by the user, under the care

of a healthcare professional, including the

person's insulin-to-carb ratio and active

insulin time. Then there is a three-day

period where the pump is on the person

but the SmartGuard Auto Mode is off (it

reverts back to the same functionality as

the MiniMed 640G system).

Once SmartGuard Auto Mode is

turned on, a reading is taken every five

minutes by the Guardian Sensor 3 CGM

sensor. Based on this the dynamic

SmartGuard Auto Mode algorithm in the

pump makes changes to the user's basal

rate, adjusting either up or down in order

to keep the glucose level stable. Every 24

hours at midnight the pump resets based

on what has happened the previous day.

Speaking further about the MiniMed

670G system, Medtronic's EMEA Marketing Manager Andrew Nicholson

says, "This cutting-edge technology

delivers improved glycaemic control whilst

allowing the person to hopefully think less

about their diabetes. With the MiniMed

640G system the focus had been on

preventing lows; with the MiniMed 670G

we are addressing the highs as well as

lows. When in SmartGuard Auto Mode,

the system adjusts to the persons real

time glucose needs by giving small

amounts of basal insulin every five

minutes as the system targets a glucose

level of 6.7 mmol/L.

All the range

Referring back to time in range (TIR),

this is a more modern way of measuring

diabetes control, made possible in the

main by the evidence supplied by the

use of CGM sensors and expressed as

a percentage: the percentage of time

someone with diabetes spends within the

optimal range of above 3.9 mmol/L and

under 10 Mmol/L. Studies have shown

that people using multiple daily injections

(MDI) spend on average 45% of their time

in range. It has to be noted that these

studies tend to be based on people with

diabetes who have fairly good control,

so others on MDI might not achieve that

number. Those using an insulin pump

have been shown as having 51% time

in range, and those using a sensor-andpump combination achieving an average

of 57% time in range.

Says Cohen, "We think you deserve

better than this. We are trying to move

people to better control by improving

time in range as well as HbA1c. The way

you run your diabetes currently takes a lot

of effort, don't underestimate how much

you know, and how much it is that you

do to control your diabetes. Our hope is

that you will have to think less about your

diabetes. Time in range is a more modern

metric, thanks to the increased use of

CGM sensors over recent years. It's really

about time in 'ranges' - less time low, less

time high, more time in the middle. The

great news is that users of the MiniMed

670G system in clinical trials in the US

have been proven to be spend an average

of 72% time in range. Our hope is to get

the amount of time spent in range even

higher than that."

""The algorithm that is inside

the MiniMed 670G system

has taken a decade to figure

out. It has involved engineers

with specialisms in applied

mathematics and theoretical

physics. This was no trivial maths

problem." - Dr Ohad Cohen,

See following pages for a glossary of terms used in this

article as well as a refresher on the idea of time in range.


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