Are spring diabetes device roll outs going to be worth it?

Groundhogs day again? Are spring diabetes device roll outs going to be worth it?

Back in 2019 I wrote an article on how media Hype impacts our diabetes management. Now here we are, a global pandemic passing behind us,  on the cusp of “release season”. (This is what I call the spring/summer period where we tend to see most our devices and upgrades launch either in the market or the info launches to providers at our various national conferences) After the lull in development and approvals brought about by Covid restrictions the diabetes community has been eagerly waiting at the windows for spring to arrive and shed some much-needed light and color back into our world! The prolonged sense of anticipation has also left us wanting more of what we’ve been promised for so long.

Now I like springtime, new blossoms, and new diabetes tech toys as much as the next person! But at the risk of sounding like a curmudgeon, I advise those salivating for something new to add to their diabetes management to look deeper into what is actually on offer. Unfortunately, our prescribers are often just repeating what the sales and clinical reps for device and pharma companies are telling them. And wow do the reps have shiny data! They make every step forward sound like the next best thing to a cure! And the data is certainly there.

Advancements in hybrid closed loop from the Medtronic 670 system was life changing for many with diabetes, and life-saving for some! But for others the system was… well I’d say nightmarish, but that implies that you ever got a full night’s sleep with the thing! The 770 system was functionally the same thing, and the 780 is looking to be a little more robust with users able to set targets from 100-150 in 10 mg/dl increments But it still does not allow for extended bolusing, leaving those of us with slowed digestion or low glycemic index diets really struggling. The system will feature auto bolusing which is a big leap ahead of the current Medtronic HCL offerings, but how it determines insulin delivery is still mired in the proprietary “secret sauce” that Medtronic makes neither clear to users, or visible in their reports. The one big plus will be that the system will automatically put the user into what it currently calls “Smart guard” when they are kicked out of, or disable automated basal delivery. This makes much more sense than the multi menu hidden path to turning on the “Suspend before/on low” features currently in use. (That’s right if you turn off automode you have to turn ON that protection, it’s not automatic!) Get ready for a whole new world of jargon too. It seems that the only verbiage Medtronic has kept the same for the 780 is basal and bolus!

But the 780 is still on hold awaiting the FDA’s golden rays to shine upon them. What about the Omnipod 5 that just got FDA approval? Well, don’t hold your breath on seeing this system before opening day! Heck, you may not see it until well after the All-Star Break. Advanced clinical release (Where physicians and Omnipod certified pump trainers with diabetes get to use the system in advance of market release) is the norm, but Omnipod has only allowed Insulet employees with type 1 to get their hands on the system so far. So, we are waiting right alongside everyone else. Will the wait be worth it? We are advising avoiding early buy in if you like tight control, have variable insulin needs for different days of the week, month, etc. or if you like a hands-on proactive approach to your management. In short, if you did not like the Medtronic systems you probably won’t like Omnipod 5 either.  Here we have another system that uses the patient’s Total daily insulin use to calculate its adjustments, maximum basal, autoboluses, pretty much everything except the target! So if you use a lot of insulin while sick, hormonal, stressed out, eating more, doing less or on a steroid medication, or less form lower carb intake, more activity, adjunctive medication use etc. The system is going to continue to use the previous days to weeks (Omnipod is being frustratingly obtuse about exact time frames) to decide how much insulin to give you on the following day when the situation reverses. The only real place of stand out with Omnipod 5 over Medtronic 770 is the use of the Dexcom sensor which is far less burdensome for the user, and the lack of tubing (Which is not a benefit for every situation) If you have a lot of trouble with lows, you’d prefer a very hands-off approach to management and do not have much variability in your daily insulin needs from day to day/week to week. The Omnipod 5 system will probably be fine for you. But if you like to be able to extend boluses, have a proactive hand in adapting to metabolic needs or have wider fluctuations in your total daily insulin use, it looks like the groundhog predicts a longer wait for you. We recommend at least waiting until more savvy users, and clinicians who are not under the Insulet umbrella get a chance to test the system out and report back so you can make a sound decision. We are a little concerned on the customer support side as well. Omnipod has always been known for having reps who are knowledgeable and helpful in supporting users. But the education that the reps have gotten thus far on Omnipod 5 seems murky, at best, and mired in “proprietary” double talk dancing around hard facts or numbers that make all the difference in how we live life with a hybrid closed loop system. Considering the fact that the company had over a year between FDA submission and approval to educate their front line educators the vague nature of the education shared is very reminiscent of the Medtronic 670 roll out where users asked questions and received pat answers about sensor placement and “Trusting the system”, rather than usable actionable education. We sincerely hope that in the time before market roll out we ALL have access to transparent direct information on just how the system works and how we can best work with the system to achieve our management goals.

As for Tandem, they’re still basking in last year’s sunshine with Control IQ. We should see the ability to bolus from the app come along this summer, but that won’t change anything about how the system delivers insulin, but will be a welcome piece of convenience for some users (Note that it is a very specific phone/software compatibility for roll out)

Dexcom has submitted data to the FDA for the G7 CGM transmitter all in one device that they’ve had in development. Reports look promising for an improvement over the current product with hopes for a smaller price tag. And Dexcom has confirmed ongoing partnership with Tandem and Omnipod for use of the G7 with those HCL systems.

As we in the Mid Atlantic enjoy what we refer to as “fool’s spring” where the weather hits 75, but we are back into the 20s by the weekend, a word of caution. It looks like Spring, but don’t put away your snow shovels just yet! And for your diabetes management.  There are advancements coming, but whether they’re worth investing your money and more importantly your management efforts in, remains to be seen.