CVE-2018-14781 is a medium-severity vulnerability affecting all versions of the Medtronic MiniMed MMT-508 insulin pump when paired with a remote controller and configured with the “easy bolus” and “remote bolus” features enabled. This vulnerability arises from an authentication bypass via a capture-replay attack on the wireless communication channel between the remote controller and the insulin pump. Specifically, an attacker within wireless range can capture valid command transmissions that instruct the pump to deliver insulin doses (boluses) and replay these transmissions to cause unauthorized insulin delivery. The weakness is classified under CWE-294, indicating improper authentication mechanisms. The CVSS 3.1 base score is 5.3, reflecting medium severity, with the vector indicating the attack requires adjacent network access (AV:A), high attack complexity (AC:H), no privileges required (PR:N), no user interaction (UI:N), unchanged scope (S:U), no confidentiality impact (C:N), high integrity impact (I:H), and no availability impact (A:N). The vulnerability does not require user interaction or authentication, but the attack complexity is high due to the need to capture valid transmissions and be in proximity. No patches or known exploits in the wild have been reported. The root cause is the lack of robust replay protection or cryptographic authentication on the wireless commands, allowing attackers to reuse captured commands to manipulate insulin delivery, potentially causing harm to patients relying on these devices for diabetes management.

For European organizations, particularly healthcare providers and patients using Medtronic MiniMed MMT-508 pumps, this vulnerability poses a significant patient safety risk. Unauthorized insulin delivery can lead to hypoglycemia, which can be life-threatening if not promptly addressed. Hospitals and clinics managing diabetic patients with these devices may face increased liability and operational challenges. The impact extends beyond individual patients to healthcare systems due to potential emergency interventions and loss of trust in medical device security. Additionally, if exploited in a targeted manner, this vulnerability could be leveraged for malicious intent, including causing harm to specific individuals or groups. Although the attack requires physical proximity, the risk remains relevant in clinical settings, patient homes, and public spaces where patients use their pumps. The lack of confidentiality impact reduces the risk of data leakage, but the high integrity impact on insulin delivery commands underscores the criticality of ensuring command authenticity. European healthcare regulators and medical device manufacturers must consider this vulnerability in their risk assessments and patient safety protocols.

Given the absence of official patches, mitigation should focus on operational and procedural controls. First, disable the “easy bolus” and “remote bolus” features unless absolutely necessary, as these enable the vulnerable wireless commands. Educate patients and healthcare providers about the risks of using remote bolus features and encourage manual insulin delivery methods where feasible. Implement physical security measures to limit attacker proximity, such as advising patients to avoid using remote bolus features in public or unsecured environments. Medtronic and healthcare providers should prioritize firmware updates or device replacements that incorporate cryptographic authentication and replay protection for wireless commands. Additionally, continuous monitoring for unusual insulin delivery patterns can help detect potential exploitation attempts. Healthcare organizations should integrate this vulnerability into their medical device risk management frameworks and incident response plans. Finally, collaboration with regulatory bodies to mandate secure design standards for wireless medical devices is essential to prevent similar vulnerabilities in the future.