Medtronic

Medtronic Joins the Smart Insulin Pen Market

companion medical inpen.jpg

Earlier this month, Medtronic announced that it is acquiring Companion Medical and its Bluetooth-enabled InPen. The decision will allow Medtronic and InPen to help more people with diabetes (type 1 and type 2) who take multiple daily injections of insulin (MDI). This acquisition also positions Medtronic in a new market with the opportunity to compete with others developing smart insulin pens, including Eli Lilly, Novo Nordisk, and Bigfoot Biomedical.

InPen is a reusable, Bluetooth-enabled smart insulin pen that works with short-acting insulin cartridges and makes insulin injection safer. This is the only FDA-cleared insulin pen that connects with an app to track data and give users personalized dosing recommendations. The InPen app offers a dosing calculator and also computes and displays real-time active insulin on board (IOB). It also allows remote monitoring; users can set the app to auto text message their dosing info to up to five people. The text message can include every insulin dose, as well as blood glucose and carb values. First cleared by the FDA in 2016, the InPen was later FDA approved for use by all ages in June of 2020.

Medtronic's Executive VP and President Sean Salmon addressed their expanded vision aimed at serving people “where they are in their diabetes journey” regardless of the insulin delivery method, in comparison with Medtronic’s original approach of only selling insulin pumps.

A worthy side note, before the purchase, Companion established agreements with both Dexcom and Senseonics for both CGMs to share data directly with the InPen app. Medtronic has stated that it does not plan to discontinue the ability of the InPen to communicate with the Dexcom CGM, even though Medtronic makes a competing product. It makes sense that down the road, Medtronic also plans to integrate its Guardian CGM with the InPen.

An Artificial Pancreas Primer

kid-circus-7vSlK_9gHWA-unsplash.jpg

We have heard the term many times, but there is so much more to understand. What is an artificial pancreas? 

An artificial pancreas (AP) is a system designed to mimic what a healthy pancreas does: monitor glucose levels and deliver insulin as needed. Its goal is to automate blood glucose control as much as possible, so the wearer does not have to perform constant fingerpricks and be so involved in decision making and insulin dosing based on those readings. Although different names have been out there for awhile - artificial pancreasclosed loop system, and bionic system, the technology is now officially being referred to as AID (Automated Insulin Delivery) systems. At this point, the FDA has approved two AID systems - the Medtronic MiniMed 670G and Control-IQ from Tandem Diabetes Care. At least 11 other companies are working hard on inventing their own versions as well, which is extremely encouraging! 

The components of current AP systems include:

  • an insulin pump, which provides a continuous flow of insulin into the body via an “infusion site” or small cannula inserted in the skin

  • a CGM that takes ongoing blood sugar readings via a little sensor worn on the skin that has its own separate cannula from the pump. There are currently two CGMs on the market in the U.S. from Dexcom and Medtronic.

  • a controller (usually a smartphone) that includes the display screen where users can see glucose data

  • algorithm software, the “brain” of the system, that crunches the numbers to predict where glucose levels are headed and then tells the pump what to do

  • glucagon, a hormone that rapidly increases blood glucose, used here as an antidote to hypoglycemia (low blood sugar)

Find out much more about AP technology from Diabetes Mine here.

Please subscribe to our blog here.

Revisiting Seven Leading Benefits of CGM

miguel-a-amutio-DOqPrsKwyuM-unsplash.jpg

Although continuous glucose monitoring (CGM) isn't the newest news anymore, it continues to be some of the best news in diabetes technology. Find out more about the opportunity for better diabetes management.

CGM:

  1. Measures the body's glucose levels in real time, providing a new glucose level every five minutes

  2. Provides a good way to monitor time spent "in range"

  3. Gives warnings if users are trending toward hypo or hyperglycemia, including threshold alerts

  4. Measures your blood sugar repeatedly without fingersticks (some CGMs do not require fingerstick calibrations)

  5. Gives you the knowledge of how every single thing affects your blood sugar, while awake and asleep

  6. Allows you to see the effect of food in real time

  7. Offers you the power to make more informed treatment decisions

Learn more about the CGMs Healthy Living offers here.

dTech Companies Expand Global Reach

Dexcom and Medtronic both shared exciting news last week! Medtronic announced that they have obtained reimbursement in Germany for the MiniMed 670G Insulin Pump System for patients with type 1 diabetes. Learn more.

Dexcom announced last week that they are now accepting orders for the Dexcom G6 CGM System for people with diabetes ages two years and up in Canada. “We are thrilled to offer the Dexcom G6 CGM system to Canadians and are proud of this innovative technology that enables more effective diabetes management,” said Laura Endres, vice president, and general manager, Dexcom Canada, Inc. Learn more.

Medtronic’s Next-Gen Hybrid Closed Loop System

medtronic logo.jpg

Medtronic's next-gen hybrid closed loop system will be the Minimed 780G, designed to help patients enjoy greater freedom and less burdens. Currently, the 780G is being studied in an in-home trial with 350 adult and pediatric patients with type 1 diabetes participating, using the device over a three-month period. The in-home study is estimated to be completed in January of 2020, with the results presented in July, 2020.

What should you expect from the new Medtronic system?

  • New vertical "modern" look

  • Automatic correction bolusing

  • A new algorithm, that according to Medtronic is more accurate and reliable

  • A function to automatically adjust for missed meals

  • Adjustable target range, down to 100 mg/dL

  • Option for remote software updates

  • Bluetooth connectivity

Stay tuned for a launch date and other news on the Minimed 780G!

Real-World Data from Medtronic's Guardian Connect & Sugar.IQ Shows Improved Outcomes

Medtronic Guardian Connect CGM.png

This week at the American Diabetes Association (ADA) Annual Meeting, Medtronic announced real-world data on its Guardian Connect continuous glucose monitoring (CGM) system and Sugar.IQ diabetes assistant app. The Guardian Connect system and Sugar.IQ app empower people using multiple daily injections (MDI) to more proactively manage their diabetes with meaningful, personalized insights. The real-world data was recorded by users of the Guardian Connect CGM paired with the Sugar.IQ.

Sugar.IQ diabetes assistant is a separate app that continually analyzes how an individual's glucose levels respond to food intake, insulin dosages, daily routines, and other factors. The Sugar.IQ app combines data from the Guardian Connect CGM system with artificial intelligence technology from IBM Watson Health to detect important patterns and trends for people with diabetes and help them make more informed decisions on how to better manage glucose levels and stay within target range.

The data showed that people using the Guardian Connect system with the Sugar.IQ app experienced 4.1% more Time in Range (63.4%) compared to Guardian Connect alone (59.3%), which represents about one extra hour per day. And those who also used the optional Glycemic Assist feature to review their response to specific foods increased Time in Range by an additional 4% compared to those not using that feature.

Learn more from the official Medtronic press release.

Medtronic Moves Beyond A1C with CGM

New+Time+in+Range+Metric.jpg

In early April, Medtronic entered into a "value-based outcomes agreement" with Blue Cross Blue Shield of Minnesota, and the two organizations have agreed to use a metric other than the gold standard A1C test to measure members' success using the device. A Medtronic spokeswoman recently told Diabetes Mine that Guardian Connect has become the first-ever stand-alone CGM using "Time in Range" as the key metric. Many advocates and innovators in the diabetes community have been pushing to move "beyond A1C.”

Medtronic's press release about their "Time in Range" metric explains:

"Time in Range (TIR) is a standard measurement in diabetes management that tracks the amount of time a person’s glucose is in their target range with 70-180 mg/dL being the standard range. Spending more Time in Range helps minimize both short- and long-term health complications from going too high or low. Results from an analysis of people who used the predictive alerts feature on the Guardian Connect system showed that they experienced fewer high events 39 percent of the time (vs. 10% without alerts) and fewer low events 60% of the time (vs. 33% without alerts)."

Medtronic also has been promoting their Time in Range infographic:

Time-in-Range-Guardian-Connect-Infographic_FINAL_Page_1-791x1024.jpg

Diabetes Mine explained how Medtronic's reimbursements will work with Blue Cross Blue Shield:

"With Blue Cross Blue Shield, they are actually tying insurance payments to the amount of time users spend in this healthy glucose range -- an approach known as "value-based payments." So if a Medtronic CGM user does not manage to stay in that ideal 70-180 mg/dL range for a certain amount of time when using the device, then Medtronic will actually pay back the cost to the insurance company."

Learn more from Medtronic.

Why Try CGM?

Why Try CGM_.png

Continuous glucose monitoring (CGM) brings many people with diabetes better insight into what is happening with their blood sugar levels in the present and over time, with a lot less hassle. A CGM is a small, wearable device system that tracks glucose throughout the day and night. Some systems notify users of highs and lows so they can take action when needed. All systems substantially minimize the need for fingerpricking.

The top CGM systems on the market right now are the Dexcom G6, the FreeStyle Libre 14-Day System, and the Medtronic Guardian Connect CGM. Each system offers a unique set of benefits, but here are some of the best benefits of CGM overall:

  • Better insight into blood glucose trends

  • Less fingerpricks

  • Small and discreet sensors

  • Smartphone apps to track blood glucose levels

  • Alarms and alerts, especially helpful when struggling with nighttime lows

  • Remote monitoring of CGM data from a smartphone, ideal for pediatrics

Get started with CGM by calling the Healthy Living CGM Therapy Team at 866.779.8512 (Option 2) or texting us at 248.577.9903. We will give you a free benefits check to help you understand your coverage and walk you through the next steps, even contacting your doctor's office for you. From start to finish, a CGM enrollment will take commercial and Medicare members roughly 1-14 days, depending on the turnaround on paperwork from the doctor's office.

Give These Insulin Pump Simulator Apps a Shot

Researching your pump options_.png

Researching your pump options? Here are some helpful tools from Tandem and Medtronic to help you understand the benefits of different insulin pumps on the market.

t:simulator App from Tandem
With the App, you can experience the touchscreen interface of the Tandem t:slim X2 Insulin Pump with Basal-IQ Technology using a smartphone or tablet. You can also enable "Tool Tips" for a tour of the pump's key features. The App provides info about the pump's technical specifications and access to a glossary of common terms for better understanding.

Download the t:simulator App at the bottom of this page.

MiniMed 670G System Simulator from Medtronic
This application provides step-by-step instructions on the different features of the 670G and 630G insulin pumps. There are training resources for both systems and the capability to explore the insulin pump through different functionality scenarios. You will find device feature videos that give more info about the Auto Mode and Suspend Before Low features.

Download the MiniMed System Simulator through Google Play or on the Apple App Store.

Medtronic Founder Earl Bakken Turned a Tiny Repair Shop Into a Giant of Medical Technology from WSJ

earl bakken medtronic.jpg

I just learned about what a fascinating and inspiring man Earl Bakken was. He co-founded Medtronic in 1949 with the unassuming goal of repairing medical equipment. But in the mid-50s, a heart surgeon in Minneapolis asked Bakken to create a pacemaker that didn’t need to be plugged in, and a few weeks later, he had invented a wearable pacemaker powered by a battery. Mr. Bakken was an inventor from an early age, and his worked sustained him late into his life. Bakken died on October 21 at the age of 94, and back in 2010 he was using his second pacemaker and third or fourth insulin pump!

Please take a moment to read the lovely Wall Street Journal article that commemorates Bakken’s life. I found this part especially interesting:

He worried that children no longer take gadgets apart. Even engineers “never get the sense of the actual object they’re designing on a screen,” he wrote. “They make faulty assumptions because they have never taken the real thing apart and put it back together again. They’ve never jiggled it in their hand, never gotten a feel for its density and heft, never lifted it to their nose and smelled it. What a pity for them—and maybe for the rest of us as well.”

We are thankful today to Medtronic Diabetes for providing insulin pump and CGM technology to many of our patients. Just like their founder, they are in the business of changing lives.

New Technology: Offering the Contour Next ONE Smart Meter

contour-one-glucose-meter.png

The blood glucose meter is one of the most important technologies to help people with diabetes manage their disease. Many of the patients we serve, particularly those using a Medtronic insulin pump, use Contour Next test strips to test their blood glucose levels. To accompany this type of test strip, we now provide the Contour Next ONE  smart meter for blood glucose monitoring. This meter is wireless and has an app for managing data from readings on a smart phone. Approved by the FDA in 2016, the Ascensia Contour Next ONE is the latest in the line of Contour meters from the company formerly known as Bayer.

Read a full, insightful review of the Contour Next ONE by dTech Diabetes Mine blogger Mike Hoskins. Hoskins notes these features and changes in the Contour Next ONE:

  • Sleeker and slimmer design
  • New screen, changed from color to black & white
  • Watch battery, instead of a rechargeable USB
  • Port light to illuminate the spot where the test strip is inserted
  • Target lights to indicate the range of your reading
  • Second-chance sampling, with a 60-second time window
  • Improved accuracy
  • Bluetooth to sync with the mobile app
  • Ability to share diabetes data through the app

To find out more about the Contour Next ONE smart meter and other diabetes technology, contact us at 866.779.8512 (phone) or 248.577.9903 (text).

Medtronic’s Guardian Connect CGM Receives FDA Approval

Medtronic.png

We have big news to share from Medtronic – their long-awaited standalone CGM has received FDA approval. Medtronic’s Guardian Connect is comprised of three parts: a thin sensor, a small plastic transmitter attached to the sensor, and the Guardian Connect app on a compatible iOS device. It transmits directly to the iPhone without using another receiver.

The Guardian Connect system is designed to help people, ages 14 to 75, who are using multiple daily injections (MDIs). Although it does not work directly with insulin pumps, Medtronic’s standalone CGM will be the only one on the market to give alerts for potential high or low glucose events up to 60 minutes in advance. The Guardian Connect system is expected to become available by July 2018, and as early as May 2018.

Benefits of the Guardian Connect system include:

  • Customized 1 hour predictive alerts – from 10 minutes up to 1 hour ahead gives you time to respond
  • Free 24-hour SMS alerts (and for up to 5 care people)
  • Easy-to-share blood glucose readings 
  • Reduced risks of hypoglycemia and more time “in-range”
  • Sleek design – marketed for an active lifestyle, half the weight of other real-time CGM systems on the market
  • Waterproof – can be submerged for up to 2.4 meters (7.5 feet) for 10-minute periods
  • Access to the Sugar.IQ system – smart diabetes assistant that looks at what affects BGLs
  • Rechargeable, re-useable, long-life technology

This news is exciting, because it means expanded options for people with diabetes when it comes to CGM.

We're here to help!

Considering an Insulin Pump? Let Us Run a No-Cost Insurance Benefits Check for You

ThinkstockPhotos-513540052.jpg

Are you ready for an insulin pump? There are many benefits to using this technology, and a few of the big ones are:

  • Fewer insulin injections
  • More predictable and precise insulin delivery
  • Fewer high and low spikes in blood sugar

Many insurances cover insulin pump therapy for their members, and our team knows how to get customers up and running quickly. We can run a no-cost insurance benefits check to find out if you’re covered and help you understand your options.

Just complete the form below or call our Insulin Pump & CGM Team at 866.779.8512 (Option 2) to start the conversation. Our experienced team can help you navigate the enrollment process and answer your questions.

Curious About CGM? Let Our Team Run a No-Cost Insurance Benefits Check for You

Dexcom G5.png

Interested in Continuous Glucose Monitoring (CGM) to better manage diabetes? Did you know that most people with type 1 diabetes on commercial health insurance have CGM coverage?

We can run a no-cost insurance benefits check to find out if you’re covered. Just complete the form below or call our Insulin Pump & CGM Therapy Team at 866.779.8512 (Option 2) to start the conversation. Our experienced team can help you navigate the enrollment process and answer your questions.

Are You Ready for CGM?

A continuous glucose monitor is a small wearable device system that tracks your glucose throughout the day and night, notifying you of highs and lows so you can take action when needed. Continuous glucose monitoring (CGM) helps many people with diabetes obtain greater insight into what is happening with their blood sugar levels and trends.

Benefits of CGM  

  • The CGM system monitors blood glucose levels in the interstitial tissue every five minutes, offering much more information than four to eight finger sticks per day.
  • CGM is very useful when you are struggling with nighttime lows, providing alarms and alerts.
  • Continuous glucose monitoring is great for pediatrics because their parents and caregivers can remotely monitor the CGM data from their smartphones.
  • Both Medtronic and Dexcom sensors and transmitters are water-resistant, if not waterproof. They are both relatively small and discreet to wear.

CGM & Insurance Coverage

  • Most commercial insurances cover CGM, and the end of the year is a good time to consider CGM since at this time deductibles are often satisfied.
  • Most insurances require a prior authorization on file, so it is essential that patients meet with their endocrinologist to discuss CGM. This is a good first step for obtaining a CGM system. 
  • Currently, no Michigan Medicaid plans consistently approve CGM, and plans will require a pre-authorization if the CGM is covered.

Starting with CGM

  • It is easy to begin using CGM, and you don’t have to commit to an insulin pump. Many patients using multiple daily injections (MDI) report that they get tighter blood glucose through the combination of MDI and CGM.
  • From start to finish, a CGM enrollment will take commercial members roughly 1-14 days and Medicaid members 2-4 weeks.

Get in Touch

Healthy Living’s Insulin Pump & CGM Therapy Team can help guide you through the process of starting with CGM and will work with your insurance company. You can reach us at 866.779.8512 (Option 2). Learn more about CGM on our website.

We love to help!

Animas Pump Line Shuts Down with Transition Plan in Place

On October 5, Animas Corporation announced that it is discontinuing manufacturing and sale of Animas Vibe® and One Touch Ping® insulin pumps. Medtronic will assist existing Animas pump patients, caregivers, and providers with the transition, including ensuring access to proper supplies. We know this news may be unsettling to our Animas customers, however, from what we understand, you will still be able to access pump supplies and support for quite some time. Learn more about the transition by visiting www.medtronicdiabetes.com/Animas. For the ‘Nuts & Bolts’ of the change, read Mike Hoskins’ article on Diabetes Mine.

You are welcome to call our Insulin Pump Therapy Team to learn more as well. Healthy Living works with Medtronic, Omnipod, and Tandem – all manufacturers of excellent insulin pumps – and our Team is well-versed in all of their product lines. We are in network with all major insurances in Michigan, including Health Alliance Plan of Michigan, Blue Cross Blue Shield, Priority Health, state Medicaid, and Medicare for insulin pumps and pump supplies. You can reach us at 866.779.8512, Option 2 (phone) or 248.577.9903 (text).

Medtronic Infusion Set Voluntary Recall

Medtronic recently announced a voluntary recall of specific lots of MiniMed infusion sets used with their insulin pumps, due to potential over-delivery of insulin after an infusion set change. According to Medtronic, this can be caused by fluid blocking the infusion set membrane during the priming/fill-tubing process.

Visit this Medtronic page to download Medtronic’s Notification Letter and learn how to determine if you have recalled infusion sets. If you do have recalled infusion sets right now, Medtronic provides Key Steps to follow. You can also reach Medtronic to ask questions about the recall at 888.204.7616.

The infusion sets currently being shipped by Medtronic contain a new, enhanced membrane material that significantly reduces the risk being addressed by this recall.

Our Insulin Pump Therapy Team can also help if you need additional assistance – just call us at 866.779.8512 (Option 2).

Best of CGM – Essential Info from Our Most Helpful CGM Blogs

Dexcom & Medtronic CGM Systems (Photo by Emily Lewis)

Dexcom & Medtronic CGM Systems (Photo by Emily Lewis)

If you are living with type 1 or type 2 diabetes, Continuous Glucose Monitoring (CGM) can help you make more informed treatment decisions that can lead to better glycemic control. Learn more about CGM through three of our most valuable blogs from the last year.

Blog 1: Try CGM for More Insights & Tighter Diabetes Monitoring

This article covers the basics and answers questions like:

  • Why is CGM so helpful?
  • How does CGM work?
  • How do insulin pumps and CGM work together?
  • Who can benefit from CGM?
  • How does Healthy Living help you get started with CGM?

Blog 2: The Top 11 Questions about CGM & What You Need to Know

This blog covers these more detailed questions:

  1. What information will I get from Continuous Glucose Monitoring (CGM)?
  2. Can I set a safe range for my blood glucose readings?
  3. Do I still have to test my blood sugar when I am using CGM?
  4. What parts make up a CGM system?
  5. Do I need an insulin pump to use CGM?
  6. What types of CGM systems are available right now?
  7. How long can I wear CGM sensors before I need to change them?
  8. Can I use the same insertion site for my insulin pump and CGM sensors?
  9. Can parents and other care team members access a patient’s CGM data?
  10. Can I view CGM data on a smartwatch?
  11. Is CGM covered by insurance?

Blog 3: Apple Watch’s Non-Invasive Glucose Tracker: Said to Become the "Holy Grail" in Diabetes

This blog describes what we currently know about the process and progress Apple is making in creating a continuous blood glucose sensor that does not break the skin to pair with the Apple Watch.

We love to help.

You can reach our Insulin Pump & CGM Therapy Team for more information via phone call at 866.779.8512 (Option 2) or text message at 248.577.9903.

Highlighting the Revolutionary Medtronic 670G – Features & Reviews

Medtronic MiniMed 670G (Photo by Steve Wood)

Medtronic MiniMed 670G (Photo by Steve Wood)

The Medtronic MiniMed® 670G System is the world’s first hybrid closed loop insulin pump system, sometimes referred to as an artificial pancreas. The system constantly self-adjusts to automatically keep your sugar levels in range, based on how you live your everyday life. This FDA-approved system is specialized for type 1 diabetes patients, ages 14 and over, and requires a prescription.  The Medtronic MiniMed® 670G System is now shipping.

3 New Features that Set the 670G Apart from Earlier Insulin Pumps:

1.     Manual Mode – Suspend-before-low option helps you avoid lows and rebound highs proactively by automatically stopping insulin 30 minutes before you reach pre-selected low limits, then automatically restarting insulin when your levels recover (without alerts).

2.     Auto Mode – Automatically adjusts basal insulin delivery up and down every 4 minutes, based on your sugar levels, to keep you in target range, all day and night. The system can temporarily change your glucose target during athletic activity to help maintain a safe range.

3.     Guardian sensor 3 continuous glucose monitoring sensor – Offers seven-day wear and easy insertion, and is the first and only CGM sensor that is FDA-approved and trusted to control insulin dosing.

Other Medtronic MiniMed® 670G System Highlights:

  • Glucose levels are automatically kept within range all night long for a restful, uninterrupted night’s sleep.
  • The system is waterproof, with a bright color screen.
  • At meals and snacks, only check your glucose and enter the number of carbs when you administer a bolus. The 670G system will do the math to regulate your insulin and keep glucose levels in range without any necessary insulin injections.

Speaking from Experience

Jason Gensler is a person with type 1 diabetes and the founder of the Foundation for Type One Diabetes. Jason has been wearing the Medtronic 670G for the last 2 years or so and can share these insights (in his words):

  • "I am experiencing very impressive results, yet I’m only testing 4-5 times per day and calibrating three times."
  • "I’d say the best aspect is that the system itself is so intuitive and user-friendly. It’s always one step ahead, and the sensor is incredibly accurate."
  • "It’s a relief! The day that it sinks in, when you realize that you’ve relinquished a majority of the control to the pump, is the day you begin to experience the freedom that so many of us haven’t had since the day we were diagnosed."
  • "Living with T1D is hard, and staying positive can be even harder, but I’d like to remind everyone to appreciate just how far our industry has come. The technology that has been developed in the last few years is unbelievable! Let’s all be grateful that we live in a time where technology can help us lead normal lives, and that we can’t have unrealistic expectations and find a cure yesterday."

Sources for Jason Gensler quotes:

https://asweetlife.org/what-its-like-to-use-the-medtronic-670g/

http://jasongensler670gexperience.com/

Learn more about the 670G directly from the Medtronic website

Medtronic 670G Is Now Shipping!

Medtronic's much-anticipated new hybrid closed loop system is shipping. This product has the potential to help patients spend more time in optimal blood sugar range while lowering the number of treatment decisions that a patient needs to make each day.

Shipping Updates

Are you interested in getting started with the new 670G hybrid system? This is what you need to know:

  1. The Healthy Living Medical Supply Insulin Pump & CGM Therapy Team (Crystal & George) can help you navigate the process, including verifying your insurance and copays, obtaining qualifying bloodwork, and learning about your personal options.
  2. There is a backlog of the new continuous glucose monitoring (CGM) sensors that are compatible with the 670G – the sensors will most likely not be available until November of 2017. For now, customers can get started using the 670G and then add CGM once it is available in late fall.
  3. For current Medtronic pump customers who are already using CGM with an older pump, you will need to hold off entirely on the new system until this fall. This is Medtronic’s policy so that you won’t have to go off CGM for the next 4-5 months. 
  4. If you already have a pump, it needs to be out of warranty to qualify for a 670G. Contact us at 866.779.8512 (Option 2) to determine if your pump is out of warranty and what your options are!

Look for an upcoming blog with more details about the functionality and benefits of the Medtronic 670G.