Over 1/3 of T1D patients quit Med-T 670G

#1

I knew there were some dissatisfied 670G users but I didn’t think it was this many.

NEW ORLEANS — Among first-time users of the MiniMed 670G hybrid closed-loop insulin delivery system (Medtronic), almost 40% stopped using the device within 9 months, primarily because of technical difficulties, shows new research presented here at ENDO 2019: The Endocrine Society Annual Meeting.

I wonder if Medtronic will continue to dominate the pump market or will this mark a long-term reversal of their fortune?

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#2

Time for Medtronic to do a complete review of their current / future technologies.

Here’s a gal who was on Calgary news last night who’s pump is off warranty and who definitely doesn’t want either of the 2 options our (Canadian) province funds (Medtronic or Omnipod). https://calgary.ctvnews.ca/diabetic-patients-await-alberta-s-approval-for-state-of-the-art-insulin-pumps-1.4349944

The “other” pump she’s alluding to is the Tandem t:slim X2, which other provinces have approved

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#3

The 670 is the first Medtronic that I refuse to purchase. I’ve had five Medtronic pump models since 1996. They began resting on their laurels at least a decade ago and I lost confidence in them at that time, that they would be innovating exciting advances in pump technology. They sure let me down, and from the looks of it, they have let down a lot of other former customers. Whenever I see someone sing the praises of the 670 with Automode, it reminds of the apologists for Sof Sensors and Enlites; neither of which were much better than random number generators for me. How they have been so BAD, when I get such amazing results from Dexcom. It kinda tells me that it isn’t my body that is the issue; it’s the difference in sensor technology. Score one for Dexcom, and a big raspberry for Medtronic.

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#4

This does not surprise me. I keep hearing bad, discouraging reports about the 670g, especially its Auto Mode.

Now, it does help people. T1s with a very bad HbA1c (10% and above) benefit greatly from it. But, in these cases, it is a “better than nothing” situation. Those with OK-good-great control won’t be happy with it.

Here’s why:

  • Frequent calibration requests (multiple times per day)
  • Has very conservative targets and behavior, like a BG of 120 mg/dL
  • Corrects the BG slowly
  • Low-suspend causes elevated BGs (130 mg/dL and above)
  • Locks you out of many treatment options, like being able to manually bolus for something (people have to work around it by entering phantom carbs)
  • Guardian sensors are often inaccurate

Anybody here with a HbA1c in the 6s or even 5s won’t benefit at all from this pump, unless these HbA1cs are bought with a lot of severe hypos. Other systems are much more advanced and efficient. DIY loops run circles around the 670g, and benefit even those who already achieve HbA1c in the upper 5% range. And the Beta Bionics iLet is even more advanced.

In terms of sophistication and development, the 670g could be compared to a car from the 1920s, while the Tandem pump and DIY projects would be cars from the 80s and 90s, and the Beta Bionics bi-hormonal pump would be a flying car from 2100.

#5

Very surprised to see how many are dumping the system. The people I have talked with who are having great success, say it is a lot of work and the first few months were horrible. But many have rave about tethering overnight numbers. Like any system, there are some who love it, some who like and some who hate it. I was a Minimed/ Medtronic user for almost 20 years and never had a problem. But I will say over that time frame, they never really did anything major in new designs.
Main reason I love my Tandem system is it’s so darn easy. I watch their video and fired it up. Haven’t looked back!

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#6

This surprises me…Everyone I know on the 670G have been, for the most part, quite happy with it. There are a few tweeks here and there that some would make but for the most part are satisfied. I think the most common complaint has been customer service/availability and reliability of supplies. That is one thing I do feel Medtronic messed up on. They were prepared for the FDA to approve the 670G so quickly and I think they got caught with their pants down. In order to get it to market they had to totally shift their produce, etc. Typically when something gets the approval from the FDA , companies will have already begun stock piling for launch. It was approved so quickly they had to scramble to get enough ready to launch. I think quality suffered and customer service suffered (My mother always said: Haste makes waste).

#7

Source: Medscape

Among first-time users of the MiniMed 670G hybrid closed-loop insulin delivery system (Medtronic), almost 40% stopped using the device within 9 months, primarily because of technical difficulties, shows new research presented here at ENDO 2019: The Endocrine Society Annual Meeting.

Closed-loop insulin pump therapy is the most advanced technology available to date for type 1 diabetes. It’s “theoretically brilliant, and it’s the future,” said co-lead investigator Gregory Goodwin, MD, of Boston Children’s Hospital, Massachusetts, but “we need better systems,” he told a press briefing here.

“For this to be available and practical for the average type 1 diabetes patient, we need more user-friendly technology,” he said. “Anyone who takes care of patients knows that to be the case,” he added.

The author of a previous study that looked at this issue, Gregory P. Forlenza, MD, assistant professor of pediatrics at the Barbara Davis Center for Diabetes, Aurora, Colorado, likened the MiniMed 670G to “a 1990s cell phone,” telling Medscape Medical News last year, “It’s not an iPhone 6.0. It’s a giant leap forward in automation of insulin delivery, but it’s not a plug-and-play system.”

Anders L. Carlson, MD, medical director of the International Diabetes Center, Minneapolis, Minnesota, agreed.

“Automated insulin delivery is the future,” he told assembled journalists here at ENDO 2019, “but the sensors need to get better.”

And he noted that the technology is not the only barrier.

Although registry data on US patients with type 1 diabetes indicate insulin pumps and continuous glucose monitors (CGMs, also referred to as ‘sensors’) — the component parts of the closed-loop systems — are increasingly being used in the United States, still only about half of patients are engaging with this technology, Carlson noted.

“There’s a chance we could leave some folks behind if we don’t address issues such as socioeconomic,” disparities and other related concerns, he said.

Why Are Patients Not Sticking With the System? "It’s a Full-Time Job"

Goodwin explained that he and his colleagues “wanted to see how the MiniMed 670G works in the real world.”

In hybrid closed-loop systems, there is algorithm-based communication between the insulin pump and CGM, and the basal insulin delivery is automated to minimize both low and high blood glucose readings, but the patient must still enter information about carbohydrate consumption.

The first such system to be marketed, the MiniMed 670G, was approved by the US Food and Drug Administration in 2016 for use in patients aged 14 years and older. In June 2018, this was expanded to include those aged 7 years and older.

Patients are eligible for the MiniMed 670G if they have experience using an insulin pump and CGM, express a preference for the device, and have the approval of their treating endocrinologist or nurse educator, Goodwin explained.

From May 2017 to August 2018, his clinic had 93 patients who elected to start treatment with the MiniMed 670G ranging in age from 5 to 25 years, with an average user age of 17 years. (Goodwin said that although the device is only approved for those aged 7 years and older, at his institution they do use it, at the discretion of the treating clinician, in those aged 5 years and older).

Of the 93 patients, 35 (38%) stopped using the MiniMed 670G within an average of 9 months of starting the device, which is “some of the longest follow-up data” to date of people on this system, said Goodwin.

Reasons for stopping use included frequent alarms, forced exits from automode so users have to switch back to manual mode, calibration requirements, premature sensor failure, skin adhesion problems, and sensor supply problems, he noted.

But overall, the majority of patients withdrew because “they were kicked out of automode,” Goodwin said, explaining that “if you don’t fulfill certain requirements, the system kicks you out.”

“Most of the patients who withdrew, withdrew completely,” he said.

“It’s a full-time job, just to keep yourself in target.”

Of the patients who continued to use the MiniMed 670G (62% of patients), those who managed to remain in automode more than 57% of the time saw significant reductions in HbA1c, he noted.

Goodwin concluded that to improve compliance with these devices and “improve success,” manufacturers need to “decrease the frequency of alarms, and decrease the frequency of forced exit from automode.”

“This was the first generation of the system. It will improve with time,” he added.

A Medtronic spokesperson told Medscape Medical News : “We have made enhancements to the system since this study was done which would likely mitigate many of the issues experienced. Specifically, we updated the software in the transmitter that sends sensor information to the insulin pump.

“When the MiniMed 670G system was initially launched 2 years ago, it included an additional layer of protection which, in certain instances, can create a continuous request for blood glucose entries. To improve the patient experience, we created a software enhancement that removes the additional safety check without compromising patient safety. All MiniMed 670G systems shipping today have this enhanced transmitter, and we are replacing the transmitter for anyone experiencing an issue.”

Goodwin also told Medscape Medical News that there’s lots of interest from companies in developing hybrid closed-loop systems using the Dexcom G6 sensor, which was approved in the United States last year.

Follow Lisa Nainggolan on Twitter: @lisanainggolan1. For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

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#8

God bless those that stayed with it. I wouldn’t have been able to miss the sleep that I am sure they did with all the alarms.

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#9

Let’s hope Tandem learned from Medtronic’s mistakes. Very anxious to hear details about Control-IQ.

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#10

This is the second time this item has been published here. Once again some important facts have been omitted.

On page 2 of the write up, there is more to the story.

"From May 2017 to August 2018, his clinic had 93 patients who elected to start treatment with the MiniMed 670G ranging in age from 5 to 25 years, with an average user age of 17 years. (Goodwin said that although the device is only approved for those aged 7 years and older, at his institution they do use it, at the discretion of the treating clinician, in those aged 5 years and older).

Of the 93 patients, 35 (38%) stopped using the MiniMed 670G within an average of 9 months of starting the device, which is “some of the longest follow-up data” to date of people on this system, said Goodwin."

          https://www.medscape.com/viewarticle/910854#vp_2

So lets understand the participants in the study were all 5 to 25 with an average age of 17. The 1/3 of patients represents 38 out of 95 studied.

Further:

“Of the patients who continued to use the MiniMed 670G (62% of patients), those who managed to remain in automode more than 57% of the time saw significant reductions in HbA1c, he noted.”

              https://www.medscape.com/viewarticle/910854#vp_2

The approved age for this pump is age 14 at present and we are are not told the number of people age 14 who dropped. However as is stated the average study age is 17. Which suggests the study of 98 patients is likely more centered above age 14.

I only suggest that before sweeping comments are made about the the 670G, the small population sample and the low age of the population may have a significant impact on the study outcomes.

Note: I am a Medtronic ambassador. My opinions are my own. They did not pay me to say nice things about Medtronic devices or the company. OK, they sent me a shirt and a cup but even I am more expensive than that.

#12

Two topics on same subject have been merged here which explains some comments that would otherwise seem odd.

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#13

I have it and I WANT OUT. So that makes me part of the 1/3. I do get sleep because that’s because I figured out in the last few weeks to SILENCE the alarms at night. :rofl: I posted this in another discussion I’m not about to run out to the next company that rolls out their closed-loops system! Now I’m wary of all the ‘shiny promises’ of these companies although I am expecting great things from them all. I just want to wait and see real-user reviews. So thankful for this forum for that reason. I prefer to use the pump in manual mode even though it’s a crappy pump (boo hoo I miss my 523).

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#14

I’m thinking that a subscription model for insulin pumps would make more sense for the end-user. That short term month to month commitment would allow unhappy users to stop using and paying for the pump.

The current system requires users to make a 4-5 year commitment without really knowing if they’re going to be happy. When we used simpler pumps, this old system worked well-enough. With the advent of automated insulin dosing systems and the revolutionary technology that they comprise, consumer due diligence when choosing a pump system is riskier.

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#15

I have been on the 670G/Guardian 3 for about two years. Every month has gotten better results. Now that I have the upgraded Guardian sensor, alarms are down and my A1c has been reduced from 7.6 to 6.9. However, I don’t believe as a teenager I would have the patience to put up with the learning curve.

#16

Medicare allows for the return of a pump as a “rental” for 1 year from purchase. Seems weird, but “thems the rules”. When I first heard that, I thought the reps were lying to me, so I checked it out. It’s legit. If anyone here hates their Medtronic pump and got it less than a year ago, it may behoove you to avail yourself of that quirky rule.

#17

That’s actually a nice consumer friendly option. I wonder if any Medicare 670G users terminated their commitment early using this policy.

It would be good if this policy spread to private insurers, too. I’ve never regretted committing to four-year stints with any of the pumps I’ve used in the last 32 years. I did pull the plug after five months using Omnipod but I never had to commit to that system long term as the ongoing pod supply was treated as a pharmacy and not a durable medical equipment benefit.

#18

Not that I’m aware of; I think only Medicare will treat the first 12 months as a rental,should a patient request the return of a pump. I didn’t become aware of this until I had the Medtronic rep out to the house late last year, followed by the Tandem rep. They both said, and I later verified, that Medicare patients can covert a purchase to a rental under the Medicare rules, should they wish to return a pump.

#19

I never heard that. But I did have a Medicare rep tell me that the pump was owned by me after 13 months. Does that also mean that the warranty expires at that time no matter what they claim? Or does the warranty expire at the time Medtronics ceases to cover it (which happened on November 12, 2018, when Medtronics stopped repairing and replacing defective Animas pumps and started replacing them with their Medtronics pump instead). I still have my Animas Ping and feel like a hostage because I do not want a Medtronics anything!

#20

The warranty is 5 years thru Medicare. I know zip about the Animas/Medtronic deal.

https://www.medtronicdiabetes.com/customer-support/tool-download-library/warranties

#21

It sounds like my experience with the medtronic sensors alone. I couldn’t go an hour at any time without it beeping at me to calibrate or that it lost the signal, or reporting false lows (that was the worst, considering my history, when I had already tested, started driving my car, and then had to exit the freeway only to find I was in the 120s, and the sensor kept beeping at me the whole way home). I would never dream of trying the 670G after my experience with medtronic sensors.

Also, I am fed up with them robocalling me twice a day to call them back when their customer service is abysmal and I know I will have to wait at least 30 minutes to talk to them. If you want to talk to me, call me with a real person. My warranty expired last week, and I suddenly start getting messages from real people. I am not surprised; it is all about the money. I am switching and never looking back.