Diabetes Dialogue: US Launch of Sequel Twiist AID System

In a live update from the American Diabetes Association (ADA) 85th Scientific Sessions in Chicago, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, shared their enthusiasm for the upcoming July 7 launch of the Sequel Twiist insulin pump.

Designed with input from the open-source Loop movement, Twiist represents a significant advancement in automated insulin delivery and reflects a shift toward more flexible, patient-centered technology. One of the most notable features is the pump’s ability to set glucose targets as low as 87 mg/dL, which is the lowest available among current commercial pumps, according to Sequel Med Tech.

In addition, Twiist introduces a "Premium Preset" function that can temporarily lower the target even further, to 67 mg/dL, for up to an hour before meals. This feature is designed to help smooth out post-meal spikes without increasing the risk of hypoglycemia, and it resets automatically if no carbs are entered, allowing for real-world flexibility without added burden.

Isaacs and Bellini also highlighted the system’s meal absorption feature, which lets users choose from three absorption profiles to match the type of meal they're having. Whether the meal is rapidly absorbed like a sugary snack, a standard mixed meal, or one that digests slowly over hours like pizza, the algorithm adjusts insulin delivery accordingly. This not only accounts for food variability but does so with a level of automation that aligns with how people actually live their lives.

Twiist also includes improved occlusion detection and will be distributed through pharmacies rather than through durable medical equipment channels, making access more straightforward. Hosts point out users can try the pump without committing to a full 4-year DME cycle, an appealing option for those curious to explore new technology without disrupting their existing care.

Bellini praised the design and flexibility of Twiist, calling it a "brilliant" system that meets patients where they are. Isaacs added that the innovation is especially inspiring given its roots in the DIY community, born out of a desire to move the field forward faster. With FDA clearance secured and distribution beginning through Byram Pharmacy, Sequel’s Twiist is poised to offer a fresh option in the growing landscape of automated insulin delivery.

Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.