Tandem Mobi insulin pump with interoperable technology

K240309 · Tandem Diabetes Care, Inc. · QFG · Mar 21, 2024 · Clinical Chemistry

Device Facts

• Record ID: K240309
• Device Name: Tandem Mobi insulin pump with interoperable technology
• Applicant: Tandem Diabetes Care, Inc.
• Product Code: QFG · Clinical Chemistry
• Decision Date: Mar 21, 2024
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5730
• Device Class: Class 2
• Attributes: Therapeutic, Pediatric

Intended Use

The Tandem Mobi insulin pump with interoperable technology (the pump) is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The 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 pump is intended for single patient, home use and requires a prescription.

Device Story

Tandem Mobi is an Alternate Controller Enabled (ACE) insulin pump; screenless design with LED, sound, and vibratory status indicators. Operates via Tandem Mobi Mobile Application; app serves as primary controller for programming basal/bolus delivery, managing profiles, and viewing CGM/pump data. Communicates via Bluetooth Low Energy (BLE) with compatible iCGMs and interoperable automated glycemic controllers (iAGC). Used in home settings by patients; transmits therapy data to Tandem Cloud. Benefits include automated insulin delivery management and expanded age indication (≥2 years).

Clinical Evidence

No clinical data provided. Substantial equivalence supported by bench testing leveraged from K223213, human factors analysis, and software verification/validation.

Technological Characteristics

Ambulatory, battery-operated, rate-programmable infusion pump. Motor-driven delivery mechanism. Connectivity via Bluetooth Low Energy (BLE). Visual, audible, and vibratory alarm system. Disposable 2mL cartridge (Ethylene Oxide sterilized, SAL 10^-6). Non-sterile pump housing. Compatible with U-100 insulin and FDA-cleared infusion sets with t:lock connectors.

Indications for Use

Indicated for management of diabetes mellitus in individuals 2 years of age and greater requiring insulin therapy via subcutaneous delivery.

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

• Tandem Mobi insulin pump with interoperable technology (K233044)

Submission Summary (Full Text)

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

March 21, 2024

Tandem Diabetes Care, Inc. Jordan Barkhimer Sr Regulatory Affairs Specialist 12400 High Bluff Drive San Diego, California 92130

Re: K240309

Trade/Device Name: Tandem Mobi insulin pump with interoperable technology Regulation Number: 21 CFR 880.5730 Regulation Name: Alternate Controller Enabled Infusion Pump Regulatory Class: Class II Product Code: QFG Dated: February 2, 2024 Received: February 2, 2024

Dear Jordan Barkhimer:

We have reviewed your section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (the Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database available at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

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Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30, Design controls; 21 CFR 820.90, Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801 and Part 809); medical device reporting of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safetyreporting-combination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

# Joshua Balsam -S

Joshua M. Balsam, Ph.D. Branch Chief Division of Chemistry and Toxicology Devices OHT7: Office of In Vitro Diagnostics Office of Product Evaluation and Quality Center for Devices and Radiological Health

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# Indications for Use

Submission Number (if known)

Device Name

Tandem Mobi insulin pump with interoperable technology

Indications for Use (Describe)

The Tandem Mobi insulin pump with interoperable technology (the pump) is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The pump is able to reliably and securely communicate with compatible, digitally connected devices, including automated insulin dosing software, to receive, and confirm commands from these devices.

The pump is intended for single patient, home use and requires a prescription.

The pump is indicated for use in individuals 2 years of age and greater.

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

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#### 510(k) SUMMARY

| Company | Tandem Diabetes Care, Inc<br>12400 High Bluff Drive<br>San Diego, CA 92130 |
|-----------------------------|------------------------------------------------------------------------------------------------------------|
| Prepared | 02 February 2024 |
| Contact | Jordan Barkhimer<br>Sr. Regulatory Affairs Specialist<br>[phone]<br>[e-mail] |
| Trade Name | Tandem Mobi insulin pump with interoperable technology |
| Common Name | Ambulatory Insulin Pump |
| Classification Product Code | QFG |
| Classification Name | Alternate Controller Enabled Infusion Pump |
| Regulation Number | 21 CFR 880.5730 |
| Device Class | Class II |
| Predicate Device | K233044, Tandem Mobi Insulin Pump with interoperable technology |

#### I. Device Under Review

The Subject Device, Tandem Mobi insulin pump with interoperable technology ("Mobi pump", "the pump"), is an Alternate Controller Enabled (ACE) Infusion Pump intended for the infusion of insulin into a patient requiring insulin therapy. The Tandem Mobi insulin pump with interoperable technology ("pump") is screenless and includes visual LED, sound, and vibratory indicators to alert the user of the pump status. The Tandem Mobi insulin pump with interoperable technology system also includes: the Tandem Mobi Mobile Application and a 2mL (200 insulin unit) Tandem Mobi cartridge and a compatible FDA cleared infusion set. The Tandem Mobi Mobile Application ("Mobile app") displays all information from, and is the primary controller of, the pump. Through the Mobile app, users will program all aspects of basal and bolus insulin delivery therapy including managing personal profiles, viewing pump and CGM data, and actively acknowledging all pump and mobile app alerts, alarms, reminders, notifications, and messages. The Tandem Mobi Mobile Application will also be used to transmit historical pump and mobile app therapy data to the Tandem Cloud. The Tandem Mobi Mobile Application will be made available via the Apple® App Store for iOS compatible smartphones based on completed device verification and validation. The Tandem Mobi cartridge is a disposable insulin cartridge compatible only with the Tandem Mobi pump.

The Tandem Mobi ACE pump can be used for basal and bolus insulin delivery with or without a CGM or with any compatible interoperable automated dosing algorithm.

The pump may be used in combination with a compatible continuous glucose monitor (CGM) system. Use of CGM is optional.

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#### II. Intended Use/ Indications for Use

The Tandem Mob Insulin Pump with interoperable technology (the pump) is intended for the subcutaneous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The 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 pump is intended for single patient, home use and requires a prescription.

The pump is indicated for use in individuals 2 years of age and greater.

| | Predicate Device<br>K233044 | Subject<br>Device |
|-----------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for<br>Use/ Intended<br>Use | The Tandem Mobi Insulin Pump with interoperable<br>technology (the pump) is intended for the<br>subcutaneous delivery of insulin, at set and variable<br>rates, for the management of diabetes mellitus in<br>persons requiring insulin. The pump is able to<br>reliably and securely communicate with compatible,<br>digitally connected devices, including automated<br>insulin dosing software, to receive, execute, and<br>confirm commands from these devices.<br><br>The pump is intended for single patient, home use<br>and requires a prescription.<br><br>The pump is indicated for use in individuals six<br>years of age and greater. | DIFFERENT<br><br>The pump is<br>indicated for<br>use in<br>individuals 2<br>years of age<br>and greater. |
| Prescription<br>Use | Prescription is required. | SAME |
| Insulin Type | NovoLog or Humalog U-100 insulin | SAME |
| Infusion Set<br>Type | Compatible, FDA cleared infusions sets with t:lock<br>connectors manufactured for Tandem Diabetes Care. | SAME |
| Pump Type | An Alternate Controller Enabled Infusion Pump (21<br>CFR 880.5730) | SAME |
| Compatible<br>Interoperable<br>Devices | Compatible with:<br>• DEN170088: Dexcom G6 Continuous<br>Glucose Monitoring System or other<br>compatible iCGM<br>• K200467: Control-IQ technology | SAME |
| | Predicate Device<br>K233044 | Subject<br>Device |
| Communication<br>with<br>Compatible<br>Interoperable<br>Devices | Bluetooth Low Energy (BLE) | SAME |
| Principles of<br>Operation | Delivery of Insulin (Bolus and Basal) programmed<br>by patient based on health care provider<br>recommendations. | SAME |
| Pump<br>Technological<br>Characteristics | The Device is an ambulatory, battery operated, rate-<br>programmable infusion pump designed for the<br>subcutaneous delivery of insulin, at set and variable<br>rates, for the management of diabetes mellitus in<br>persons requiring insulin. The device includes a<br>disposable cartridge which is motor driven to deliver<br>patient programmed basal rates and boluses through<br>an infusion set into subcutaneous tissue. | SAME |
| Alarm Type | Visual, audible, and vibratory | SAME |
| Bolus<br>Calculator | The Device contains a built-in bolus calculator | SAME |
| Bolus and Basal<br>Insulin Control | Yes | SAME |
| Display of<br>Primary<br>Glucose and<br>Therapy<br>Information | The Device can display Glucose and Therapy<br>information and trends from the pump and<br>compatible interoperable devices.<br><br>The pump does not include a graphical user<br>interface. Instead, Primary Glucose and Therapy<br>information and trends from the pump and<br>compatible interoperable devices are displayed in the<br>Tandem Mobi Mobile Application. | SAME |
| Use of Mobile<br>Application | The t:connect mobile app is not optional and has the<br>following functions:<br>View pump therapy data, trends, alerts,<br>alarms, and notifications. Program Correction Boluses, Bolus Override,<br>and Food (Standard) Boluses. Terminate (Cancel or Stop) all bolus types<br>regardless of origin of bolus request being<br>made on the Tandem Mobi Insulin Pump or<br>the t:connect mobile app. Update historical pump data to Tandem<br>Cloud The t:connect mobile app when paired with<br>Tandem Mobi Insulin Pump and iOS | DIFFERENT<br>t:connect<br>Mobile App<br>was split into<br>two apps, one<br>specific to<br>t:slim X2<br>(t:connect<br>Mobile App)<br>and the other<br>specific to<br>Tandem Mobi<br>(Tandem Mobi |
| | Predicate Device<br>K233044 | Subject<br>Device |
| | compatible smartphone, will be able to<br>control all aspects of pump therapy. | Mobile<br>Application) |
| Sterilization | The pump is provided non-sterile. | SAME |
| | The cartridge is provided sterile via Ethylene Oxide<br>Gas to a Sterility Assurance Level (Sal) 10-6. | |
| Cartridge<br>Length of Use | Every 3 days for compatible insulins. | SAME |

#### III. Technological Characteristics Compared to Predicate Device K233044

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#### IV. Overview of Non-Clinical Performance Tests

Appropriate testing was performed to confirm the Subject Device met specified requirements and performed as intended. See summaries below.

### Usability/Human Factors:

No new Human Factors testing was performed to support this 510(k) Notification. A comparative Use Related Risk Analysis was performed to support this 510(k) Notification.

### Software Verification and Validation:

No new Software testing was performed to support this 510(k) Notification.

# Electrical Safety/ EMC:

No new Electrical and Electromagnetic Compatibility (EMC) was performed to support this 510(k) Notification.

### Insulin Compatibility and Biocompatibility:

No new insulin compatibility testing was performed to support this 510(k) Notification.

### Sterilization and Shipping:

No new sterilization and shipping integrity of the system.

### Special Controls:

Evaluation and adherence to the Special Controls of the Predicate Device (K233044) demonstrates continued assurance of the safety and effectiveness of the Subject Device.

### Clinical Testing:

Clinical testing was provided to support this 510(k) Notification. The clinical testing provided was the same testing provided in 510(k) K232380.

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## Conclusion:

The Subject Device serves the same function as the Predicate Device. Furthermore, the Subject Device performs insulin therapy functions that are the same as that of the Predicate Device. The required technical documentation provided in this Special 510(k) demonstrates the Subject Device is as safe and as effective as the Predicate Device. Therefore, the Subject Device has been evaluated to be substantially equivalent to the Predicate Device and does not raise new or different questions of safety or effectiveness.