Table 1:

Explanation of MiniMed 670G Hybrid Closed Loop System Using a CARES Paradigm Example

	MiniMed 670G
CALCULATION	HCL system --Uses TDI calculated from last 2–6 days --Automated basal calculated by system q 5 minutes --HCL set point = 120 mg/dl --No automated correction doses. Manual correction doses based on HCL algorithm and not on programmed sensitivity factors
ADJUSTMENT (for HCL mode)	Can modify: I:C ratios (for meal boluses), AIT (for subsequent correction doses), Temp target of 150 mg/dl (to change HCL set point) Cannot modify: Basal rates, ISF, HCL set point of 120 mg/dl (except when using temp target of 150 mg/dl)
REVERT	-- Will revert to OL if persistent hyperglycemia, maximum or minimum delivery thresholds, loss of CGM data, sensor integrity concerns --Must turn off HCL in order to use temporary basal rates and/or combo boluses --Consider turning off for illness/ketones as system may suspend insulin. If insulin needs temporarily increase during illness, HCL may not be able to respond quickly enough. Use temp basals in OL during illness if persistent hyperglycemia. --Consider turning off for dramatic change in insulin sensitivity (e.g. steroid use) due to system taking days to adjust TDI calculations
EDUCATION	--Consider treating hypoglycemia with less CHO (e.g. 5–10g) if system has not delivered insulin (been suspended) for period of time prior to low glucose --Important to pre-bolus for optimal mealtime management (similar to traditional insulin pump) --System may display “BG required” for HCL functioning, when user is required to enter a fingerstick BG value into the pump. This is different from a sensor calibration. Users should understand difference between sensor calibration and BG required alerts. ----Follow system prompts for “BG required” --For dosing adjustments, change I:C ratios (10–25%) and active insulin time --Cannot use temp basals and/or combo boluses in HCL mode (‘temp target’ feature will allow for temporary reduction in basal insulin delivery in HCL mode)
SENSOR/SHARING	MiniMed Guardian 3 --Requires 2–4 calibrations for optimal use --6–7 day sensor life --Perform SMBG for diabetes management decisions --Important to calibrate when glucose is stable ( i.e. before meals, bedtime, or when no sensor trend arrows) to prevent calibration errors
	AIT= Active Insulin Time, BG= Blood glucose, CGM= Continuous glucose monitor, CHO = carbohydrates, HCL= hybrid closed loop, I:C = Insulin to carbohydrate, ISF = Insulin sensitivity factor, OL= open loop, PLGS = Predictive Low Glucose Suspend, SMBG = Self-Monitoring Blood Glucose, TDI= total daily insulin, TS= Threshold suspend