Evolving Wearable Insulin Delivery Devices - AID, CGM, and More

Summary

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Podcast Episode Summary

Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives

Episode: Evolving Wearable Insulin Delivery Devices – AID, CGM, and More

Hosts: Dr. Diana Isaacs & Dr. Natalie Bellini
Date: June 30, 2026

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Episode Overview

This episode dives into the rapidly evolving landscape of tubeless, wearable insulin delivery devices. Drs. Diana Isaacs and Natalie Bellini discuss the surprising entrance of Modular Medical’s Pivot pump, updates from established device makers, new options in patch pump technology, and the broader implications for people with diabetes. The hosts focus particularly on patch pumps, comparing new and upcoming devices on features, compatibility, and accessibility.

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Key Discussion Points & Insights

1. The Surprise Launch of the Pivot Pump (Modular Medical)

• Introduction to the Pivot:

  • The Pivot caught many off guard when it debuted, earning FDA approval as a tubeless insulin pump. Unlike current automated insulin delivery (AID) systems, the Pivot does not interface with a continuous glucose monitor (CGM) or algorithm.

    “I remember they were at ADCs last year and had a product theater and almost kind of came out of nowhere.” — Diana Isaacs (00:28)

• Device Features:

  • Holds 300 units of insulin (higher than many competitors)
  • Offers up to two programmable basal rates (.05–4 units/hr)
  • Has a button for bolus administration
  • Two-piece design: removable for bathing/showering
  • Disposable battery
  • Anticipated to be lower cost (details pending)

• Comparison to Other Devices:

  • Similar in simplicity to the V-Go, but with greater capacity and easier filling process
  • Modular design reflects patent constraints and evolving user preferences

2. The Tubeless Pump Landscape: Growing Competition and AID

• Competitive Environment:

  • Omnipod has been the only true tubeless pump widely available, making the Pivot’s launch notable.
  • Patch pumps are increasingly seen as the future, with more companies developing their own versions.

• Upcoming Devices:

  • Beta Bionics “Mint” (early 2027)
  • Tandem: Tubeless “Mobi” and Sigi (200-unit capacity)
  • Medtronic: Minimed “Fit” (planned 300-unit reservoir)
  • Each is expected to have full AID with CGM integration.

“So we've got all these other pump companies realizing that patches are the way to go. That patch pump, people like it. They like having no tubing.” — Natalie Bellini (04:30)

• Algorithms and Real-World Value:
  • The power of connected pumps + algorithm: improvement in overnight glycemic control and time-in-range.
  • Many new devices likely to seek partnerships with established algorithms (e.g., Tidepool Loop).

“You go to bed at 180, you wake up at 110… That’s the goal of these algorithms and it really does increase that time in range.” — Natalie Bellini (06:43)

3. Who Benefits: Patient Selection and Clinical Guidance

• Pivot’s Role:
  • Best suited for patients resistant to or unable to use CGM
  • Larger capacity addresses populations needing >200 units/3 days
  • May serve as a bridge for future AID integration

“We're going to try it a little bit with people that absolutely, for whatever reason, refuse CGM.” — Natalie Bellini (05:07)

• Guidelines and Considerations:
  • ADA guidance recommends AID for type 1 diabetes — thus, non-AID pumps may fill niche roles.
  • Accessibility and coverage through pharmacy benefit versus durable medical equipment (DME) channels could expand access.

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4. Notable Updates: CeQur Simplicity and “Once Weekly” Insulin

• CeQur Simplicity:

  • Now offers a 7-day patch (up from 3–4 days), with a larger 240-unit reservoir.
  • Introduced a 1-unit bolus option, accommodating users with lower insulin needs.
  • The device is bolus-only—basal insulin must be administered separately.

• Potential Synergies:

  • Once-weekly basal insulin (e.g., “icodec,” launching August) paired with 7-day patch could simplify regimens.
  • No app integration: intentionally simple for user ease; “push-the-button” dosing.

“It truly in the name is simplicity… You don't have to worry about your app… It just works.” — Diana Isaacs (11:15)

• Combined Weekly Habits:
  • The opportunity to synchronize weekly basal, patch replacement, and even GLP-1 dosing for type 2 diabetes.

“That would be a really nice day of the week. You pick everything and do all of your seven day things on the same day.” — Natalie Bellini (10:29)

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5. Challenges and Practicalities

• Device Design and Usability:

  • Multiple devices now use a reusable/non-disposable component (due to patent landscape); challenges include loss, hospital-related disposal mishaps.
  • Higher insulin reservoir options reduce frequency of fills/changes, addressing user convenience.
  • Device cost and real-world affordability are “to be determined.”

• Insurance & Pharmacy Distribution:

  • Movement of some pumps into the pharmacy channel (vs. DME) could reduce cost burden for many patients.
  • DME often covers only 50% of device costs, while pharmacy benefits tend to be more generous.

"If we can get more of these insulin pumps going through pharmacy benefit, it helps a lot of people… This may help a lot more people that way." — Natalie Bellini (12:38)

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Notable Quotes & Memorable Moments

• “We have actually several of the aid systems… pretty much all of them have some type of tubeless pump that… will be coming likely in the next six months to year or two.” — Diana Isaacs (02:18)
• “I really want them on CGM more than anything else. But I’m happy also about the 300 unit capacity because lots of people need more than that.” — Natalie Bellini (03:52)
• "You press the sides, you do two units. Well now they're also coming out with a one unit... that's nice for people that need lower doses of insulin." — Diana Isaacs (08:33)
• “I love the idea of combining the two. The once weekly insulin… and then you put your patch on every Sunday. Go. I think that is going to help a lot of people.” — Natalie Bellini (09:54)
• “Which is great for options for patients. Hopefully they can all make it in this space.” — Diana Isaacs (12:21)

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Timestamps for Key Segments

| Timestamp | Segment | |---------------|-------------| | 00:00–02:34 | Introduction and Pivot pump overview | | 02:34–05:17 | Competitive landscape and upcoming devices | | 05:18–06:43 | Device features and AID’s benefits | | 07:06–09:25 | In-depth on CeQur Simplicity, secure simplicity updates | | 09:25–11:15 | Weekly regimen integration, patient adherence | | 11:15–12:21 | Simplicity, capacity differences, and market outlook | | 12:38–13:41 | Insurance, pharmacy benefit, and device access | | 13:41–End | Closing reflections and preview of future episodes |

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Conclusion

This episode provides a timely, nuanced snapshot of the swiftly changing landscape of wearable, tubeless insulin delivery. Drs. Isaacs and Bellini offer practical comparisons, discuss patient-centered innovations, and highlight the convergence of patch pump technology and simplified weekly regimens. The episode demonstrates both the potential and the pitfalls of new developments, underlining the value of diverse options in diabetes care.

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Transcript

[A]

Hello, and welcome to another episode of Diabetes Dialogue. Technology, Therapeutics, and Real World Perspectives. My name is Diana Isaacs, and I'm joined with my co host, Natalie Bellini. And in this episode, we want to talk patch pumps and wearable insulin delivery. Because there has been a lot of news and a lot of advancements in this space. And one kind of surprise, I guess, is, is the Pivot, which is brand new in this space. And this is actually a tubeless insulin pump. I remember they were at ADCs last year and had a product theater and almost kind of came out of nowhere. And they. They had a lot of nice stuff at their booth. Actually.

[B]

It was. Actually, you and I were both like, wait, where did this come from? Right. I.

[A]

It was like, very, very surprising. But anyway, they got their pump called the Pivot, FDA approved, and this is really a very new device. So the company is Modular Medical, and this is a pump. You know, it's not exactly a pump. It is a pump, but it's not a pump in the sense that it's not automated insulin delivery. It's not communicating with a cgm. However, it kind of reminds me a little bit of Vigo in the sense that it will have basal rates and it also will have a button to do boluses. And it's a little different than Vigo in the sense that it holds more insulin. It actually holds 300 units of insulin. And it sounds like we will be able to program up to two basal rates, which can range from.05 all the way up to 4 units per. Per hour. So, I mean, someone, again, will have to kind of fit into that, but I think that would include a lot of people. And then, you know, it'll have the ability to do the boluses. It holds 300 units, so it is a larger amount of insulin that it is holding. So it's really interesting because, I mean, like, on one hand, this space, I would say, is pretty crowded. Like, right. We have Omnipod, we have secure simplicity, which we'll talk about. Also has some pretty exciting updates.

[B]

And.

[A]

And we have actually several of the aid systems. Actually, pretty much all of them have some type of tubeless pump that is in the pipeline that will be coming likely in the next six months to year or two. So curious, Natalie, your. Your thoughts on this?

[B]

So we know that, you know, Omnipod has been the only. The only pump that is a completely tubeless, not pretending to be tubeless pump on the market.

[A]

Right.

[B]

And with that has allowed us to use it for Medicare, has allowed us to. Right. There's no tubing. So you don't have. Some people struggle with seeing insulin and air bubbles look very similar when you're old. Right. Just like anything else, it's harder and harder to see. Right. So we've used a lot of them. It goes through the pharmacy benefit. We don't have to deal with C peptide or positive insulin antibodies. All of that has gone away and it's been wonderful. Other companies have taken notice, including this Modular Medical. And I think what they've decided is let's get something out because, you know, it's FDA approved for type 1 diabetes, which is wonderful. But my guidance says type 1 diabetes, I'm supposed to be offering aid so through ADA guidelines. Right. So there's a little give and take there.

[A]

Right.

[B]

But I'm thrilled that there's another one available. I think that they can now partner with with an available algorithm. Such as what? Such as tidepool Loop. That is what SQL Twist uses, but it's not an exclusive there. So they could go with somebody who will let them use their algorithm, which will be interesting. So I think that there's plenty of potential. It'll be interesting how many we use without connection to cgm because people don't check. Right. So I really want them on CGM more than anything else. But I'm happy also about the 300 unit capacity because lots of people need more than that. 200 units in three days that Omnipod holds. But the really exciting part is also though that you were right. So we've got all these other pump companies realizing that patches are the way to go.

[A]

Right.

[B]

That patch pump, people like it. They like having no tubing. They, they now I, I don't mind tubing, but other people really want this alternative. So what do we have? Beta Bionics is. Is developing a. Their pump is going to be called the Mint. We have Tandem coming out with tubeless Mobi as well as sigi. We have two coming from them as well as Minimed coming out with the Minimed fit. So those are all going to be aid. So where do I find this Modular Medical, this pivot pump coming is it's going to land. We're going to try it a little bit with people that absolutely, for whatever reason refuse cgm. Because I still think having it on your body and able to dose is going to be. People are going to do it more, engage with it more hopefully than they do taking out a pen and actually injecting.

[A]

Right.

[B]

So I see it having a place, I see it having A place and being that much further ahead to getting an aid system set up with it.

[A]

Yeah. And I think, you know, there's some unique things about it. So the battery is disposable. There is, it sounds like, you know, it's, it's two pieces, so you can remove it for like showering and bathing and everything. And then it's supposed to be lower cost. Now we'll see it, Right. We have to see when it comes out and what the actual cost is. But supposedly the pieces and the parts to make it, and if it doesn't have an algorithm in it, you would hope it, it is lower cost. Right. That may be one of the advantages where someone says, all right, like maybe, you know, we don't need aid in this situation. Having something like this where it's just easy to wear it and easy to dose would be enough, you know, enough to make a difference. So, you know, there's certainly a lot of potential, but like you mentioned, every single pump out there is pretty much has some type of tubeless insulin delivery that is coming and some very soon. I mean, tubeless Moby is. I mean, hopefully any day that is going to be out there. And then Mint, they announced that's probably going to come very early 2027. That's going to come faster than we thought. And those have algorithms, and we love our algorithms because they increase.

[B]

People wake up at 100, right. Or 110 or 120 or whatever they're targeting their overnight is what gets better right away. Right. We love this. You go to bed at 180, you wake up at 1 10, you go to bed at 100, you wake up at 1 10. That's the goal of these algorithms and it really does increase that time and range. And ultimately our, our, our heartfelt goal is to reduce the risk of complications.

[A]

Right. So one thing is, I mean, I think when I compare this to like a Vigo, this seems a lot better just because with a V Go, you're limited really to three, three set basal rates. You also have to fill the device every day. And it comes with this large filling container thing, this pivot. The way you fill this is very similar to an omnipod. I mean, you do take it from a vial and you put it in, but it's a pretty straightforward filling process. Oh, another thing I do want to highlight is all of these tubeless pumps, including the pivot, seem to have a disposable part and then a non disposable part. And I think some of that is Because Insulet, which has Omnipod, has patents on their fully tubeless disposable insulin delivery. So we are going to see that the others will have some type of reusable parts which I mean on one hand it's fine, right? But on the other we all know people lose those parts or you go to the hospital and they accidentally throw it away like there. You know, it's definitely an extra thing to be aware of. But one thing I especially want to highlight is because I don't know if we've talked about this, there's news with secure simplicity. So they had a big splash at ADA where they announced that they're coming out with a seven day patch. And previously, you know, they started off with three days, that has recently expanded to four days and now seven days is really nice, like to not have to change it more often than that. But the other super exciting thing is that their patch has been two units. Like you press the sides, you do two units. Well now they're also coming, coming out with a one unit. And that's nice for people that need lower doses of insulin. Just the one unit. But one caveat with the secure simplicity is that it is just bolus. So it's not for long acting that is taken separate. Someone still would need to take their long acting insulin injection. Now I happen to think that with weekly insulin coming in August so I could act a weekly is supposed to be available in August. Like how perfect will that be? People could take weekly insulin and then wear this patch for a week. So I think that's awesome. But it's just different in the sense a person's not getting their basil compared to like pivot. Now they're gonna be getting basil and they have the bolus within the pump.

[B]

And I think the, the one thing that you, you forgot is that you know, when you think about okay, I'm gonna have this patch on now for seven days. I probably need more insulin. So the Reservoir went from 200 units up to 240 units.

[A]

Oh, I didn't forget that I was leaving that for you.

[B]

Oh, there you go. Right, yeah. So that we now have a 240 unit capacity for the secure simplicity. So I really do think that there will be more opportunity to. And I love the idea of combining the two.

[A]

Right.

[B]

The once weekly insulin, you take your insulin every Sunday, your basal and then you put your patch on every Sunday. Go. I think that is going to help a lot of people just again just do it starts to get this, okay, what's My habit. What's my. And it might actually help a lot, right, to just do the same thing. And you might even take a GLP1 on top of it that we're not taking away always with insulin. With people with type 2, we are assuming that they are on the right therapy in the background, whether that is a combination or pieces, parts of metformin, SGLT2 GLP1 GLP GIP, soon to be GLP GIP Luca got right. Like we want them to be maximized on that before we start insulin. So that would be a really nice day of the week. You pick everything and do all of your seven day things on the same day. It might increase the number of people who actually do it once a week on the right day. I'm excited about that.

[A]

I'm really excited about it too. And I think the fact that it doesn't have basil in it means that 240 units is more likely to make it through the full seven days. Of course, if it doesn't, people can change their patch earlier. But the other thing that I think is unique about secure simplicity is it truly in the name is simplicity. So it's not paired with an app. It's not like it's designed.

[B]

Right?

[A]

Exactly. Keep it simple, push the button. Like you don't have to worry about your app. You don't have to worry about the room on your phone to download the app and keep it connected and remember your password and all the things. Like it just works. And so it is very effective. And so I think that really has a unique advantage over some of the other products. So I, you know, I'm glad we have that as an option. It'll just be really interesting what happens in the pump space. Because, you know, on one hand pivot is 300 units, which is unique because Omnipod is 200 tubeless. Moby will be 200, just as the regular mobi is 200. I believe the mint is also going to be 200. Now the mini Med, their pump that will eventually come out, that's tubeless. Theirs is supposed to be 300. So that will be another kind of larger capacity. But I remember, like, I remember Embekta, right? They were supposed to be coming out with a 300 unit tubeless pump. And then that kind of just like they're like, oh, never mind. We're going to focus on injections, injection and needles instead. So. So I don't know, I guess it'll just be interesting. Like the pump space is definitely has a lot of players in it. Which is great for options for patients. Hopefully they can all make it in this space.

[B]

Well, and I think the big part too is that if we can get more of these insulin pumps going through pharmacy benefit, it helps a lot of people who, you know, that durable medical equipment benefit. When you, when a company goes to get their benefits to wherever, whatever insurance company they're going to, to reduce cost, a lot of times they'll say, well, durable medical equipment is 50%. So we only pay for 50% of your coverage for DME. And we don't think about that until someone needs a hospital bed or a wheelchair or an insulin pump. And so this, you don't get a 50% pharmacy benefit, at least at this point. Don't get any ideas. You all the, you know, to the, to the insurers out there. But truly, it may help a lot more people that way. And so I'm excited about it. We'll have to see. I mean, I think we're going to have, I don't know, six episodes in the next year alone just on new and improved algorithms, patch pumps, all kinds of new things that we know are coming in the future, in the near future.

[A]

Right. It's definitely very exciting. So. All right. Well, that's awesome. That's the update for today. Thanks everyone for tuning in. That wraps up this episode of Diabetes Dialogue, Technology, Therapeutics and Real World Perspectives.

[B]

Thanks, everyone.