What’s next for Medtronic Diabetes? A Look into CGM and Pump Pipeline

By Adam Brown and Brian Levine

Medtronic hopes to launch at least 10 products over the next two years: new CGM and apps, 670G pump with Bluetooth, AI, and more!

Medtronic held an investor meeting earlier this week, which included a presentation on the company’s diabetes device pipeline – including CGM, apps, and its next-gen closed plans. See the highlights below, broken down into major product launches planned within the next year (by April 2019), within two years (by April 2020), and beyond. (More specific timing than that was not given.)

The pipeline is exciting, and reflects Medtronic’s bigger move to go beyond an insulin pump company – especially by providing helpful tools to those on multiple daily injections (MDI).

For a refresher on the diabetes technology discussed in this article – CGM, insulin pumps, and more – click here. 

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Launch within the next year (by April 2019):

• Guardian Connect mobile CGM and Sugar.IQ app launch in the US. The standalone CGM will begin launching in the US between now and July on Apple iOS devices. (Android is in development.) It will require two fingersticks calibrations per day, is approved for seven-day wear, and is not approved for insulin dosing. Along with Guardian Connect, Medtronic will finally launch the long-awaited artificial-intelligence-powered Sugar.IQ companion app. As we’ve covered before, Sugar.IQ will function as a “personal diabetes assistant,” recognizing patterns in diabetes data. In a preliminary study, Sugar.IQ increased the time-in-range of CGM users by 33 minutes per day. 

• “Inner Circle” – CGM gamification. This new app was announced for the first time in Medtronic’s presentation. Medtronic CGM users will earn “points” for spending more time-in-range (70-180 mg/dl is how the system defines time-in-range). These points can then be “redeemed” – Medtronic didn’t say for what, though we might guess discounts, gift cards, digital badges, etc. If you wear CGM, let us know if you would be motivated by this!

• Sugar.IQ app with “Hypoglycemia Prediction” (four-hour window). This improvement to the Sugar.IQ app promises to notify users well in advance of a low: “You are expected to experience a low within the next four hours.” Medtronic believes it is over 80% accurate, though we’ll be excited to hear how well it does in real-world use. Kelly Close, diaTribe Editor-in-Chief, loves this feature on the new Dexcom G6.

• MiniMed 670G hybrid closed loop launch in Europe, the Middle East, and Africa (countries not specified). The 670G has been available for over a year now in the US, but the international launch has been delayed quite a bit. As of Medtronic’s presentation earlier this week, a 670G launch outside the US is now expected sometime in the next 10 months. This will make 670G the first hybrid closed loop system available in most countries. (For context, Diabeloop expects to launch its system in France, the Netherlands, and Sweden this year; we’re not sure if it will hit that timing.)

• Possible: MiniMed 670G for kids under 14 years-old (not mentioned at the meeting). Data from the 7-13-year-old study is currently under FDA review. An indication for children ages 2-6 could come soon after, as a study in that age group was wrapping up as of February.

Launch within two years (by April 2020 according to Medtronic):

• “Sugar.IQ Dosing Assistant” and insulin pen dose capture. These features, designed for people on multiple daily injections of insulin, will allow for automatic logging of insulin doses, as well as advanced food logging. The Dosing Assistant will presumably help users determine how much insulin to give themselves. It’s not clear how Medtronic will capture the insulin dose – will it launch its own reusable pen? Will it use Companion Medical’s InPen (a reusable, Bluetooth-enabled insulin pen)? Will it use a cap like Common Sensing’s Gocap (a reusable, Bluetooth-enabled cap for disposable insulin pens)? 

• 

  Bluetooth-enabled MiniMed 670G pump and mobile app display. Adding Bluetooth to the MiniMed 670G will allow it to send data to a phone app, enable remote monitoring (for caregivers), likely allow for remote software updates, and possibly even enable users to control their pump from a smartphone app. By the time this is launched, Medtronic may move to the improved Harmony sensor (see below). Once it adds Bluetooth, Medtronic will switch to using Roche’s Accu-Chek Guide Link BGM.

• Project Harmony CGM sensor. Details were limited on this next-generation CGM sensor, which we expect to be more accurate than the current Guardian Sensor 3. Harmony will come with “adaptive” fingerstick calibrations (unclear what this means) and approval for insulin dosing (like Dexcom’s G5/G6 and Abbott’s FreeStyle Libre). In a previous meeting, Medtronic expected that the sensor would have longer 10-day wear and need only one fingerstick calibration per day; we’re not sure if that is still the plan. The transmitter looks the same as the current version.

Pipeline products more than two years out (after April 2020 according to the company): 

• Project Unity CGM sensor. This square-shaped sensor is expected to be fully disposable (i.e., no reusable transmitter), not require calibrations (like Dexcom’s G6 and FreeStyle Libre), and last 10-14 days. As sensors go smaller and better, there’s going to be more and more competition – great for users.

• “Glucose prediction” for multiple daily injection users. This feature could combine CGM and captured dose data to predict future glucose levels. As the image below shows, messages could say things like, “Hey Dave…a little low right now, but you’ll be back in range in 30 min.”

• Advanced Hybrid Closed Loop with automatic correction bolusing. This system appears to use the same pump as 670G and the new Unity CGM (see above). According to Medtronic’s slide, the goal of the system is to deliver over 80% time in range, up from the ~70% time-in-range the MiniMed 670G delivers currently. A study pitting a Medtronic’s Advanced Hybrid Closed Loop with auto-bolusing vs. the 670G is expected to begin this year.

• A combo CGM-insulin set with extended wear. No additional details were provided this week, but a 2016 meeting expected this to be a combo seven-day CGM-insulin infusion set, with a hoped-for launch by April 2021. The single patch would house the Harmony CGM sensor and a cannula for insulin infusion – one place on the body. The key to making this product work is extending the duration of the infusion set beyond the current three days – a difficult feat! We’re not positive every pump wearer wants this, but more alternatives are always a win for the diabetes community.

• Personalized Closed Loop. Medtronic hopes that through smarter data analysis (especially with artificial intelligence), it could improve time-in-range beyond 85% – wow! See diaTribe’s article from last year about where the experts think time in range should be (spoiler: no consensus yet). For example, combining different sensor inputs could make the automated insulin delivery algorithm smarter – more intelligently adapting to a user’s patterns.