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2017 Type One Nation Technology and T1D

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This presentation was delivered at the 2017 JDRF TypeOneNation Summit in Tulsa, OK on 1/28/2017. It is a summary of insulin pumps, CGMs, data display and management software, and other aspects of technology related to type 1 diabetes.

Published in: Health & Medicine

2017 Type One Nation Technology and T1D

  1. 1. 2017 TYPE ONE NATION SUMMIT TECHNOLOGY UPDATE CLAYTON MCCOOK, DVM T1D PARENT
  2. 2. INTRODUCTION • Personal Information/Background • Our family/our Lily • Personal introduction to diabetes technology • Disclaimer/Financial Conflicts of Interest
  3. 3. SOURCES/ACKNOWLEDGEMENT • Company websites • diaTribe (www.diatribe.org) • DiabetesMine (www.healthline.com/diabetesmine) • Diabettech (www.diabettech.com) • Nightscout (www.nightscout.info, www.nightscoutfoundation.org) • OpenAPS (www.openAPS.org, www.diyps.org) • Gottabemobile.com
  4. 4. OVERVIEW • Pump technology • CGM technology • Smart meters and pens • Data management platforms • Diabetes management apps • Future “AP” products • DIY technology • Nightscout • Smart watches • DIY “loop” systems
  5. 5. PUMP TECHNOLOGY •Animas •Insulet •Medtronic •Tandem
  6. 6. ANIMAS VIBE • Integrated with Dexcom G4 CGM • Approved for children as young as 2 • Basal rate increments as low as 0.025 U/h (range: 0.025-25 U/h) • Bolus rate increments as low as 0.05 U (range: 0.05-35 U) • Completely waterproof/submergible up to 12 feet for 24 hours
  7. 7. ANIMAS ONETOUCH PING • Approved for patients 18 and older • Basal rate range 0.025-25 U/h • Completely waterproof/submergible up to 12 feet for 24 hrs. • Bolus calculator installed • Calorie King database of over 500 foods • Remote bolus feature via One Touch meter
  8. 8. ANIMAS ONETOUCH VIBE PLUS • FDA approval 12/20/2016 • First insulin pump integrated with Dexcom G5 • Approved for patients age 2 and older • Approved by Health Canada on same day • Similar specs as OneTouch Vibe
  9. 9. ANIMAS FUTURE PLANNED TECH • Hybrid “closed-loop” technology • Built-in hyper- and hypoglycemia minimizer • Animas pump/Dexcom CGM • Pivotal trial in 2016, hope to launch in 2017 • Note • 1/23/17 earnings call • “exploring everything from selling these divisions off, to shutting them down completely, to creating ‘operating partnerships’ or strategic alliances to keep them afloat.” • source: www.healthline.com/diabetesmine/jnj-diabetes-evaluating-business
  10. 10. INSULET • Omnipod system: pod + PDM • Only tubeless pump on market • Waterproof/submergable • Hands-free insertion (cannula) • Approved for all ages • Basal range 0.05-30 U/h • Bolus range 0.05-30 U (increments of 0.05/0.1/0.5/1 U)
  11. 11. INSULET FUTURE PLANS • Next-generation mobile pod • Bluetooth-enabled PDM and mobile app • Able to see IOB, bolus, and Dexcom G5 data on app • Expected to debut in 2017 at ADA Scientific Sessions • Omnipod Horizon Automated Glucose Control System • Algorithm integrated into pod • Hybrid closed loop • Investigational study on algorithm in adults completed • Expected launch in 2019
  12. 12. MEDTRONIC MINIMED PARADIGM • Stand-alone pump (not compatible with CGM) • 2 models available: • 523: 180 U reservoir • 723: 300 U reservoir • Remote control capabilities/linking meter • Basal rate increments as low as 0.025 U/h (range: 0.025-35 U/h) • Bolus rate increments as low as 0.025 U (range: 0.025-25 U) • Bolus Wizard to help avoid “stacking” • Not waterproof (must disconnect to swim/bathe)
  13. 13. MEDTRONIC MINIMED 530G • Compatible with Enlite Sensor (built-in CGM) • 2 models available: 180 U reservoir/300 U reservoir • Basal rate increments as low as 0.025 U/h (range: 0.025-35 U/h) • Bolus rate increments as low as 0.025 U (range: 0.025-25 U) • Not waterproof (must disconnect to swim/bathe) • Approved for ages 16 and up • Bolus Wizard to help avoid “stacking” • Linking meter • Threshold Suspend capability with predictive alerts • Stops insulin delivery for up to 2 hrs. if CGM reads below set value • Notifies you before sensor reads high or low
  14. 14. MEDTRONIC MINIMED 630G • Compatible with Enlite Sensor (built-in CGM) • Color screen with automatic light adjustment • Basal rate increments as low as 0.025 U/h (range: 0.025-35 U/h) • Bolus rate increments as low as 0.025 U (range: 0.025-25 U) • Waterproof up to 12 feet for up to 24 hrs. • Approved for ages 16 and up • SmartGuard technology with predictive alerts • Stops insulin delivery for up to 2 hrs. if CGM reads below set value • Notifies you before sensor reads high or low
  15. 15. MEDTRONIC MINIMED 670G • FDA approval granted Sept. 2016, will ship in 2017 • Approved for ages 14 and up (pediatric study underway) • Compatible with Guardian Sensor 3 • Utilizes SmartGuard HCL (hybrid closed loop) technology • Performs automatic adjustments to basal rates • User must still bolus for meals/blood sugar correction • Similar specifications/appearance as 630g
  16. 16. TANDEM T-SLIM G4 • Integrated with Dexcom G4 CGM • Approved for ages 6 and older • Micro-Delivery® technology • Basal rate increments as low as 0.001 U/h (range: 0.001-35 U/h) • Bolus as low as 0.05 U minimum bolus, 25 U maximum bolus • Smallest CGM-enabled pump on market • Full color touchscreen display, watertight • 300 U capacity
  17. 17. TANDEM T:SLIM X2 • Smallest insulin pump on market • Approved for ages 6 and older • Micro-Delivery® technology • Basal rate increments as low as 0.001 U/h (range: 0.001-35 U/h) • Bolus as low as 0.05 U minimum bolus, 25 U maximum bolus • Full color touchscreen display, watertight • Bluetooth-enabled (remote software updating capability) • 300 U capacity
  18. 18. TANDEM T:FLEX • Designed for people w/insulin needs >80 U/day (480 U capacity) • Approved for ages 12 and older • Micro-Delivery® technology • Basal rate increments as low as 0.05 U/h (range: 0.05-35 U/h) • Bolus as low as 0.05 U minimum bolus, 60 U maximum bolus • Full color touchscreen display, watertight
  19. 19. TANDEM FUTURE PLANS • Dexcom G5-enabled t:slim X2: mid-2017 • Automated Insulin Delivery system: end of 2017 • 1st generation: Predictive Low Glucose Suspend • Feasibility trial finished in August 2016, pivotal trial early 2017 • Second-generation Tandem system: 2018 • Utilization of Dexcom G6 sensor & TypeZero Technologies algorithm • University of Virginia (more later)
  20. 20. CGM TECHNOLOGY • Dexcom • Medtronic • Abbott Freestyle Libre
  21. 21. DEXCOM • Dexcom G4 Platinum with Share • Requires use of receiver • Receiver paired with iPhone  data to cloud • Range: 40-60 feet • Approved for ages 2 and older • Labeled for 7 day wear, average error 9% † • Dexcom G5 • Receiver not required • BT-enabled transmitter (larger) • Direct pairing with iPhone  data to cloud • Range: 15-20 feet • Approved for ages 2 and older • Labeled for 7 day wear, avg. error 9% † †Source: https://diatribe.org/fda-approval-medtronic-minimed-670g-hybrid-closed-loop-system
  22. 22. DEXCOM SHARE FOLLOWERS • Use of Follow app (iOS or Android) • PWD can have up to 5 “followers” • Can follow up to 5 PWD • G4 with Share or G5 • Can customize alerts • Can get readings on Apple Watch, Pebble, Android Wear
  23. 23. DEXCOM FDA FINGERSTICK REPLACEMENT • Granted on 12/20/2016 • Allows users to replace finger stick for dosing decisions • First CGMS allowed to be used to make decisions • Approval for patients age 2 and older • Still requires twice a day calibration • Potential ramification: CMS (Medicare)
  24. 24. • Dexcom G5x: 50% smaller transmitter than G5 • Dexcom G6 sensor • 10-14 day wear, single calibration per day • Pivotal trial started, hope to launch in 2018 • Next-generation receiver: touchscreen display • Next-generation inserter: push-button • Google Tech: collaboration with Verily for small sensor: 2018- 2020 DEXCOM FUTURE PLANS
  25. 25. MEDTRONIC CGM • Enlite sensor • Compatible with 530g and 630g pumps • Medtronic claims “manufacturing updates” to improve performance • One-touch inserter now available • Labeled for 6 day wear, average error 14% † • Guardian Sensor 3 • FDA approval 2016, launch later this year • Compatible with 670g pump • Labeled for 7 day wear, average error 10.6% † †Source: https://diatribe.org/fda-approval-medtronic-minimed-670g-hybrid-closed-loop-system
  26. 26. MINIMED CONNECT • Uploader communicates w/pump via RF • Uploader uses BLE to send data to mobile app • Data can be remotely monitored and downloaded • iOS or Android • Displays CGM and pump data • CGM: current sensor reading (3,6,12, 24-hr. graphs available) • Pump: active insulin, insulin in reservoir, pump battery level
  27. 27. FREESTYLE LIBRE CGM • Libre Pro approved in U.S. • Small sensor worn on arm (about quarter size) • 2 week wear, no calibration • Scanned for data at office visit(s) • Unlike Freesyle Libre (Europe), no reader device
  28. 28. SMART METERS • One Drop Chrome • FDA approval 12/6/16 • Subscription based platform • Meter sends data to cloud via Android or iOS • Dario All-In-One BGM system • Integrated meter, strips, lancets, mobile app, and web portal • Turns smartphone into BG meter (Android or iOS) • Subscription based platform • Other “smart” meters (BLE): Roche’s Accu-Chek Connect, LifeScan’s OneTouch VerioSync, Livongo for Diabetes, Telcare, the iHealth meter, Sanofi’s iBGStar
  29. 29. SMART INSULIN PENS • InPen (Companion Medical) • FDA approval 2016, launch expected 2017 • Dosage calculator, logbook, temp. monitor, last dose, IOB • Tracking & reporting to HCP • Novolog + Humalog • ESYSTA Pen (Emperra Digital Diabetes) • Launched in Germany, submitted to FDA • Works with Lilly, NovoNordisk, Sanofi insulin • Has countdown and insulin dosing calculator, sends data to cloud/app
  30. 30. DATA MANAGEMENT: PUMP/CGM SPECIFIC • Medtronic: CareLink • Dexcom: Clarity • Animas: DiaSend • Insulet: Abbott CoPilot • Tandem: t:connect
  31. 31. DATA MANAGEMENT: CROSS PLATFORM • Tidepool: nonprofit, open source • Dexcom, Insulet, Medtronic, Tandem, Animas, Bayer, Abbott, OneTouch • Blip/Blip Notes: see data from multiple sources in one place • Nutshell (in beta): historical meal analysis • Glooko: subscription based • Sync BG, CGM, physical activity, etc. • Mobile app (Android or iOS) • Carb count database • Send data to cloud/provider • Personal/clinical advisor available
  32. 32. DATA MANAGEMENT: SIMULATION • Perceptus.org: Free, open source • Input-driven data analysis • Can integrate with mLab data • Basal/bolus optimization • Mixed meals input • Exercise input
  33. 33. DIABETES APPS: • Dexcom Share/Follow • CalorieKing • Carb Counting with Lenny • MySugr Diabetes • MyFitness Pal • BG Monitor Diabetes Source: www.gottabemobile.com/best-diabetes- apps
  34. 34. “ARTIFICIAL PANCREAS:” BIGFOOT BIOMEDICAL • Founders: Jeffrey Brewer, Lane Desborough, Bryan Mazlish, Jon Brilliant • Founded in 2014, Acquired Asante Snap assets 2015 • “Smartloop” system: Snap-like pump + Dexcom CGM • Feasibility study begun August 2016 • Pivotal trial 2017, hope to submit to FDA in 2017 & launch in 2018 • JDRF funding announced 1/26/17 • equity investment through JDRF T1D Fund, a “strategic venture philanthropy fund” • www.bigfootbiomedical.com/jdrf-t1d-fund/
  35. 35. OTHER “ARTIFICIAL PANCREAS” SYSTEMS • Beta Bionics • Dr. Ed Damiano (Boston University) • Bihormonal (insulin + glucagon) + insulin-only systems • Lancet study released 12/2016: 11 day study of adults, average BG 141 mg/dL • Future studies include integrated device (iLet), pivotal studies of both types of devices • Hope to launch in 2018 • TypeZero Technologies • University of Virginia • inControl: smartphone-based AP system • 28 clinical trials involving 475 patients • Licensing agreement with Tandem signed in 2016
  36. 36. NIGHTSCOUT • Created in 2013 by Lane Desborough, John Costik, many others • First remote monitoring software available • Free, open source, volunteer driven • CGM in the Cloud FB page: 30,000+ worldwide members • Supports Dexcom, Medtronic, Libre • xDrip, Parakeet, Pebble integration • Nightscout Foundation (go see James and family!!!)
  37. 37. NIGHTSCOUT
  38. 38. SMART WATCHES • Pebble (R.I.P.) • Acquired by FitBit in 2016, immediately shut down (potentially good news though) • All models supported, large variety of watchfaces available • Data from Dexcom Share, xDrip, or Nightscout site • Apple Watch • myBG, Nightscouter: display data from Nightscout site (App Store); Nightguard: data from Nightscout site (Github) • Dexcom Share2, Dexcom Follow, Dexcom G5 Mobile (App Store) • Garmin • CGM Loop, CGM Hike/Run/Watch/Edge (Andreas May), G-Force/Look No Hands/Nightscout Watch (Phimby) • AndroidWear • Nightwatch: collects data from Dexcom Share servers, xDrip, or Nightscout site • Scrollable/zoomable BG graph, customizable levels, 4 watchfaces
  39. 39. OPENAPS • Created by Ben West, Dana Lewis, Scott Leibrand • Android-based DIY “closed loop” system • Utilizes open source oref0 algorithm • Requires Nightscout for monitoring • Requires older Medtronic pump (Ben West) • Uses CareLink USB/Raspberry Pi or Intel Edison • Automatically adjusts basal rate based on CGM reading • “Meal Assist” feature, Autotune
  40. 40. LOOP • Open source iOS based DIY “closed loop” system • Created by Nate Racklyeft, maintained by Pete Schwamb, others • Requires older Medtronic pump • Uses “RileyLink” as interface between pump/iPhone • Automatically adjusts basal rate based on CGM readings • Remote bolus through iPhone app, Apple Watch
  41. 41. QUESTIONS?

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