K Number
K223213
Device Name
Tandem Mobi Insulin Pump with Interoperable Technology
Date Cleared
2023-07-10

(266 days)

Product Code
Regulation Number
880.5730
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
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. The pump is indicated for use in individuals six years of age and greater.
Device Description
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 t:connect mobile app (K203234) and a 2mL (200 insulin unit) Tandem Mobi cartridge and a compatible FDA cleared infusion set. The t:connect mobile app (" 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 t:connect mobile app will also be used to transmit historical pump and mobile app therapy data to the Tandem Cloud. The t:connect mobile app 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, such as the Dexcom G6 Continuous Glucose Monitoring System (DEN170088). Use of CGM is optional.
More Information

No
The summary does not mention AI, ML, or any related technologies. The device description focuses on standard insulin pump functionality and interoperability with other devices and software.

Yes
The device is intended for the subcutaneous delivery of insulin for the management of diabetes mellitus, which is a therapeutic purpose.

No

The device is an insulin pump intended for the delivery of insulin for the management of diabetes, which is a therapeutic function, not a diagnostic one. While it can display CGM data, its primary function is not to diagnose a condition.

No

The device description explicitly states that the system includes a "Tandem Mobi insulin pump with interoperable technology" which is a physical hardware component for delivering insulin. While the system also includes a mobile app for control, it is not solely software.

Based on the provided information, the Tandem Mobi insulin pump with interoperable technology is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is the subcutaneous delivery of insulin for the management of diabetes. This is a therapeutic function, not a diagnostic one.
  • Device Description: The device is described as an "Alternate Controller Enabled (ACE) Infusion Pump" for infusing insulin. It includes components for controlling and monitoring insulin delivery.
  • Lack of Diagnostic Function: There is no mention of the device performing any tests on biological samples (blood, urine, etc.) to diagnose a condition or provide information for diagnosis. While it can receive data from a CGM (which is a diagnostic device), the pump itself is not performing the diagnostic test.
  • Anatomical Site: The insulin is delivered subcutaneously, which is a route of administration, not a site for in vitro testing.

In summary, the Tandem Mobi insulin pump is a therapeutic device used to administer insulin, not a diagnostic device used to perform tests on biological samples.

N/A

Intended Use / Indications for 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.

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

Product codes

QFG

Device Description

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 t:connect mobile app (K203234) and a 2mL (200 insulin unit) Tandem Mobi cartridge and a compatible FDA cleared infusion set. The t:connect mobile app (" 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 t:connect mobile app will also be used to transmit historical pump and mobile app therapy data to the Tandem Cloud. The t:connect mobile app 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, such as the Dexcom G6 Continuous Glucose Monitoring System (DEN170088). Use of CGM is optional.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

six years of age and greater.

Intended User / Care Setting

single patient, home use

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

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

Usability/Human Factors:

Human Factors validation testing was conducted to demonstrate intended users can effectively use the Subject Device for its intended purpose in its expected use environment.

Usability tasks were evaluated in accordance with ANSI AAMI HE 75 Human Factors Engineering- Design of Medical Devices, ANSI/AAMI/IEC 62366-1:2015 Medical devices -Part 1: Application of Usability Engineering To Medical Devices, and, Guidance for Industry and FDA Staff - Applying Human Factors and Usability Engineering to Medical Devices -February 3, 2016.

The results from the Human Factors Validation study demonstrate users can safely and effectively use the features of the Subject Device in expected use environment.

Software Verification and Validation:

Software development activities included establishing detailed software requirements. linking requirements with associated verification and validation activities, software code inspection, software code walkthrough, static code analysis, unit testing, and system level testing to ensure that the software conforms to user needs and intended use. Software verification and validation testing was carried out in accordance with ISO 14971:2019 Medical Devices - Application of Risk Management to Medical Devices, ANSI AAMI IEC 62304:2006/A1:2016 Medical Device Software - Software Life Cycle Processes, FDA guidance General Principles of Software Validation: Final Guidance for Industry and FDA Staff, Mobile Medical Applications -Guidance for Industry and Food and Drug Administration Staff, February 9, 2015, and FDA guidance Multiple Function Device Products: Policy and Considerations- Guidance for Industry and Food and Drug Administration Staff. July 29, 2020.

In addition, Cybersecurity evaluations were carried out in accordance with Content of Premarket Submissions for Management of Cybersecurity in Medical Devices- Guidance for Industry and Food and Drug Administration Staff.

The Subject Device software was verified and validated to meet acceptance criteria and performed as intended.

Electrical Safetv/ EMC:

Electrical and Electromagnetic Compatibility (EMC) Testing were performed according to applicable requirements set forth in IEC 60601 general standard. Results confirm the Subject Device met specified requirements.

Insulin Compatibility and Biocompatibility:

The Subject Device utilizes the same insulin as the Predicate Device. Insulin Compatibility Testing was performed to ensure the indicated insulin performed as intended in the Subject Device. In addition, biocompatibility of the Tandem Mobi sleeve accessory was performed and met the acceptance criteria. Results confirm the Subject Device met specified requirements.

Sterilization and Shipping:

Sterilization, packaging, storage and shipping testing was conducted to ensure the Subject device met the requirements. Results confirm the sterilization and shipping integrity of the system.

Special Controls:

Evaluation and adherence to the Special Controls of the Predicate Device (K203224) and Reference Devices (K200467 and DEN180085) demonstrate continued assurance of the safety and effectiveness of the Subject Device.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s):

K203234

Reference Device(s):

K200467, DEN180058

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5730 Alternate controller enabled infusion pump.

(a)
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.(b)
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 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.

0

Image /page/0/Picture/0 description: The image shows 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, with the letters "FDA" in a blue square. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

July 10, 2023

Tandem Diabetes Care, Inc. Louise Focht Director, Regulatory Affairs 12400 High Bluff Drive San Diego, California 92130

Re: K223213

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: October 14, 2022 Received: October 17, 2022

Dear Louise Focht:

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 (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 located 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.

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

1

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 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 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 (DICE@fda.hhs.gov) or phone (1-800-638-2041 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

Enclosure

2

Indications for Use

510(k) Number (if known) K223213

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 melliting 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 six years of age and greater.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) SUMMARY K223213

| Company | Tandem Diabetes Care, Inc
12400 High Bluff Drive
San Diego, CA 92130 |
|-----------------------------|------------------------------------------------------------------------------------------------------|
| Prepared | June 9, 2023 |
| Contact | Louise Focht
Director Regulatory Affairs
+1 (858) 255 6363
lfocht@tandemdiabetes.com |
| 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 | K203234, t:slim X2 Insulin Pump with interoperable
technology (with t:connect Mobile app) |
| Reference Device | K200467, Control-IQ Technology
DEN180058, t:slim X2 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 t:connect mobile app (K203234) and a 2mL (200 insulin unit) Tandem Mobi cartridge and a compatible FDA cleared infusion set. The t:connect mobile app (" 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 t:connect mobile app will also be used to transmit historical pump and mobile app therapy data to the Tandem Cloud. The t:connect mobile app 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)

4

system, such as the Dexcom G6 Continuous Glucose Monitoring System (DEN170088). Use of CGM is optional.

Intended Use/Indications for Use II.

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.

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

Predicate Device (K203234)Subject Device
Indications for
Use/ Intended UseThe t:slim X2 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 with NovoLog or Humalog U-
100 insulin.

The Pump is indicated for use in individuals 6
years of age and greater. | 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.

The pump is indicated for use in individuals six
years of age and greater. |
| Prescription Use | Prescription is required. | SAME |
| Insulin Type | NovoLog or Humalog U-100 insulin | SAME |
| Infusion Set Type | Compatible, FDA cleared infusions sets with
t:lock connectors manufactured for Tandem
Diabetes Care | SAME |
| Pump Type | An Alternate Controller Enabled Infusion Pump
(under 21 CFR 880.5730) | SAME |
| Compatible
Interoperable
Devices | Compatible with:
DEN170088: Dexcom G6 Continuous
Glucose
Monitoring System or other compatible
iCGM
K193483: Basal-IQ technology
K200467: Control-IQ technology | SAME |
| Communication
with Compatible
Interoperable
Devices | Bluetooth Low Energy (BLE) | SAME |
| Principles of
Operation | Delivery of insulin (Bolus and Basal)
programmed by the patient based on health care
provider recommendations. | SAME |
| Pump
Technological
Characteristics | The Device is an ambulatory, battery operated,
rate-programmable infusion pump designed for
the subcutaneous delivery of insulin, at set and
variable rates, for the management of diabetes
mellitus in persons requiring insulin. The device
includes a disposable cartridge which is motor
driven to deliver patient programmed basal rates
and boluses through an infusion set into
subcutaneous tissue. | SAME |
| Alarm Type | Visual, audible, and vibratory | SAME |
| Bolus Calculator | The Device contains a built-in bolus calculator. | SAME |
| Bolus and Basal
Insulin Control | Yes | SAME |
| Display of
Primary Glucose
and Therapy
Information | The Device can display Glucose and Therapy
information and trends from the Pump and
compatible interoperable devices. | SAME
The pump does not include a graphical user
interface. Instead, Primary Glucose and Therapy
information and trends from the pump and
compatible interoperable devices are displayed in
the t:connect mobile app. |
| Use of t:connect
Mobile app | The t:connect mobile app is optional and its use
is limited to the following:
• View Pump therapy data, trends, alerts,
alarms, notifications, and reminders as a
secondary display.
• Program Correction Boluses, Bolus
Override, and Food (Standard) Boluses.
• Terminate (Cancel or stop) all bolus
types regardless of origin of bolus
request being made on the t:slim X2
Insulin Pump or the t:connect mobile
app.
• Update historical pump data to Tandem
Cloud | SIMILAR
The t:connect mobile app is not optional.
In addition to functions of the t:connect mobile
app as described in the Predicate Device, the
t:connect mobile app, when paired with Tandem
Mobi insulin pump and running on a compatible
smartphone, will be able to control all aspects of
pump therapy in the same manner as the Predicate
Device. |
| Sterilization | The pump is provided non-sterile.
Cartridge provided sterile via Gamma Radiation
to a Sterility Assurance Level (Sal) 10-6. | EQUIVALENT
The pump is provided non-sterile.
Cartridge provided sterile via Ethylene Oxide Gas
to a Sterility Assurance Level (Sal) 10-6. |
| Cartridge Length
of Use | Every 2 or 3 days depending on insulin type
used | SIMILAR
Every 3 days for compatible insulins |

III. Technological Characteristics Compared to Predicate Device K203234

5

6

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:

Human Factors validation testing was conducted to demonstrate intended users can effectively use the Subject Device for its intended purpose in its expected use environment.

Usability tasks were evaluated in accordance with ANSI AAMI HE 75 Human Factors Engineering- Design of Medical Devices, ANSI/AAMI/IEC 62366-1:2015 Medical devices -Part 1: Application of Usability Engineering To Medical Devices, and, Guidance for Industry and FDA Staff - Applying Human Factors and Usability Engineering to Medical Devices -February 3, 2016.

The results from the Human Factors Validation study demonstrate users can safely and effectively use the features of the Subject Device in expected use environment.

Software Verification and Validation:

Software development activities included establishing detailed software requirements. linking requirements with associated verification and validation activities, software code inspection, software code walkthrough, static code analysis, unit testing, and system level testing to ensure that the software conforms to user needs and intended use. Software verification and validation testing was carried out in accordance with ISO 14971:2019 Medical Devices - Application of Risk Management to Medical Devices, ANSI AAMI IEC 62304:2006/A1:2016 Medical Device Software - Software Life Cycle Processes, FDA guidance General Principles of Software Validation: Final Guidance for Industry and FDA Staff, Mobile Medical Applications -Guidance for Industry and Food and Drug Administration Staff, February 9, 2015, and FDA guidance Multiple Function Device Products: Policy and Considerations- Guidance for Industry and Food and Drug Administration Staff. July 29, 2020.

In addition, Cybersecurity evaluations were carried out in accordance with Content of Premarket Submissions for Management of Cybersecurity in Medical Devices- Guidance for Industry and Food and Drug Administration Staff.

The Subject Device software was verified and validated to meet acceptance criteria and

7

performed as intended.

Electrical Safetv/ EMC:

Electrical and Electromagnetic Compatibility (EMC) Testing were performed according to applicable requirements set forth in IEC 60601 general standard. Results confirm the Subject Device met specified requirements.

Insulin Compatibility and Biocompatibility:

The Subject Device utilizes the same insulin as the Predicate Device. Insulin Compatibility Testing was performed to ensure the indicated insulin performed as intended in the Subject Device. In addition, biocompatibility of the Tandem Mobi sleeve accessory was performed and met the acceptance criteria. Results confirm the Subject Device met specified requirements.

Sterilization and Shipping:

Sterilization, packaging, storage and shipping testing was conducted to ensure the Subject device met the requirements. Results confirm the sterilization and shipping integrity of the system.

Special Controls:

Evaluation and adherence to the Special Controls of the Predicate Device (K203224) and Reference Devices (K200467 and DEN180085) demonstrate continued assurance of the safety and effectiveness of the Subject Device.

Clinical Testing:

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

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 Traditional 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.