Link to the Article abstract for this article titled Optimizing Hybrid Closed-Loop Therapy in Adolescents and Emerging Adults Using the MiniMed 670G System by Messer Et al. that was published on Diabetes Care in April 2018. Inbox me to see how we can get you a copy of this paper. Disclaimer.
Bottom line: Your Endo might need to really get aggressive in adjusting your carb-ratios for Auto Mode.
This article is probably the most detailed of any publicly available Medtronic sanctioned studies that actually discusses the MiniMed 670G pump and gives guidelines on how to optimize Auto Mode. It delves a little and provides references on how the HCL algorithm used in Auto Mode works and the inputs that can be adjusted when it comes to Auto Mode.
In their trials, the authors worked on optimizing Auto Mode inputs for 31 adolescent and young adult participants (14-26 years old) over a period of 3 months.
The study provides three settings that can be used to tune Auto Mode, namely: carb to insulin ratio, Active Insulin Time (AIT) and Bolus Speed (although this setting is not used or explained for the trial).
The main takeaways from this paper can be summarized as follows:
– Relatively aggressive personalized carb ratio adjustments were required (10-20% of the initial calculated entries determined for AutoMode by the medical team) to meet BG targets over the course of the study. This is quite a big adjustment since probably the medical team had already cut down the carb ratio that the participants had used in their previous pumps or in manual mode.
– There was an average 0.75% decrease in HbA1c over the period of study for the whole group studied. Not sure what to make of this result since we know young adults might not be as compliant as older patients. But, do not expect monumental changes in HbA1c due to the conservative nature of Auto Mode. But if you are looking at an HbA1c goal between 6.5 and 7, I think Auto Mode will do the trick.
-The active insulin time (AIT) was adjusted considerably to between 2-3 hours, although initial AIT settings were not adjusted by a big magnitude during the study.
– At the end of the study, the average participant use rate for Auto Mode was 72% down from 87% at the beginning of the study. This just says that it is a lot of work to optimize and stay in Auto Mode.
– The article gives actual clinical recommendations and teaching points on how to effectively optimize Auto Mode.
I think this paper is worth passing to your endocrinologist or trainer when talking about your expectations and fine-tuning your pump.