twiist
Afrezza
Summary
The twiist AID system was cleared by the FDA for use with CGMs that have received FDA designation as integrated continuous glucose monitors (iCGMs). As the twiist AID system gets closer to commercial availability, Sequel Med Tech will publicize the list of compatible CGM
*Recently FDA approved for people with type 1 diabetes ages 6 and up.
Inhalable regular human insulin. Cartridges come in three doses: 4, 8, and 12-unit doses.
Components
Infusion Set
An infusion set contains the thin plastic tubing that delivers insulin from the pump to the body.
Controller
Pump is controlled by the twiist app on an iPhone. Data from both the pump and CGM are viewable on the twiist app Home Screen.
Pump
Pump can be worn with a pump clip, adhesive patch or in a pocket.
Inhaler
Small refillable inhaler contains a compartment for powdered insulin containing cartridges.
Cartridge
Cartridges come in three doses: 4, 8, and 12-unit doses. All color coded.
Device Details
Overview
This system automatically adjusts insulin delivery according to continuous glucose monitor (CGM) readings and predicted blood sugar levels. It is the first FDA-approved AID system with Apple Watch compatibility.
Nothing on the body when not in use. Visible when dosing.
Affordability and Access
$$$$
No insurance coverage data. Anticipated to be provided through Pharmacy.
$$$$
Widely covered. Price range; 0-$99/month, depending on insurance coverage. $35/month for medicare and commercial insurance plans.
Data Monitoring Options
Yes
Compatible with Tidepool - a web-based diabetes data management system.
No Options
Data View Options
Yes
Data is stored and can be viewed directly from the twiist app on the mobile device (iPhone), and can be linked to an Apple Watch for viewing data as well.
No Options
Duration and Storage
3-day pump 10-day sensor
Sensors last 10 days, and transmitters last 90 and work at 50ºF – 108ºF. The reservoir holds 300 units and is disposable, and the pump can be used for up to 3 years.
10 Days
Open cartridges last up to 10 days. Sealed cartridges may be stored in a refrigerator at 36°F - 46°F until the expiration date.
Vision / Auditory / Dexterity
YES text to speech
YES vibration alerts
A LOT of dexterity needed
NO text to speech
NO vibration alerts
LITTLE dexterity needed
Patient Considerations
Active Lifestyle
Waterproof. The pump, when connected to the cassette, has a rating of IP28, indicating protection from continuous immersion in water. The pump can tolerate immersion to depths of up to 12 feet (3.7 m) for 1 hour.
Body free of devices. Does not remain attached to the body.
Avoiding Highs and Lows
Automatically adjusts insulin delivery. Increases or decreases insulin delivery to meet glucose targets. Insulin delivery settings can be aggressive or conservative.
Very short-acting. Absorbs quickly through the lungs to correct high blood sugar but requires attention to prevent lows.
Comfort
Low-profile. Low profile with an adhesive design that prevents the pump from catching on other objects.
Many components. Have to carry multiple cartridges that can be bulky.
Easy Insulin Dosing
Customizable. Can bolus from phone, smartwatch, or directly from the device without needing to be attached to your phone. The device also directly measures the volume (amount) and flow (speed) of insulin delivered with every micro-dose
Less precise but easy dosing. Dosing may be less precise due to the inhaled method of dosing, but color-coded cartridges make dosing easier. Dosing can also be done based on small, medium, or large meals and can be administered 1-2 hours post meals.
Easy to Use
Watch compatible. The twiist AID system is the first FDA-approved AID system that can be directly controlled from an Apple Watch.
Simple design. Whistle-like device for inhaling insulin.
Fewer Fingersticks
Factory-calibrated sensor. Fingersticks needed for backup only.
Frequent finger-sticks are required.
Privacy
Discreet. The pump is in two pieces - the top (algorithm and battery) and the bottom (insulin chamber and AVS technology)
Hideable. Small, discreet, and portable device that's not as noticeable as injections.