twiist
Medtronic InPen
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.
The InPen system enhances management with multiple daily injections because it tracks data in real-time and offers personalized dosing recommendations. This system combines the Guardian Connect CGM with smart insulin pens for more time in range.
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.
Controller
Inpen connects to a mobile app and displays dosage information directly on a smart mobile device.
Cartridge
InPen is compatible with Humalog, Novolog, and Fiasp U-100 3.0 mL insulin cartridges.
Sensor
Sensor is inserted underneath the skin, either on the abdomen or arm. InPen is compatible with the Medtronic Guardian Connect sensor (left) or the Dexcom G6 sensor (right).
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.
Discreet and modern option for people using multiple daily injections.
Affordability and Access
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No insurance coverage data. Anticipated to be provided through Pharmacy.
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Widely covered. InPen is covered by many insurance companies, typically users pay $50-$60 out-of-pocket copays for the one-year device. Prices range from $0- $549. For those without any insurance coverage, the pen's full price is $549.
Data Monitoring Options
Yes
Compatible with Tidepool - a web-based diabetes data management system.
Yes
Data can be easily shared with a healthcare provider or family members directly through the InPen app.
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.
Yes
Data can be viewed on the InPen mobile app with dosage recommendations, glucose readings, and glucose trends.
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.
12-month pen 7-day sensor
Sensor lasts for 7 days, insulin pen lasts for up to 12 months with refillable cartridges, transmitter is rechargeable. Sensor can be stored between 36°F - 86°F and pens can be kept at room temperature.
Vision / Auditory / Dexterity
YES text to speech
YES vibration alerts
A LOT of dexterity needed
NO text to speech
NO vibration alerts
A LOT of 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.
Light on body. Pens are easy to use and do not remain attached to the body, sensor is waterproof.
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.
Limited customizability. System integrates the Guardian Connect CGM for high or low alerts but requires manual dose adjustment and limits the ability to adjust insulin levels throughout the day.
Comfort
Low-profile. Low profile with an adhesive design that prevents the pump from catching on other objects.
Many components. Have to carry InPen and pen needles. CGM is attached to the body and requires more tape than other sensors.
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
Dosing recommendations. Displays dosing recommendations and reminders for long-acting insulin.
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. Replaces regular insulin pen. No additional devices to add on.
Fewer Fingersticks
Factory-calibrated sensor. Fingersticks needed for backup only.
2 daily finger-sticks are needed to calibrate the sensor.
Privacy
Discreet. The pump is in two pieces - the top (algorithm and battery) and the bottom (insulin chamber and AVS technology)
Hideable. Pens are portable but visible when in use. Frequent injections are unavoidable. View recommendations and data on a smartphone.