Twiist—The Breakthrough AID System Changing Diabetes Care

The future of automated insulin delivery (AID) just got exciting.

The twiist AID System offers a new approach to automated insulin delivery for people with type 1 diabetes (T1D). Twiist features integration with the Tidepool Loop algorithm, customized dosing options, and target glucose ranges from 87-180 mg/dL. It also boasts faster occlusion detection, improved accessibility, and affordability, with complete control from your iPhone or Apple Watch.

Twiist: A Smarter, Safer Way to Manage Diabetes?

The FDA recently approved twiist for use with Humalog insulin and the Tidepool Loop algorithm. To better understand twiist, you have to understand Tidepool Loop.

Tidepool Loop—More than Just an App

What started as a DIY (do-it-yourself) open-source project created by the diabetes community has quickly grown into a comprehensive AID system that manages blood sugar levels with less effort and greater precision. The nonprofit Tidepool became the first community-developed FDA-approved AID algorithm.

The iPhone app connects to your insulin pump and continuous glucose monitor (CGM). It uses a smart algorithm to automatically adjust (every five minutes) your insulin throughout the day and night based on constant glucose level readings to keep users in a tight target range.

So why is Twiist even needed?

Tidepool Loop is the software, and Twiist is the hardware

You could say Tidepool Loop is the brain (algorithm), and twiist is the body (an insulin pump and delivery system).

Compared to other pumps working with Tidepool Loop, here are a few twiist advancements:

Twiist’s iiSure™ Technology

Twiist claims to have more accurate, more precise insulin delivery. It measures insulin volume directly, not just by counting clicks.  

Fast Problem Detection

Twiist reports fast occlusion detection (blockages and other issues) with users’ infusion setups nine times faster than traditional pumps, which means fewer dangerous episodes of low and high blood sugar.

More Precise, Personalized Control

Twiist asserts tighter control. By allowing lower glucose targets (87 mg/dL compared to 110 mg/dL in pumps like Omnipod or Tandem), individuals can achieve non-diabetic range numbers by microdosing (less than a full unit).

Improved Bolus Options

Twiist provides customized blousing based on food types to adjust insulin to carbs. Users can enter ‘fast,’ ‘medium,’ or slow-acting carbs to help manage post-meal blood sugar spikes.

First Pump to Integrate with Tidepool Loop

The Twiist system offers the first pump (Deka insulin pump) explicitly built for the Tidepool Loop, an approved device for use with Humalog insulin and the Tidepool Loop algorithm.

CGM Compatibility

The system does not have its own built-in continuous glucose monitor (CGM) but instead links wirelessly to external CGMs.

Here are a few CGMs compatible with twiist:

• Abbott FreeStyle Libre 3 Plus
• Senseonics Eversense 365 (implantable) (expected Q3 2025)
• Future Abbott’s glucose-ketone sensor – ketone detection alongside glucose monitoring

More Affordable and Accessible

Twiist also claims to be reasonably priced and convenient. Twiist will be available in regular pharmacies, unlike other pumps that require long-term durable medical equipment (DME) contracts. It also employs a subscription pricing model ($0 to $50 per month).

Individualized Diabetes Management

We know no T1Ds are exactly alike, which is why personalized diabetes management is critical. Twiist offers precise micro-dosing, customized target glucose ranges, and various bolus options to achieve tighter control and improve health outcomes. Furthermore, the company plans to provide its AID system through pharmacies, utilizing a pay-as-you-go model that enhances accessibility and affordability.

Designed for individuals with T1D aged six and older, twiist is FDA-approved, with an estimated launch date in the second quarter of 2025. Interested parties can sign up for updates at www.twiist.com.