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Evidence-Based Diabetes Management September 2017

UnitedHealthcare's Medtronic Deal Sparks Furor, but a Year Later, Innovation Continues

Andrew Smith
UnitedHealthcare has not released numbers on how many patients are affected by its exclusivity deal with Medtronic. While the initial press stories criticizing the transaction have died down, a JDRF initiative calls on insurers to preserve patient choice.
Such a situation would not be historically unique. The number of pump makers has waxed and waned considerably over the past 40 years. New entrants have kept coming in with new technology, trying to dethrone MiniMed, the dominant player purchased by Medtronic for $3.7 billion in 2001.21 None have succeeded, but their efforts have helped fuel a steady improvement in pump technology. Pumps have gotten considerably smaller, more discrete, smarter, easier to use, and more reliable since they first appeared in the 1970s.22   There is reason to believe that more players will enter the market with new ideas. For example, Bigfoot Biomedical is performing clinical trials on a system that includes a pump that has no controls on its body because it is controlled through a smart phone app.23 

Even if fewer new companies enter the market and the pace of traditional pump development slows, patients will see differences. Today’s models are good enough that observers like Close see little need for dramatic hardware improvement, regardless of how competitive the pump market is. Mechanical improvement will continue, she thinks, but more of the value will come from the brains of the pump.

“Insulin is an incredibly dangerous drug, and a machine will always figure out dosing better than patients or parents or partners. Automation is where we’re going, and it’s all about the algorithms and who can make the easiest-to-use systems—take away steps, make things easier to use and smarter. That could come from the largest pump manufacturer, but it doesn’t necessarily have to. It can come from another company or academic or even hobbyist who wants to write it,” said Close, who gave the interview while testing a system that used software written by 1 individual to control her insulin.

“I can’t wait to try the 670G, and I can’t wait until it’s widely available. For now, having a smart algorithm in a box that costs $126 and keeps me between 80 and 120 all night every night is pretty excellent. Medtronic raised the bar with its new pump and the outcomes that they have proven (mainly less hypoglcyemia)—and they shouldn’t, and won’t, take their eye off the ball because the field will keep raising the bar ever higher.”

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22. Bigfoot Biomedical enrolls first patients in clinical trial of smartloop automated insulin delivery system [press release]. Milpitas, CA: Bigfoot Biomedical; July 21, 2016. Accessed August 20, 2017.
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