ASweetLife is taking a look at the new diabetes tech that you can look forward to in 2020.
If there’s a theme of the upcoming year, that theme is interoperability. The various makers of insulin pumps, continuous glucose monitors and insulin management algorithms have all been very busy making agreements with each other so that tech from one company can talk to tech from another.
Perhaps as a result, the hybrid closed-loop insulin system is about to explode in popularity. In January, with the release of Tandem’s Control-IQ system, patients will for the first time be able to link together different components to create an FDA-approved closed loop system. As the year unfolds, and more components hit the market, they’ll have increased freedom to mix and match with pieces from different manufacturers. Until now, loopers were restricted to the Medtronic 670G system, or their own DIY concoctions.
But it’s not all about the artificial pancreas:
When ASweetLife spoke to Dexcom CEO Kevin Sayer over the summer, he gave us a tantalizing preview of the upcoming G7:
“The insertion will be actually easier than G6. The transmitter will be disposable. The sensor is significantly smaller than the G6… We have committed internally to an extended life of up to 14 or 15 days.”
The G6 has been a runaway success for the business, and the company has had to hustle to keep up with demand. Sales should continue to grow over in the next year, and the company keeps inking agreements with more and more partners, which will allow the G6 to be interoperable with just about everything.
Nevertheless, Dexcom already has its eye on its next signature product, and is giving the celebrated G6 system a complete overhaul:
“The G7 is not a change of the algorithms or app experience, it’s a completely physical change… Very few companies would make the bet that we’re making.”
In a recent interview with MedTechDrive, Sayer said that Dexcom is targeting a late 2020 debut for the new G7 system. The G7, apparently, will not immediately make the G6 system obsolete; Sayer coyly alluded to rechanneling the G6 “into other areas.” Sayer confirmed to us that the company’s mid-term goal was to tap into the Type 2 diabetes market; perhaps the business will pivot G6 towards those millions of potential customers?
It was only days ago that Tandem won FDA approval for its new Control-IQ technology. The Control-IQ is the first approved interoperable automated glycemic controller device. The device works with a compatible insulin pump and a compatible CGM, closing the loop and delivering and adjusting insulin automatically. A recent trial showed that participants using the closed loop technology spent 10% more time-in-range than a control group manually adjusting their own insulin dosage.
Of particular note, the Control-IQ (when combined with a pump) will be the first commercially available system to automatically deliver correction boluses for high blood sugar. It’s an exciting time as we get closer to the dream of a truly superb artificial pancreas, which would eliminate so much of the glucose micromanagement that can be so stressful.
Current users of Tandem’s own insulin pump, the t:slim X2, will be able to upgrade to the Control-IQ for free. Because the device is interoperable, as more insulin pumps are approved by the FDA for use in an interoperable closed-loop system, users will be able to build their own artificial pancreas systems by mixing and matching components.
The Control-IQ should be available as early as January 2020.
The very popular Omnipod, still the only tubeless insulin pump on the market, is due to receive a major upgrade. While users today can harness Omnipod’s recently unveiled DASH system to control insulin dosage with a nifty personal diabetes manager smartphone app, there’s a big difference between a suggested insulin dose and an automatically delivered one.
Enter the Omnipod Horizon, an interoperable hybrid closed-loop system. The Horizon is also used in conjunction with a Dexcom G6 continuous glucose monitor, and will automatically adjust basal insulin rates in response to blood sugar readings.
Parents and caretakers of children with Type 1 will be excited to learn that the system has already been successfully tested on little ones. The tubeless setup has always been a particular attraction for those tasked with keeping up with the excitable little rugrats, and an automatic system that’s less likely to get yanked off on the playground is sure to find success. One parent in the study gushed, “This is the first night since my child was diagnosed with Type 1 diabetes that I slept through the night.”
The Omnipod Horizon system should debut in the second half of 2020.
Meanwhile, Omnipod is also hoping to integrate its system with a third-party looping algorithm, Tidepool Loop. The Omnipod-Tidepool collaboration should also be available in the second half of 2020.
Medtronic Minimed 780G
Medtronic is not going to let the interoperability craze win without a fight: there’s a new Minimed in the works too.
The Minimed 670G made a huge splash when it became the first hybrid closed-loop insulin pump available on the market. Many users remain fiercely loyal to the system, but there have been bumps in the road for Medtronic. Last month the company had to warn its customers of a potentially dangerous equipment malfunction,and research has showed that a high percentage of 670G users eventually ceased to use the auto mode function, chiefly because of technical difficulties. One of the researchers compared the device to a 90’s cellphone– a huge technological leap forward, but still one much in need of improvement.
Facing fresh competition from the likes of Tandem and Omnipod, we’re excited to see what Minimed is able to do to improve its system. Early reports suggest that the new 780G system, referred to as an advancedhybrid closed loop system, will deliver automatic correction boluses and will allow users to set a glucose target as low as 100 mg/dL. We’re extra excited about that last feature; the closer that a loop system can bring its user towards a truly healthy blood sugar level, the better.
There hasn’t been much news lately, but earlier reports claimed that Medtronic is targeting a late 2020 debut for the 780G.
Smart Insulin Pens
With so much attention paid to the next generation of insulin pumps and looping algorithms, do the old-fashioned injectors have anything to look forward to?
Yes. Several companies are lining up to join InPen in the smart insulin pen market.
Smart insulin pens primarily link up with smartphone software in order to keep track of the doses that you’ve already injected. Having insulin history at your fingertips can be a benefit for both the fastidious and the scatterbrained among us, both to analyze and refine control and to serve as a quick reminder of how much insulin you might already have on board. And if you enter in information on meals and exercise and blood sugar readings, the app can begin to actually suggest doses for you.
Lilly, the pharmaceutical giant that produces Humalog and other insulins, is preparing to release its own smart insulin pen and associated diabetes management system. Lilly’s pen will also be able to communicate with a Dexcom glucose monitor, adding an extra layer of effortless data to inform personalized dosing recommendations.
Novo Nordisk, that other pharmaceutical giant, has similar plans. The NovoPen 6 and the NovoPen Echo Plus will be able to communicate with both the G6 and the Freestyle Libre to help inform dosing recommendations. Each pen will also have a tiny electronic screen, to display insulin on board and the size and timing of the last injection.
Smart pens have already taken a foothold in Europe, and some analysts predict that they will grow in prominence in the US because insurers will almost inevitably prefer them as less expensive alternatives to insulin pumps.