MiniMed Insulin Pump Personalizes Blood Sugar Control

The pump system has proved to improve the length of time users spend in ideal glucose range

With Robert Vigersky MD

Sensor-augmented pumps outperform other modes of insulin delivery for keeping blood glucose levels in a healthy range in numerous studies.

An insulin pump system has been shown to increase the length of time users spend in ideal glucose range according to a paper to be released at the virtual ENDO-2020 conference.

Robert Vigersky MD, chief medical officer of the Medtronic diabetes group and his team will present research based on data for patients with type 1 diabetes aged 7 and older who enabled auto mode on their MiniMed ™ 670G system pumps from between March 2017 to July 2019. Patient data was studied for TIR (Time In Range) – between 70 and 180 mg/dl, as well as time below and time above range (TBR and TAR, respectively). The researchers also analyzed data for a sub-group of more than 51,000 patients who had at least 7 days of data with auto mode both turned on and off.

More than 70% of the time analyzed was in range, with 0.4% TBR for the larger group and 1.9% TBR for the sub-group, and 26.8% TAR and 6.2% TAR for the two groups respectively. TIR increased during the auto mode time, from 60.9% to 69.9%, and both TBR and TAR decreased.

Study results

Data for the three age groups studied was as follows:

  • For 7 to 13 year-olds (n=1,417): TIR increased from 48.7 to 61.5%, while TBR increased from 0.5% to 0.6% and 2% to 2.2% in the group and sub-group respectively, and TAR went down from 49.3% to 36.3% and from 20.5% to 13.0%, respectively.
  • For 14 to 21-year-olds (n=4,194): TIR increased from 51.0% to 61.5%; TBR decreased from 0.7% to 0.6% and from 2.3% to 2.0%, respectively; and TAR decreased from 46.7% to 36.5% and from 18.5% to 12.5%, respectively.
  • For adults over 22 (n=45,643): TIR increased from 62.2% to 70.9%; TBR decreased from 0.7% to 0.5% and from 2.6% to 1.9%, respectively; and TAR decreased from 35.2% to 27.3% and from 9.9% to 6.3%, respectively.

The results represent a 9% improvement over more than 6 million user days

Vigersky says there have been no head-to-head clinical studies of the system with other insulin pumps – Medtronic or otherwise.

“However, comparing outcomes reported in the literature, the MiniMed 670G system has the best time-in-range and A1C results of any hybrid closed loop system,” he says. “Our focus in on clinical trials related to innovations that build on the automation available in the system.” 

Among the innovations in the new system is the ability to automate and personalize basal insulin delivery 24 hours a day, Vigersky notes. “The personalization comes from daily updates to the basal insulin settings. It is the only commercially available technology in the world that proactively drives increased Time in Range (TIR) by consistently guiding to the target of 120 mg/dL throughout the day.” This is the lowest range offered in an automated insulin pump system, he adds. 

Pumps that deliver fixed basal insulin rates are less able to adapt to changes that happen every day for people with diabetes, such as when they eat and what they eat. In designing this new system, Medtronic focused on “creating a system that could help with better glucose control by proactively increasing and decreasing the basal rate every 5 minutes so that patients experience fewer and less severe high and low glucose excursions. This results in an improved quality of life as well as improved blood glucose control for those living with type 1 diabetes.”

There are numerous studies that show that sensor-augmented pumps outperform other modes of insulin delivery for keeping blood glucose levels in a healthy range, that they can be cost effective, and that insulin pumps can assist in particular with patients who have trouble adhering to their insulin regimen.

Discussion

This current study, which is in process for publication later this year, shows the benefits of an insulin pump system in a large group of patients, Vigersky says. “Pivotal trials of diabetes technology tend to be small and often include highly motivated people who may already be managing their diabetes well.”

This selection bias prevents providers from knowing if the technology is equally beneficial to patients who are not as highly motivated. This study is “remarkable that the time-in-range, time-above-range, and time-below-range results in this study of over 100,000 people with diabetes mirror those of the pivotal trial which included only 124 subjects,” he says. “Our insulin pump technology, which automatically adjusts background insulin every 5 minutes based on each person’s unique needs, continues to show key benefits for those that use it.”

The pump has also been studied in younger children with type 1 diabetes ages 2 to 6, the results of which will be published this year as well. Vigersky says that there are others who are studying the use of the MidiMed system in older people and in pregnant women. “In addition, we continuously look at the real-world data available globally and will continue to share meaningful insights about the system with the healthcare community.”

While this large population study shows that many people can benefit from the use of insulin pumps like this, it does require user interaction, and Vigersky says that not everyone with type 1 diabetes will be willing to make the kind of effort required. In the future, he says there may be automated insulin pump systems that require less user input, thus making the technology available to an even wider group of patients.

While most patients with type 2 diabetes do not require insulin pumps, some do find benefits from the systems. Vigersky says there are no trials right now for automated pump systems with type 2 diabetes. “Because of differences in the disease between type 1 diabetes and type 2 diabetes, automated insulin delivery is usually not necessary for people living with the latter,” he says.

However, pumps can be beneficial for type 2 diabetes patients who need very high doses of insulin.

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