Diabetes Dialogue: MiniMed Vivera Data and Twiist Type 2 Clearance

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Automated insulin delivery (AID) is moving toward systems demanding less from users, and new feasibility data suggest a next-generation algorithm may hold glycemic targets in type 1 diabetes even without meal announcements.

On a recent episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, reviewed first-in-human results for the MiniMed Vivera algorithm and the new type 2 diabetes clearance for the twiist AID system.

The feasibility trial enrolled 24 adults with type 1 diabetes across 3 consecutive 3-week phases: full meal announcement, no meal announcement, and announcement at will.¹ Mean time in range (70 to 180 mg/dL) was 82.3%, 73.8%, and 76.7% across the respective phases, with no device-related serious adverse events.¹ Time below 54 mg/dL stayed between 0.2% and 0.3% in every phase.

The algorithm also permits a glucose target as low as 90 mg/dL and starts automated mode from total daily dose alone, without the manual-mode run-in required by the MiniMed 780G system. Most participants nonetheless kept a 100 mg/dL target, and a few selected a higher one.

Participants entered with tightly managed disease, with a mean baseline HbA1c of 6.9% and a run-in time-in-range of about 83% on the 780G system. Full-announcement results therefore matched the existing algorithm, placing the advance in performance without announcements. Outcomes in people with higher HbA1c, and the patient-reported burden of each announcement strategy, remain untested.

The FDA cleared the twiist system from Sequel Med Tech for adults with insulin-treated type 2 diabetes in October 2026. In the 13-week pivotal trial of 307 adults, HbA1c fell 0.7% (95% CI, -0.9 to -0.6), and time in range rose from 57% to 73% with no severe hypoglycemia.² Labeling may ease payer coverage and support prescribing among clinicians less experienced with pump therapy.

The twiist algorithm draws on programmed basal rates and insulin sensitivity factors, a design closer to Control-IQ+ than to MiniMed or Beta Bionics systems. Clinicians familiar with the system report raising the maximum basal limit allows rapid correction of hyperglycemia, even among users who rarely bolus.

Collectively, the developments point toward AID systems requiring less user input across diabetes types. Pivotal trials in broader populations will determine whether reduced burden comes without meaningful glycemic tradeoffs.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References

1. Tirosh A, Wheeler BJ, Laron Hirsh M, et al. Efficacy and safety of the MiniMed Vivera algorithm: results from a first-in-human feasibility trial. Diabetes Technol Ther. Published online October 14, 2026. doi:10.1177/15209156261496632

2. Levy CJ, Kanapka L, Graham TE, et al. A multicenter 13-week evaluation of the twiist automated insulin delivery in insulin-treated type 2 diabetes: the twiist-T2D pivotal trial. Diabetes Care. Published online October 7, 2026. doi:10.2337/dc26-1270