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Medtronic’s Minimed 780G hybrid closed-loop system received FDA approval on April 21, 2023, for use in people ages 7 and older with type 1 diabetes (T1D). This technology boasts a handful of significant unique features that strive to help people manage the daily demands of diabetes.
Part of the groundbreaking 780G system is Medtronic’s Guardian 4 continuous glucose monitor (CGM) sensor that operates with SmartGuard technology — which automatically evaluates and potentially adjusts your insulin doses every 5 minutes.
This highly anticipated technology was approved in Europe in 2020, and Canada in 2022, but faced delays in the US. At last, here’s a closer look at the Minimed 780G hybrid closed-loop insulin pump featuring SmartGuard technology and the new Guardian 4 sensor.
How is it different from other hybrid closed-loop pumps?
Today, there are a handful of hybrid closed-loop insulin pumps on the market, including:
- Medtronic’s 780G operating SmartGuard technology and the Guardian 4 sensor
- Insulet’s Omnipod 5 operating with Dexcom’s G6 CGM
- Tandem’s t:slim X2 operating with Control IQ and Dexcom’s G6 CGM
- Tidepool Loop app which integrates with other insulin pumps and CGMs
So, what makes Medtronic’s MiniMed 780G system different than the rest? While you might think, “but other closed-loop systems automatically adjust insulin doses based on CGM data,” they don’t even do half the automatic work of the 780G system.
Key unique features of the 780G system include:
- New meal detection technology that auto-adjusts basal and bolus insulin every 5 minutes as needed
- “Glucose target” setting as low as 100 mg/dL
- Infusion site that can be worn up to 7 days
- Reservoir that can be swapped independently of infusion set
- “Low glucose suspend” kicks in even during “manual mode”
- Guardian 4 sensor requires no finger-pricks or while using SmartGuard in auto-mode
“A lot can happen to blood sugars in the span of an hour or even just a few minutes,” explains Que Dallara, EVP and President of Medtronic Diabetes, “so we’ve designed our system for real life.”
“It’s more than what you would ever do manually — the ability to make 12 potential adjustments an hour and throughout the night,” Dallara told T1D Exchange. “It doesn’t involve you. We’ve been serving the diabetes community for 40 years, so we have the data to develop and train our algorithms to most closely mimic the function of a pancreas.”
The first-ever system to evaluate and adjust every 5 minutes
With the first-ever “meal detection technology”, the 780G automatically evaluates and adjusts basal and bolus insulin doses based on data from the Guardian 4 sensor with SmartGuard technology — including when you forget to dose insulin for a meal altogether.
It can make up to 12 autocorrections per hour compared to its competitors which can only make one adjustment per hour and with only 60% of the necessary insulin dose.
The SmartGuard algorithm is designed to mimic the function of the pancreas as closely as possible with these frequent five-minute evaluations and adjustments. Before increasing or decreasing insulin delivery, it is evaluating the variety of critical variables that are so hard to juggle in real life with T1D.
“Each time that an autocorrection bolus is given, as often as every five minutes, there is a mathematical formula that the system goes through,” explains Jennifer McVean, MD, Pediatric Endocrinologist and Senior Director of Medical Affairs at Medtronic.
In addition to evaluating insulin on board, target glucose level, and rate of blood glucose rising or falling, the algorithm predicts future blood glucose levels with the goal of keeping you as safe as possible. (Read more about the research on SmartGuard’s safety here.)
“The system predicts the future glucose for each correction bolus, and it will subtract insulin from the bolus if it is predicted to cause low blood glucose,” adds McVean. “The user doesn’t know this is happening in the background.”
“If the patient enters carbs and the system determines the user needs a correction, it adds insulin to the dose,” continues McVean. “If the system predicts the user may go low, it will subtract insulin.
“Other closed-loop systems offer only one auto-correction once an hour and can only auto-dose up to 60% of the insulin you need, that doesn’t mimic how the pancreas works,” added Que.
Do keep in mind that regardless of SmartGuard’s ability to compensate for a missed meal bolus, users are still expected — to the best of their ability, knowing we all make mistakes — to bolus insulin appropriately before a meal as directed by their healthcare team.
Its new infusion set can be worn for up to 7 days
All other insulin infusion sets — hybrid or not — can be worn for up to three days (72 hours). This can be a tedious part of managing T1D with a pump. This seemingly constant need to change your infusion site, on top of CGM sensor site changes, can be exhausting.
This seven-day feature is the first in the world of insulin pumps — and it means you can potentially schedule both your pump site and CGM site changes on the same day.
If you need more than 300 maximum units of insulin in the reservoir, you can swap out the reservoir without changing the infusion site — making it possible to get the full seven-day use of the infusion site.
This new infusion set also boasts several benefits. Here’s a closer look at the three new features of this infusion site technology:
- New H-cap connector: The H-cap connector is the interface between the reservoir containing insulin and the tubing the insulin flows through. This new filtration process decreases the risk of occlusions (blockages) and maintains proper insulin flow.
- New tubing: The new tubing material improves the ability to maintain the insulin’s stability and efficacy.
- New adhesive patch: The adhesive patch used to keep the infusion site attached to your body is designed to last longer and protect your infusion site throughout the intended seven-day wear.
“The best feedback that we receive from our customers is that it leads to fewer interruptions and decreases the burden of their routine,” says McVean. “It’s intended to double the infusion set wear time and make living with diabetes easier.”
It offers a “glucose target” setting of 100 mg/dL
A common source of frustration for those using other closed-loop systems is the limit of the “glucose target” settings. Working in tandem with the Guardian 4 CGM, the 780G system can be set for a target blood glucose of 100 mg/dL — the lowest of any closed-loop system.
No other systems allow the user to aim for a glucose level of 100 mg/dL.
Medtronic’s ability to offer a “glucose target” of 100 mg/dL comes down to the innovation and safety of its algorithm.
“We are the only system that has auto-basal and autocorrection every 5 minutes in order to safely target 100 mg/dL,” explains McVean. “We also have a ‘safe meal correction’ and ‘safe autocorrection feature’ that adjusts meal and correction doses to minimize the risk of lows. This means it can deliver higher amounts of correction insulin to achieve a lower target because of the safety module built into our algorithm.”
In the clinical trials, one of the most notable benefits of these frequent auto-adjustments is the work it’s doing while you sleep.
“Users are waking up in the morning at target despite late-night snacks,” explains McVean. “And when you look at the dosing history, you can see that SmartGuard was hammering away all night long with auto-corrections to keep blood glucose levels in range.”
When will it become available to the public?
New customers: Visit Medtronic’s Diabetes.Shop on May 15, 2023, where you can work with your healthcare team to get the 780G and Guardian 4 sensor.
Existing customers: Any current 770G users can upgrade to the newest algorithm at no cost even if they’re out of warranty. This offer ends April 21, 2024. Do note, however, that the 780G will work with the Guardian 3 sensor, however it will not include the SmartGuard algorithm. The new infusion site product can also be used with the 770G.
Learn more: Open to the public, there will be free educational webinars on
- May 4, 5-6pm CT
- May 15, 6-7pm CT
- June 1, 5-6pm CT
- Register here
Shipments of the 780G and Guardian 4 sensor start in June 2023.
The power of automation
While you can (and likely will) switch to “manual mode” at times, Medtronic says being in SmartGuard at least 90 to 95 percent of the time is how you’ll maximize the benefits.
“We really believe in the power of automation,” says Dallara. “To develop this technology was a mountain of work, but the starting point for us is always with the customer and we think about the problem we’re trying to solve. How do we simplify living with diabetes as much as we can with technology?”
Both Dallara and McVean expressed the pride the entire Medtronic team feels while bringing this technology to people with T1D in the US.
“There is really a decade of work behind the scenes that the type 1 diabetes community doesn’t see, led by our amazing PhD scientist and his team — they brought this to life,” notes Dallara.
“I’ve seen the impact it had on my patients,” explains McVean, who served as an investigator during the clinical trials. “While using this system, a teenage patient of mine said, ‘Sometimes, now, I forget I have diabetes’. That’s something I hope everyone living with type 1 diabetes can experience.”
Hi David! The 780G algorithm would’ve suspended insulin dosing prior to or upon the arrival of a low blood sugar! The algorithm is constantly “looking into the future” to predict the risk of lows, so it would’ve suspended basal insulin, too. Then you’d treat the low with an appropriate amount of carbs.
Is it possible to perhaps further describe ” a mountain of work” that is required to approximate how a healthy pancreas perceives, reacts to, and adjusts for changes? Algorithms and coding are particularly vexing when you try to get them to mimic the complex combined kinetics, chemistry, and physical responses of biological environments.
Can you comment on the CGM being offered with the new Medtronic 780 pump? So many of us tried the Guardian system a few years ago and had a terrible time with the constant alarms and recalibrations. Some of us switched to Tandem (with Dexcom) because of these issues. Has it really improved? Thanks for any insights!
Based on the information we provided in this article, the Guardian 4 sensor is quite different than its predecessors. No calibrations and required to be accurate enough to enable SmartGuard technology with the lowest glucose target of any hybrid technology. Based on this, we can assume they’ve improved their CGM technology dramatically! We look forward to hearing feedback from users in the coming future!
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how do you manage lows (<65 BG) while on 770G and 780G? I have always been informed if 770G does provide extra insulin, It can be stopped. When low, I lose mental capacity to to adjust 770G to prevent additional insulin being infused.
As result, if my BG is very low, I do not include carbs which may trigger additional insulin.
What do 780G users do, when snack is required while experiencing very low BG values?