The integrated MiniMed Paradigm REAL-Time insulin pump and glucose monitoring system: implications for improved patient outcomes.

The MiniMed Paradigm REAL-Time system (Medtronic Diabetes, Northridge, CA) was launched in 2006 and integrates real-time continuous glucose monitoring (CGM) with an insulin delivery device. The perceived advantages of such a system include the ability for patients to view and be alerted of glucose information in real-time and affords them a method to adjust insulin delivery in response to these data. Moreover, glucose, insulin, and meal information stored in the system can be uploaded by the patient to a computer using the web-based CareLink Personal Therapy Management software, or similarly by their Health Care Professional (HCP) using CareLink Pro software. The Paradigm REAL-Time system offers two distinct capabilities over conventional multiple daily injection therapy with self-monitoring of blood glucose, mainly the abilities to observe and react to glucose changes in a timely and appropriate manner using the Bolus Wizard calculator feature of the pump and to retrospectively review integrated glucose sensing and insulin delivery data. Retrospective review of uploaded data allows patients and HCPs the opportunity to modify insulin therapy and to potentially improve glycemic control without the use of a traditional glucose diary. When using CGM, the review of CareLink data can highlight interactions among meals, insulin delivery, and resulting glucose levels and supports an overall assessment of glycemic control as well as aid in the adjustment of insulin therapy regimens. Although the Paradigm REAL-Time system does not automatically adjust insulin delivery based on sensor glucose data in its current embodiment, this integrated system forms the basic platform for future generations of products in which the sensor will modify insulin dosing in semi- and ultimately fully closed-loop modalities.