Medtronic 780G review - my honest thoughts 2 years in

Medtronic announced yesterday that the FDA has finally approved the Medtronic 780G with Smartguard and the Guardian 4 sensor in the US 🥳 so I thought it would be a good time to update my review 📝.

I've written two reviews before - this one after 5 months with the system and this one after a year. The first one is the #1 result on google and keeps getting hits after all this time so it's clear there is still a lot of interest in what this system is like in real life.

The headline is still the same - this system is giving me the best blood sugar control with the least amount of effort in my 16 years of living with type 1.

Here's a breakdown of everything I like and don't like about the system, what's changed since my last reviews and whether I would recommend it to others.

What I like

Here's everything I liked after a year and still like after 2 years with even more benefits building the longer I've used the system.

🎯 The results are life changing! I typically get 70-80% TIR from week to week. On average for the last 3 months I've been at 75%. I've had some days at 100% too, which get their obligatory share on social media 🦄.

😴 Night time sugars are nailed. I can have late night snacks, hot chocolate before bed, not stress about eating pizza or curry for dinner - little things that improve quality of life - because I know that Smartguard will gently sort out my sugars while I sleep. THIS IS MAJOR! I've struggled to wake up in range in the past before using this system. NO MORE! It's also made me appreciate how much effort it takes to stay in range overnight as I can see how much the Smartguard has been fine tuning things.

🍬I don't have to intervene unless I'm hypo or planning to exercise. It's a huge weight off my mind. The Smartguard algorithm is dealing with my sugars in the background, I have outsourced that job so I don't need to check and correct in between meals.

👍The system has evolved and improved while I've been using it. When I started on the 780G back in 2021 I was on the Guardian 3 sensor which wasn't great, and I was using cannulas I didn't like. Both of these have been upgraded and much improved👇 .

🌟The new Mio Advance cannulas are the best! In my last reviews I complained about the cannulas I was using (Quicksets and Mios), but now I use the Mio Advance cannulas which are quick and easy to apply, comfortable to wear and very robust. I've noticed that the Tandem pump uses cannulas that are equivalent to the old Mios and that's enough to put me off using that system as I hated those cannulas so much (way too fiddly, there were frustrated tears).

😇The Guardian 4 sensor is great (in some ways). I have a bit of a love/hate relationship with the Guardian 4 sensor. Compared to the Guardian 3, I love it. Once it's on and you've done an initial calibration you don't have to babysit it. I've worked out that it works best for me on my upper arm where it's comfortable to wear and the adhesive stays on. Having said that, if I could pick any CGM on the market, I probably wouldn't choose this one. The 780G system only works with the Guardian 4 CGM so that's something people need to be aware of. There's a new Medtronic sensor in the pipeline which will address my gripes with the Guardian 4 and I cannot wait to try it! (**Update: If you want to read more I've written a dedicated post all about the Guardian 4 here**)

🩸I don't finger prick any more. Well, I have to do it once a week to set up a new sensor but otherwise I don't feel the need to. Overall I've found the Guardian 4 sensor to be very accurate and I totally trust it to do its thing. I really hate finger pricking so this is a major factor affecting my quality of life. The other thing worth noting is that the pump accepts calibrations from any glucose monitor, and the Accu-chek Guide monitor that comes with it is very small, easy to use and wirelessly sends readings to the pump.

💪The pump clips are surprisingly robust. If you've ever had a broken pump clip, you'll know what a pain it is. Flimsy pump clips that snap has been an issue with ALL the pumps I've had in the past. Not with this pump! My original clip is still going strong and it's taken a hammering considering how often it is clipped and unclipped on a daily basis. It also doubles up as a tool to unscrew the battery cap and is easy to take off and reattach. Well done to Medtronic for getting this important detail right.

🚚 It's easy to order replacement sensors. The Guardian 4 CGM is meant to last 7 days but unfortunately in my experience (and other users based on what they've told me), they fail early quite often. You can easily order replacement sensors online or through the Penny app (sometimes they take a long time to come though).

➡️It's easy to get started. I had tried to make a DIY loop before but something always got in the way. I didn't want to do it myself. Everything with the 780G comes with instructions and training that are very easy to follow. Everything works together really easily straight out of the box.

📄The Carelink reports are helpful and save your settings. When I started on the system I really enjoyed the buzz of looking at the results and charts, but as time has gone on I haven't looked at the Carelink reports as much. It would be great if they could have more actionable insights, otherwise it's just a set of backward looking data. I was relieved that I had uploaded my pump data to Carelink though when I had to order a replacement pump and get everything set up again. Having the information to hand made it much easier to deal with.

🧠My mental bandwidth has been unlocked. A surprising upside to using this system for the last two years is the mental bandwidth I now have to think about my health beyond my blood sugars. I suppose it's a bit like having a house with a leaky roof - now that the leak has been dealt with I can think about painting the walls. The more I've learned about staying well with type 1 diabetes and the older I get, the more I am open to making other tweaks to my routines.

What I don't like

👿The Guardian 4 sensor has some annoying features. It's big. It has ugly overtape. It looks messy and "medical" compared to the super cute Freestyle Libre 3. It takes a few hours to do a changeover (1 hour to charge the transmitter, 2 hour warm up then a calibration via a finger prick), so it's not great if your sensor expires in the evening. It's a bit of a process to apply, but I can do it one handed now without any help. It took practice and I need to watch what I'm doing in the mirror but I have got the hang of it. It's OK, and I can live with it because of the functionality it provides.

❌The pump has no remote control function. I miss this from my last pump (when it worked) and this is a feature that other pumps offer. To do anything on this pump you have to physically get it out from your clothing and press the buttons. It's frustrating that this pump can obviously receive data wirelessly but this function isn't built in. I used to wear my old pump with a body band under my clothes and control it through a handset but now I have to wear clothes that give me access to the pump. Wearing high neck dresses means a trip to the ladies is needed to bolus for lunch or cancel an alert.

🤖The pump is bulkier than others on the market. When I first switched to this from the Roche Insight pump the 780G felt much bigger in comparison, but it didn't take long to get used to it. Despite its size it's still comfortable to wear - I clip it to my bra or my waistband and it's fine, even though I do get a bit envious of some of the smaller pumps out there.

🏃‍♀️Managing exercise takes more thought and planning. I used to just pre-load carbs before going out for a walk and/or under bolus for food so I didn't have too much insulin on board during the exercise. If I pre-load carbs with this system then it will see my sugars going up and give me more insulin so it defeats the purpose. You can set a temporary target for exercise but you need to remember to do this in advance. I find I still go low if I rely on this alone and need to drip feed carbs throughout the activity to keep things level.

💉The reservoir has to be manually filled. This is a feature of the Medtronic reservoirs / cannulas and is a mild faff but is easy and doesn't take too long. The Roche pump I used before had pre-filled cartridges so that was a bit more convenient. From what I've seen online, the Tandem pump reservoir is even more of a faff to fill so I should be grateful that, relatively speaking, the 780G process is quite quick and easy.

📱The app isn't compatible with my phone. I have an android phone and the app doesn't work reliably for me so I don't use it. The app doesn't have much functionality (you can't bolus from it or clear alarms) but it is a useful display device so you can see what your sugars are doing without looking at the pump (helpful if you're out walking or in a meeting for example). It also automatically uploads your pump information to Carelink but I have to do this manually using my laptop instead which is a mild inconvenience.

🕔Sensor deliveries are sometimes delayed. I've had some frustrating times where sensor shipments have been delayed and I've been left in a tight spot with no spares left. To their credit, Medtronic have listened to me and put things right, but I would always recommend ordering sensors in plenty of time so you don't end up running out.

🗓️The algorithm doesn't account for the menstrual cycle. The menstrual cycle is something that affects insulin sensitivity - we know this anecdotally and the scientific research has confirmed this - so I would love it if there was an option to enter information about the menstrual cycle into the pump and have this variable factored in too.

🍕Can't do extended or dual wave bolus in Smartguard mode. This is a bit of a limitation of the system and to get around it I sometimes split a bolus. This doesn't always work as I often forget the second bolus and end up going high (which does get corrected by Smartguard over the next few hours) but if I had given the entire bolus upfront I would have gone low. It would be cool to have this option in future (or better still, do away with meal announcements entirely😉).

Overall - would I recommend the Medtronic 780G?

The Medtronic 780G has massively improved my life with type 1 diabetes! I am so happy and grateful to be using this system.

Is the system right for you?

It's a great system for someone new to hybrid closed looping (like I was). It works so well for my blood sugar control and I can accept the compromise of living with its limitations. It's an all in one kit with one provider and one platform which streamlines the admin and makes everything easy to set up. If you've had a Medtronic pump before you'll have a head start as it all feels quite familiar. Incremental improvements have been made in the last couple of years and it looks like it will continue to get better.

Others more experienced with looping might not be willing to accept the compromise of being locked into a system that is not interoperable with other devices. People who want to optimise and choose the "best" pump, CGM and algorithm for them might prefer to look at the mix and match options elsewhere in the market, or go down the DIYAPS route. Now that I have got some looping experience under my belt I'm much more tempted by the look and sound of some of the other options - I'm not totally sure yet whether I'll renew this system in 2 years' time - it depends how the Medtronic offering evolves between now and then.

I'll leave it to you to make up your own mind and I hope that sharing my experience of real life with the 780G helps.

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