Omnipod 5 ACE Pump

K231826 · Insulet Corporation · QFG · Oct 18, 2023 · Clinical Chemistry

Device Facts

Record IDK231826
Device NameOmnipod 5 ACE Pump
ApplicantInsulet Corporation
Product CodeQFG · Clinical Chemistry
Decision DateOct 18, 2023
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 880.5730
Device ClassClass 2
AttributesTherapeutic

Intended Use

The Omnipod 5 ACE Pump (Pod) is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The Omnipod 5 ACE Pump is able to reliably and securely communicate with compatible, digitally connected devices, including automated insulin dosing software, to receive, execute, and confirm commands from these devices. The Omnipod 5 ACE Pump is intended for single patient, home use and requires a prescription.

Device Story

Wearable, tubeless insulin pump (Pod) delivers subcutaneous insulin at set/variable rates; manages diabetes mellitus. Pod pairs via Bluetooth with compatible controller/smartphone running Omnipod 5 App. System receives, executes, and confirms commands from automated insulin dosing software. Used in home environment by patients. Pod includes insulin reservoir (85-200 units), soft cannula, and adhesive backing for 3-day wear. App provides insulin delivery history and status information. Enables automated insulin delivery when integrated with interoperable continuous glucose monitor (iCGM). Benefits include precise, automated insulin management and remote monitoring via mobile interface.

Clinical Evidence

No clinical data. Evidence consists of human factors summative study (n=60) in simulated use environment, software verification/validation, EMC/wireless coexistence testing, and electrical safety testing per IEC standards.

Technological Characteristics

Wearable, tubeless, single-use insulin pump. Materials: adhesive pad, soft cannula. Energy: battery-powered. Connectivity: Bluetooth. Sterilization: sterile. Software: embedded firmware and mobile application (iOS/Android). Standards: IEC 60601-1, 60601-1-2, 60601-1-6, 60601-1-8, 60601-1-10, 60601-1-11, 60601-2-24.

Indications for Use

Indicated for subcutaneous insulin delivery for diabetes mellitus management in patients requiring insulin. Intended for single-patient, home use by prescription.

Regulatory Classification

Identification

An alternate controller enabled infusion pump (ACE pump) is a device intended for the infusion of drugs into a patient. The ACE pump may include basal and bolus drug delivery at set or variable rates. ACE pumps are designed to reliably and securely communicate with external devices, such as automated drug dosing systems, to allow drug delivery commands to be received, executed, and confirmed. ACE pumps are intended to be used both alone and in conjunction with digitally connected medical devices for the purpose of drug delivery.

Special Controls

Alternate controller enabled infusion pumps must comply with the following special controls:

*Classification.* Class II (special controls). The special controls for this device are:(1) Design verification and validation must include the following: (i) Evidence demonstrating that device infusion delivery accuracy conforms to defined user needs and intended uses and is validated to support safe use under actual use conditions. (A) Design input requirements must include delivery accuracy specifications under reasonably foreseeable use conditions, including ambient temperature changes, pressure changes ( *e.g.,* head-height, backpressure, atmospheric), and, as appropriate, different drug fluidic properties.(B) Test results must demonstrate that the device meets the design input requirements for delivery accuracy under use conditions for the programmable range of delivery rates and volumes. Testing shall be conducted with a statistically valid number of devices to account for variation between devices. (ii) Validation testing results demonstrating the ability of the pump to detect relevant hazards associated with drug delivery and the route of administration ( *e.g.,* occlusions, air in line, etc.) within a clinically relevant timeframe across the range of programmable drug delivery rates and volumes. Hazard detection must be appropriate for the intended use of the device and testing must validate appropriate performance under the conditions of use for the device.(iii) Validation testing results demonstrating compatibility with drugs that may be used with the pump based on its labeling. Testing must include assessment of drug stability under reasonably foreseeable use conditions that may affect drug stability ( *e.g.,* temperature, light exposure, or other factors as needed).(iv) The device parts that directly or indirectly contact the patient must be demonstrated to be biocompatible. This shall include chemical and particulate characterization on the final, finished, fluid contacting device components demonstrating that risk of harm from device-related residues is reasonably low. (v) Evidence verifying and validating that the device is reliable over the ACE pump use life, as specified in the design file, in terms of all device functions and in terms of pump performance. (vi) The device must be designed and tested for electrical safety, electromagnetic compatibility, and radio frequency wireless safety and availability consistent with patient safety requirements in the intended use environment. (vii) For any device that is capable of delivering more than one drug, the risk of cross-channeling drugs must be adequately mitigated. (viii) For any devices intended for multiple patient use, testing must demonstrate validation of reprocessing procedures and include verification that the device meets all functional and performance requirements after reprocessing. (2) Design verification and validation activities must include appropriate design inputs and design outputs that are essential for the proper functioning of the device that have been documented and include the following: (i) Risk control measures shall be implemented to address device system hazards and the design decisions related to how the risk control measures impact essential performance shall be documented. (ii) A traceability analysis demonstrating that all hazards are adequately controlled and that all controls have been validated in the final device design. (3) The device shall include validated interface specifications for digitally connected devices. These interface specifications shall, at a minimum, provide for the following: (i) Secure authentication (pairing) to external devices. (ii) Secure, accurate, and reliable means of data transmission between the pump and connected devices. (iii) Sharing of necessary state information between the pump and any digitally connected alternate controllers ( *e.g.,* battery level, reservoir level, pump status, error conditions).(iv) Ensuring that the pump continues to operate safely when data is received in a manner outside the bounds of the parameters specified. (v) A detailed process and procedure for sharing the pump interface specification with digitally connected devices and for validating the correct implementation of that protocol. (4) The device must include appropriate measures to ensure that safe therapy is maintained when communications with digitally connected alternate controller devices is interrupted, lost, or re-established after an interruption ( *e.g.,* reverting to a pre-programmed, safe drug delivery rate). Validation testing results must demonstrate that critical events that occur during a loss of communications (*e.g.,* commands, device malfunctions, occlusions, etc.) are handled appropriately during and after the interruption.(5) The device design must ensure that a record of critical events is stored and accessible for an adequate period to allow for auditing of communications between digitally connected devices and to facilitate the sharing of pertinent information with the responsible parties for those connected devices. Critical events to be stored by the system must, at a minimum, include: (i) A record of all drug delivery (ii) Commands issued to the pump and pump confirmations (iii) Device malfunctions (iv) Alarms and alerts and associated acknowledgements (v) Connectivity events ( *e.g.,* establishment or loss of communications)(6) Design verification and validation must include results obtained through a human factors study that demonstrates that an intended user can safely use the device for its intended use. (7) Device labeling must include the following: (i) A prominent statement identifying the drugs that are compatible with the device, including the identity and concentration of those drugs as appropriate. (ii) A description of the minimum and maximum basal rates, minimum and maximum bolus volumes, and the increment size for basal and bolus delivery, or other similarly applicable information about drug delivery parameters. (iii) A description of the pump accuracy at minimum, intermediate, and maximum bolus delivery volumes and the method(s) used to establish bolus delivery accuracy. For each bolus volume, pump accuracy shall be described in terms of the number of bolus doses measured to be within a given range as compared to the commanded volume. An acceptable accuracy description (depending on the drug delivered and bolus volume) may be provided as follows for each bolus volume tested, as applicable: Number of bolus doses with volume that is <25 percent, 25 percent to <75 percent, 75 percent to <95 percent, 95 percent to <105 percent, 105 percent to <125 percent, 125 percent to <175 percent, 175 to 250 percent, and >250 percent of the commanded amount. (iv) A description of the pump accuracy at minimum, intermediate, and maximum basal delivery rates and the method(s) used to establish basal delivery accuracy. For each basal rate, pump accuracy shall be described in terms of the amount of drug delivered after the basal delivery was first commanded, without a warmup period, up to various time points. The information provided must include typical pump performance, as well as worst-case pump performance observed during testing in terms of both over-delivery and under-delivery. An acceptable accuracy description (depending on the drug delivered) may be provided as follows, as applicable: The total volume delivered 1 hour, 6 hours, and 12 hours after starting delivery for a typical pump tested, as well as for the pump that delivered the least and the pump that delivered the most at each time point. (v) A description of delivery hazard alarm performance, as applicable. For occlusion alarms, performance shall be reported at minimum, intermediate, and maximum delivery rates and volumes. This description must include the specification for the longest time period that may elapse before an occlusion alarm is triggered under each delivery condition, as well as the typical results observed during performance testing of the pumps. (vi) For wireless connection enabled devices, a description of the wireless quality of service required for proper use of the device. (vii) For any infusion pumps intended for multiple patient reuse, instructions for safely reprocessing the device between uses.

Predicate Devices

Related Devices

Submission Summary (Full Text)

{0} FDA U.S. FOOD &amp; DRUG ADMINISTRATION # 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ## I Background Information: A 510(k) Number K231826 B Applicant Insulet Corporation C Proprietary and Established Names Omnipod 5 ACE Pump D Regulatory Information | Product Code(s) | Classification | Regulation Section | Panel | | --- | --- | --- | --- | | QFG | Class II | 21 CFR 880.570 – Alternate Controller Enabled Infusion Pump | CH – Clinical Chemistry | ## E Purpose for Submission: Modifications to the device to add a new mobile application which is compatible with iOS devices. ## II Intended Use/Indications for Use: A Intended Use(s): See Indications for Use below. B Indication(s) for Use: The Omnipod 5 ACE Pump (Pod) is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The Omnipod 5 ACE Pump is able to reliably and securely communicate with compatible, digitally connected devices, including automated insulin dosing software, to receive, execute, and confirm commands from these devices. The Omnipod 5 ACE Pump is intended for single patient, home use and requires a prescription. Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993-0002 www.fda.gov {1} C Special Conditions for Use Statement(s): Rx – For prescription use only. The Omnipod 5 System is NOT recommended for people who: - are unable to monitor glucose as recommended by their healthcare provider - are unable to maintain contact with their healthcare provider - are unable to use the Omnipod 5 System according to instructions - are taking hydroxyurea as it could lead to falsely elevated CGM values and result in over-delivery of insulin that can lead to severe hypoglycemia - do NOT have adequate hearing and/or vision to allow recognition of all functions of the Omnipod 5 System, including alerts, alarms, and reminders. The Pod must be removed before Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan, or diathermy treatment. In addition, the Controller and smartphone should be placed outside of the procedure room. Exposure to MRI, CT, or diathermy treatment can damage the components. The Omnipod 5 ACE Pump (Pod) is compatible with the following U-100 insulins: NovoLog®, Humalog®, and Admelog®. III Device Description The Omnipod 5 (OP5) ACE Pump is a wearable, tubeless insulin pump intended to be used with a compatible controller such as an interoperable automated glycemic controller (iAGC) for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The OP5 ACE Pump is a component of the OP5 System, which also includes the OP5 Application (“App”). The OP5 ACE Pump (may also be called “OP5 Pod” or “Pod” for the body-worn physical component implementing the ACE Pump functionality) pairs through secure Bluetooth technology and can only be paired with one controller for its use life (up to 80 hours). The ACE Pump sends delivery confirmation, state information, and alarms and alerts to the compatible App/controller. Data logging is performed by the Pod components and App, where insulin delivery history is viewable through the App/controller software. The OP5 Pod is identical to the predicate Omnipod DASH System Pod (K191679) except for having additional electronic hardware components on the printed circuit board assembly (PCBA), new battery/power supply, and additional modules of software. The OP5 Pod is a small, lightweight, single-use, sterilized device designed to attach to the body via an adhesive pad that is heat-staked to the bottom of the Pod. The Pod’s adhesive backing keeps it in place for up to 3 days and is applied to areas with a layer of fatty tissue including the abdomen, hip, back of upper arm, upper thigh, or lower back. When used with an interoperable continuous glucose monitor (iCGM), the Pod should be placed within line-of-sight of the CGM. Once removed, the Pod cannot be reapplied. K231826 - Page 2 of 5 {2} The Pod includes an insulin reservoir that can be filled with 85 – 200 units of compatible U-100 rapid-acting insulin. Insulin is delivered through a soft cannula that is automatically inserted into the subcutaneous tissue by the Pod. The Pod is waterproof to 25 feet (7.6 meters) for up to 60 minutes. The Pod housing includes a viewing window at the insertion site for checking proper cannula placement and integrity. K231826 - Page 3 of 5 ## IV Substantial Equivalence Information: A Predicate Device Name(s): Omnipod 5 ACE Pump (Pod) B Predicate 510(k) Number(s): K203768 C Comparison with Predicate(s): | Device & Predicate Device(s): | K231826 | K203768 | | --- | --- | --- | | Device Trade Name | Omnipod 5 ACE Pump | Omnipod 5 ACE Pump | | General Device Characteristic Similarities | | | | Intended Use/Indications For Use | Intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The Omnipod 5 ACE Pump is able to reliably and securely communicate with compatible, digitally connected devices, including automated insulin dosing software, to receive, execute, and confirm commands from these devices. The Omnipod 5 ACE Pump is intended for single patient, home use and requires a prescription. | Same | | General Device Characteristic Differences | | | {3} | Omnipod 5 App Operating System | iOS and Android Operating System | Android Operating System | | --- | --- | --- | V Standards/Guidance Documents Referenced: ANSI AAMI ISO 14971:2019 Medical devices – Application of Risk Management to Medical Devices IEC 62304:2015-06 Medical Devices Software - (Software life cycle processes) IEC 60601-1-2:2020-07 Medical Electrical Equipment- Part 1-2: Collateral Standard: Electromagnetic Disturbances - Requirements and Tests IEC 60601-1:2020-08 Medical Electrical Equipment - Part 1: General Requirements for Basic Safety and Essential Performance IEC 60601-1-6:2020-07 Medical Electrical Equipment - Part 1-6: Collateral standard: Usability IEC 60601-1-8:2020-07 Medical Electrical Equipment - Part 1-8: Collateral Standard: Tests and Guidance for Alarm Systems in Medical Electrical Equipment and Medical Electrical Systems IEC 60601-1-10:2020-07 Medical Electrical Equipment - Part 1-10: Collateral Standard: Requirements for the development of physiologic closed-loop controllers IEC 60601-1-11:2020-07 Medical Electrical Equipment - Part 1-11: Collateral Standard: Requirements for Medical Electrical Equipment and Medical Electrical Systems Used in the Home Healthcare Environment ANSI AAMI IEC 62366-1:2015-06 Medical Devices – Part 1: Application of Usability Engineering to Medical Devices ANSI AAMI HE75:2009/(R)2018 Human Factors Engineering – Design of Medical Devices VI Performance Characteristics: A. Analytical Performance The analytical performance of the Omnipod 5 ACE Pump was previously established and described in the public decision summary for K203768. B. Other Supportive Instrument Performance Characteristics Data 1. Human Factors: Human factors validation tests were conducted with the Omnipod 5 App (iOS) installed on a compatible mobile device with interoperable technology. A total of 4 formative studies were conducted. After each study, information was fed back into the design of the User Interface. The final device design was evaluated in the summative study performed with 60 representative participants interacting with the device in a simulated use environment. All K231826 - Page 4 of 5 {4} study participants received training that was consistent with the training that patients would receive with the commercial product. Usability evaluations assessed comprehension and usability of the device for critical device tasks. Results of the study demonstrated that the device could be used safely by intended users in the intended use environment when used in combination with a digitally connected device. 2. Software: Detailed information on software of the device was reviewed and found to be acceptable. 3. Electromagnetic Compatibility and Wireless Coexistence: Insulet performed EMC and wireless coexistence evaluations including testing to appropriate standards for EMC (IEC 60601-1-2:2020-9) demonstrating that the device is immune at appropriate EMI exposure levels. Insulet also performed wireless coexistence testing consistent with RTCA/DO-160G to demonstrate that the device will perform as expected in the home healthcare environment. 4. Basic Safety and Essential Performance (Electrical Safety): Insulet performed testing to demonstrate compliance with basic safety and essential performance in accordance with IEC 60601-1, IEC 60601-1-6, IEC 60601-1-8, IEC 60601-1-10, IEC 60601-1-11, and IEC 60601-2-24. The device complies with those standards. 5. Cybersecurity: Detailed information on cybersecurity of the device was reviewed and found to be acceptable. The sponsor also provided a software bill of materials, which provided details on all software used in the device and the hardware platform that the device was installed on. This included all manufacturer-developed, commercially licensed, open source, and off-the-shelf software components (including firmware as relevant), along with an identification of the hardware runtime environment in which each resides, with relevant version and/or model information, as well as details on whether each component was actively supported by its manufacturer or legacy licensed. VII Proposed Labeling: The labeling supports the finding of substantial equivalence for this device. VIII Conclusion: The submitted information in this premarket notification is complete and supports a substantial equivalence decision. K231826 - Page 5 of 5
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