For anyone taking long-acting and short-acting (pre-meal) insulin, an insulin pump offers freedom from all of the hassle of injections.
If you decide to eat a little more, or do some unexpected exercise, you can just push a button to administer more or less insulin. And the pump’s continuous background drip of insulin mimics the action of a healthy pancreas, so your blood sugar levels can remain much steadier.
Traditionally, insulin pumps were stand-alone devices. But in recent years, they’re increasingly connected to a continuous glucose monitor (CGM) to create a more automated glucose monitoring and insulin dosing combo marketed as a “closed loop system.”
What’s a “closed loop” for diabetes?
Insulin pumps are increasingly being combined with CGMs to create “artificial pancreas” or “closed loop” systems that automate blood sugar monitoring and insulin dosing.
Read all about the development of artificial pancreas technology here.
Whether the pump is connected to a CGM or not, the person wearing it still plays an important role in determining how much insulin they need and when they need it, especially around meals.
But no worries — modern pumps are very intuitive and easy to use. And there’s no age limit on using a pump; they are used by children, all the way up to older adults.
Read on to learn about current insulin pumps available in the United States, some older models still in use, and a glimpse at next-gen insulin pump technology.
Here is a rundown of the existing insulin pumps on the market in the United States (listed in alphabetical order) and what they offer to people with diabetes:
Tandem t:slim X2
The X2 is the latest iteration of the signature touchscreen insulin pump from California company Tandem Diabetes Care, first introduced back in 2012. The X2 has built-in Bluetooth connectivity, and received FDA clearance in 2016. It was launched to market the following year.
Tandem’s X2 is a traditional tubed insulin pump, meaning insulin is delivered via a long plastic cannula connected to the body via an infusion set. What makes it stand out from competitors are the color touchscreen display and innovative insulin cartridge design. Tandem’s cartridge uses a bag of insulin rather than a clear, hard-case reservoir inside like most of the other tubed pumps.
What’s also unique about t:slim X2 is the capability to update the unit remotely from home, a first in the diabetes pump world. This means users can update the pump’s features just by plugging the device into a computer and connecting to Tandem’s updater site, rather than needing to buy a whole new expensive piece of hardware.
The latest iterations of this pump bring more closed loop capabilities: either an auto-insulin shutoff feature known as Basal-IQ, launched in 2018, or their more advanced Control-IQ algorithm, launched in early 2020, that auto-adjusts insulin delivery to offset high blood sugars.
Currently, this pump only works with the Dexcom CGM sensors, but Tandem tells us they have agreements for future integration with other CGMs, including the Abbott Libre flash glucose monitor.
Medtronic’s Minimed 670G Hybrid Closed Loop
Medtronic has been a long-time leader in tubed insulin pump technology. They are also the only company that manufactures both a pump and CGM.
Their newest combo system, the Minimed 670G, was FDA-approved in 2016 as the first-ever “hybrid closed loop system” that can automatically monitor glucose and adjust basal insulin doses in people 14 years of age and older with type 1 diabetes (T1D).
The 670G monitors glucose using Medtronic’s Guardian 3 CGM sensor and automatically adjusts basal insulin to keep users as close as possible to the fixed target blood sugar level of 120 mg/dL.
It has the ability to predictively alert users to impending low blood sugars, and can adjust insulin accordingly or shut off background insulin if the user reaches a low threshold. It was dubbed a “hybrid” closed loop upon launch because it does not take over glucose control completely as is expected from a full artificial pancreas.
You can read about the basic use experience of the 670G in our review here.
Note that Medtronic is the oldest pump company on the market, beginning with their acquisition of Minimed back in 2001. Many may recognize their horizontally-oriented pumps that looked similar to pagers, but those older iterations have now officially been discontinued and replaced with the “6-series” that have a more modern look and vertical orientation.
Omnipod tubeless patch pump
The only full-featured tubeless insulin pump on the market is made by the Boston-area company Insulet.
First launched in 2005, this system has gone through a few iterations before the newest Omnipod DASH system was released in 2019. Insulin is delivered via a small pod with an adhesive back that’s stuck onto your skin, that is controlled via wireless connection to a handheld PDM (Personal Diabetes Manager). The newest DASH model has built-in Bluetooth and touchscreen PDM with color display.
The newest Omnipod also no longer houses a built-in fingerstick glucose meter as earlier models did.
While Omnipod doesn’t currently allow for remote control of insulin delivery via a mobile smartphone app, that’s in the works as of mid-2020, Insulet tells us.
While insulin pumps have largely been aimed at the T1D population of people on intensive insulin therapy,
Those already-mentioned existing pumps from Medtronic, Tandem, and Insulet are certainly options that people with T2D use and have available. More than that, two other devices aimed specifically at the type 2 population are worth mentioning:
Valeritas V-Go
This simple, daily-use disposable “patch pump” was launched back in 2011 and in 2019 announced a milestone of 20 million devices sold.
The stick-on unit (no plastic tubing) holds one day’s worth of fast-acting insulin, and is pre-set to deliver one of three fixed basal (background insulin) rates for the day.
Despite the large user base, there’s new concern that the V-Go may disappear from market soon on the heels of manufacturer Valeritas filing for bankruptcy. Word has it they are planning for a sale to Denmark-based biotech firm Zealand Pharma, which is also developing a rescue glucagon pen.
Omnipod U-500 Pods
Omnipod-maker Insulet has been talking about its interest in offering a higher-concentrated insulin delivery device for a number of years now.
The new pods would use Eli Lily’s higher-concentrated U-500 insulin, which would make the tubeless pump a real option for patients who need large amounts of insulin, which is the case for many people with type 2 diabetes. There’s no official timeline yet on when this might become available.
Medtronic’s 770G and 780G models
We have learned about some key features of Medtronic’s next-generation of pumps in development, particularly the 780G model known as the Advanced Hybrid Closed Loop (ACHL).
The form factor will be the same as the 670G, but it will also include advanced features:
- an auto-correction bolus every 5 minutes to help keep users in optimal range and auto-adjust for missed meals
- adjustable glucose target between 100 to 120 mg/dL (compared to the 670G’s fixed target at 120 mg/dL)
- built-in Bluetooth for data-sharing and remote monitoring
- over-the-air software updates (similar to Tandem’s) so users won’t have to buy a whole new device each time an improvement is available
Medtronic tells us they plan to ask FDA regulators for approval of this new system for adults and kids as young as age 2 right from the start — instead of starting with adults and doing pediatric studies later, which is traditionally the case.
Medtronic already submitted the BLE-enabled component of its future 780G device to the FDA in early 2020. Once that’s approved and available, it will be called the 770G, and will serve as a stopgap between the existing 670G and the more sophisticated 780G still under development — adding the Bluetooth connectivity for data-sharing and remote monitoring.
To clarify, Medtronic plans to launch the 770G first as a separate device, prior to the eventual release of the full-featured 780G. The company is enthusiastic about customers being able to easily upgrade to 780G and newer features remotely, rather than requiring a new hardware purchase. FDA approval is expected in late 2020 or early 2021, with a launch following that.
t:sport mini pump
A new Tandem mini pump in the works is known internally as “t:sport,” though that may not be the official brand name when it hits market. It will be a hybrid of sorts, roughly half the size of the existing t:slim X2 pump and without any display screen at all.
Notably, this will be a patch pump with no tubing, that includes a side-button to administer a quick insulin dose directly from the device itself. The t:sport will stick to the skin with an adhesive, but unlike the Omnipod, would be detachable.
The hope is to give customers a choice of how they want to use it: either via smartphone app, or a separate receiver device. Tandem had originally planned to submit this to FDA for consideration by mid-2020, but delays due to the COVID-19 crisis have pushed that timeline back.
While these insulin pumps are no longer made or sold to new customers in the United States, many are still circulating, used by die-hard fans and in some cases, do-it-yourselfers who’ve hooked these older models up to their own homemade connected systems.
Medtronic’s earlier Minimed pumps
In its heyday, the Minimed 530 was monumental because it did what no other insulin pump had done before: It automatically suspended insulin delivery if you crossed a certain low glucose threshold. Medtronic snagged FDA approval for that Low Glucose Suspend (LGS) or threshold-suspend feature in September 2013 and it remained available until October 2018, when Medtronic discontinued it and earlier “5-series” pumps in favor of the newer 6-series devices.
The discontinuation of those classic Medtronic pump models that looked like colorful pagers marked the end of an era. The Minimed Revel and Paradigm designs, as well as the 530G (with auto-shutoff for low blood sugars), are actually still widely used but are no longer being manufactured or sold by the company. The supplies are becoming more difficult to find as time moves forward.
Animas
One of the oldest brands of pumps was Animas, which hit market in the early 2000s and became part of pharma giant Johnson & Johnson. The popular Animas Ping and Vibe insulin pumps were the latest in a long line of their tubed insulin pumps through the years.
Unfortunately Animas was shut down October 2017, after J&J announced it would be closing its pump division for good.
The company stopped manufacturing its devices and transferred remaining customers to Medtronic for supplies and pump support up until 2019. Some people are still using these devices, but with different infusion sets and supplies obtained through third-party vendors.
Roche Accu-Chek
Another longtime insulin pump manufacturer was Roche Diabetes Care, with its Accu-Chek pump line. In 2003, Roche acquired Disetronic and used that as base technology to eventually rebrand and launch the Accu-Chek Spirit pump in 2006.
That evolved through the years, but Roche eventually stopped selling this pump in the United States in early 2017, and transferred all remaining customers to Medtronic for support and supplies. Like Animas in 2019, customers were then forced to switch pump brands or go through third-party suppliers to continue using the unit. While Roche hasn’t shut the door on eventually bringing a new pump back to the U.S. market in future years, there’s no guarantee.
The future of insulin pumping definitely appears to be connecting these devices to CGMs for improved blood glucose control. This of course has pushed the issue of device interoperability to the forefront.
Behind this evolution has been pressure from the patient community rallying behind a #WeAreNotWaiting mantra — pushing to get innovative technology out more quickly and allow data and device integration.
Many of the folks creating DIY connected systems are using older, discontinued insulin pumps such as the Minimed Revel and Paradigm models. Despite an FDA warning and mainstream media concern that surfaced in 2019, thousands of people are now safely and successfully using these homemade systems.
Meanwhile, FDA has published new interoperability protocols to help the established medtech industry create products that are more “modular” and can work together safely and seamlessly. For insulin pumps like the Tandem t:slim X2, that means gaining a
This is important to keep in mind when shopping for new insulin pump technology.
Most private insurance companies cover insulin pumps under the durable medical equipment (DME) portion of the policy. You’ll need to work with a doctor to get a prescription and Letter of Medical Necessity confirming your diagnosis and medical need.
The paperwork can be somewhat daunting, so most insulin pump companies offer help in the form of dedicated insurance service teams that work with patients to apply for coverage.
The terms of coverage vary(Your Insurance May Vary is a well-known mantra in our Diabetes Community), and your choice of covered device may be limited because some insurance companies have “preferred” deals with certain pump makers.
This became quite controversial after Medtronic signed an exclusive deal with United Healthcare (UHC) in 2016, locking their members in to that brand of pump only.
A similar deal followed in 2019 for the latest Medtronic tech approved for children. While UHC and Medtronic insist that exceptions can be made in certain cases, many plan members found they weren’t able to obtain a non-Medtronic pump of their choice. Fortunately as of July 1, 2020, UHC began offering a choice by expanding their coverage to include Tandem pumps along with Medtronic’s.
Health insurance hurdles can definitely add an additional layer of difficulty in trying to decide which insulin pump is your best choice.