What CGM systems are available in 2018?
Question: what do Cerberus (the hound from hell), Chimera (the fire-breathing beast) and the backfield for the Super-Bowl-winning Phiadelphia Eagles have in common?
Answer: All are 3-headed monsters capable of kicking some serious butt.
Why bring this up in a diabetes blog? Simple. The world of diabetes is chock full of 3-headed monsters. We have three insulin makers, three dominant meter manufacturers, three pump companies, and for the first time, three companies producing CGMs (continuous glucose monitors).
Competition is definitely a good thing – it keeps all parties on their toes, striving to innovate, improve, and serve the customer in the best way possible while keeping costs down. But having multiple options can make everything seem a bit more confusing. There is no doubt that CGM can improve the quality of life and blood sugar control for just about everyone with diabetes. But which system is best for you?
When making a choice, it helps to understand what each system has to offer: the good, the bad, and the ugly (see – another threesome!). We do our best here at Integrated Diabetes Services to remain fair & impartial when it comes to these types of comparisons. We also try everything out personally before recommending anything to our patients. So here are some facts and observations that might help you to become a more educated consumer.
THE THREE HEADS
Presently, personal-use, CGM systems are available from:
- Dexcom
- Abbott
- Medtronic
Dexcom’s system, called G5, will be replaced in the summer of 2018 by the G6 (don’t you love the creative names?). G5 and G6 have many characteristics in common, but G6 offers a number of advantages, so we’ll discuss both.
Abbott’s system, called Freestyle Libre, was introduced in the US earlier this year, and has been available in other parts of the world (albeit a slightly different version) for the past several years.
And the latest entrant, Medtronic, is on the precipice of introducing the Guardian Connect system, a CGM that is not linked to a pump and can be used by just about anyone.
HEAD TO HEAD COMPARISON: The Latest Continuous Glucose Monitors
Dexcom
Dexcom is the system that most people are familiar with and has become somewhat synonymous with CGM. The Dexcom G5 (to be replaced by the G6 in mid-2018) features a comfortable, easy-to-insert, long-lasting (approved for 7 days, most get about two weeks of use) sensor that produces the most accurate data in the CGM business. Following a two-hour warmup period (during which data is not available) and initial fingerstick calibration, G5 asks for fingerstick calibrations at least once every 12 hours. It continues to provide data even without the calibrations, but regular calibration is necessary to ensure ongoing accuracy.
The MARD (average difference between sensor values and lab values) is around 9%, and Dexcom clearly outperforms the other sensor in terms of accuracy when glucose levels are in a low range. The re-usable transmitter emits a signal that carries approximately 20 feet, has a 3-month battery life and does not require any kind or charging or other maintenance. The receiver displays the data (current glucose values updated every five minutes, trend graphs and rate-of-change arrows) and emits alerts (customizable beeps or vibrations) for pending high/low glucose values. The high/low alerts can be customized by time-of-day. The receiver can take the form of a handheld touch-screen receiver, a smart phone (iPhone or Android), or Tandem X2 insulin pump. Those using a smart phone can have the data transmitted for viewing on a smart watch. Because the data generated by G5 is stored in the cloud, loved ones have the option of seeing live reports on their cell phones and receiving alerts in the event of potential problems.
Dexcom’s recently approved G6 will offer everything G5 has to offer, plus a number of new benefits: An even simpler 1-button insertion process, a flatter-profile sensor/transmitter, vastly improved day-1 accuracy, a 10-day sensor usage cycle (compared to the current 7-day cycle), a sensor that is unaffected by acetaminophen (Tylenol), and an optional predictive alert for very low glucose values. The biggest improvement is that G6 is CALIBRATION-FREE. No fingersticks are required. Yet it achieves the same accuracy as G5 WITH calibrations. Not bad! However, G6 can accept calibration values in case the sensor is drifting off course and deviating significantly from fingerstick values. The calibration entry allows the sensor to get back on track and improve its accuracy from that point forward.
Reports can be generated quickly and easily via Clarity software on either a PC or smartphone. Data and reports can be shared automatically with healthcare providers in a variety of ways. Dexcom is also compatible with just about every “midware” program (for merging data pump & CGM data), including Tidepool, Diasend and Glooko.
Freestyle Libre
Freestyle Libre has some but not all of the features of a traditional CGM. The sensor and transmitter are combined into one compact unit that inserts very, very, very easily. After a 12-hour warmup period, the user can “scan” the sensor with a handheld receiver to see a current glucose value along with a trend arrow and graph of the most recent eight hours of data. The sensor/transmitter is replaced every 10 days (assuming the adhesive holds in place), and no re-use of sensors is possible. NO fingerstick calibrations are required. In fact, you CAN’T calibrate Libre, even if your fingersticks values differ by quite a bit from what the sensor is showing.
Libre is relatively inexpensive compared to other CGM systems (about $60 for the durable receiver/scanner, $40 per sensor).
The accuracy of Libre is good despite the absence of fingerstick calibrations. It has a MARD of about 10%, and the sensors are not affected by acetaminophen. However, Libre is far less accurate when glucose levels are on the low side, producing false alerts (reading low when glucose isn’t really low) about 40% of the time. And the inability to calibrate the system can sometimes leave the user with a sensor that runs chronically higher or lower than actual glucose values.
But the major drawback is the lack of alarms/alerts for pending high and low glucose levels. The user has to physically “scan” the sensor in order to generate any data and see what is going on with their glucose level. This can expose users to highs and lows any time they are not scanning, such as during the night, between meals, while driving, and when exercising.
Libre also lacks the ability to transmit data to a cell phone or to “share” the data electronically with loved ones and caregivers. This will likely change over the next several years (there is even a company that is marketing a product to amplify the signal and send it to a smartphone), but for the time being, the only person who can see what’s going on is the one who is scanning the sensor. Downloading is limited to Freestyle Libre desktop software, which does not merge data from other devices (such as pumps). However, Libre and pump data can be merged through the Tidepool data management system.
Guardian Connect
The Guardian Connect system from Medtronic features the same Guardian sensor that is used with the Medtronic 670G hybrid closed-loop pump. The sensor insertion process is relatively simple and painless, although the taping process can be clunky and cumbersome. The transmitter uses Bluetooth technology to send signals to the Guardian Connect app that runs on various smartphones. After a 2-hour warmup period, glucose readings are transmitted to the app every five minutes. The sensor is intended for seven days of use, although many people find that they can re-use the same sensor beyond seven days. However, as was the case with previous versions of Medtronic’s CGM, the transmitter must be removed from the sensor and re-charged on a weekly basis.
What’s really different now compared to prior Medtronic CGMs is the accuracy and reliability of the sensor. When calibrated 3-4 times daily (using a really good meter, such as the Contour Next from Ascensia), its accuracy is close to that of Dexcom: a MARD (average discrepancy between sensor and LAB values) of 9-10%. The Guardian Connect App provides the user with high/low alerts that are customizable by time of day. It also features predictive alerts that can help the user guard against highs and lows up to 60 minutes before they occur. Although these types of long-term predictive alerts may generate some false alarms, they can also help users to spend more time within a safe target glucose range.
Another cool thing about Guardian Connect is… well… connectability. Data from the app uploads automatically into Medtronic’s Carelink software. This allows quick, easy access to a variety of reports by users as well as their healthcare providers. Plus, loved ones can receive alerts via text message on their smartphones whenever trouble arises. Medtronic has also developed a new feature for users: Sugar IQ, a data analysis system that points out how everyday activities affect glucose levels. Of course, this will require logging information into the app, and there’s no telling whether it will generate truly useful/applicable observations, but the prospect does sound interesting.
| Dexcom G5/G6 | Freestyle Libre | Medtronic Guardian Connect | |
|---|---|---|---|
| MARD (lower number means better accuracy) | 9% | 10% | 10% |
| FDA Approved For ages | Age 2+ | Age 18+ | Ages 14-75 |
| Calibration Required? | G5 – yes – 2x daily G6 – NO, but can calibrate if sensor is off-track | No, and not possible | Yes – 3-4xdaily |
| Sensor Life | G5: 7-14 days (or more) G6: 10 days | 10 days | 7 days |
| Warmup time (New Sensor) | 2 hours | 12 hours | 2 hours |
| Transmitter | Lasts 3 months, no recharging | Fresh Transmitter connected to each sensor | Must re-charge weekly |
| Display options | Smart phone smart watch (via phone BT connection), Tandem X2 pump Handheld receiver | Handheld scanner | Smart phone Smart watch (via phone connection) |
| Hi/Low Alerts | Yes, customizable | None | Yes, customizable, including extended predictive alerts |
| Live Data Sharing | Yes – high/low alerts and current glucose level/trend | None | Yes – high/low alerts |
| Downloading/Data Analysis | Automatic upload to Clarity software. Compatible with most midware programs for merging data with other devices (Diasend, Glooko, Tidepool) | Freestyle Libre software Tidepool (midware) | Automatic upload to Carelink Software Sugar IQ program for analyzing data |
| Cost/Coverage | Approx $300 per transmitter $80 per sensor $600 per receiver G5 covered by Medicare and most private insurance plans | Approx $60 for scanner $40 per sensor Covered by Medicare and most private insurance plans | Approx $1000 per transmitter $80 per sensor Coverage Pending |
CHOOSE YOUR HEAD
Unlike choosing which of Cerberus’s heads is going to turn your head into its own personal lunch, choosing a CGM is really a no-lose proposition. You will undoubtedly benefit from any system you choose. However, as is the case with insulin pumps, certain ones may be a better choice for you personally.
DEXCOM G5/G6
DEXCOM G5/G6 is a great option for anyone who wants a reliable, proven system that is simple and flexible – particularly those who are treated with intensive insulin therapy. The customizable high-low alerts and “sharing” features make it ideal for those trying to ward off serious hypoglycemia. Although the sensors are a bit pricey, the ability to re-use them (until they stop working properly) helps keep the cost down. Those looking to improve their diabetes management and spend more time within their target range can certainly benefit. Dexcom is also in cahoots with a number of companies developing hybrid closed-loop systems, so use of Dexcom now creates a more seamless transition to future technologies.
FREESTYLE LIBRE
FREESTYLE LIBRE is a nice choice for those who are at little risk of hypoglycemia, which includes most people with type-2 diabetes who are not taking insulin. The prolonged warm-up period and lack of high/low alerts can leave the user vulnerable to dangerous glucose levels. Also, the inability to calibrate the system may frustrate users who micro-manage their insulin and demand a high degree of accuracy.
It can also be a reasonable option for those who are easily distracted or annoyed by the alarms/alerts generated by the other CGM systems. Finally, Libre is a good option for those who must pay out-of-pocket for their equipment and supplies. The scanner costs a fraction of what the “hardware” costs with the other systems, and the sensors cost about half.
MEDTRONIC GUARDIAN CONNECT
MEDTRONIC GUARDIAN CONNECT carries the Medtronic name, which means different thing to different people. The company invests a ton in research & development, and is financially secure for the long-haul. Medtronic puts a great deal of its resources into “what to do with the data.” Their Carelink program and new Sugar IQ algorithm can be instrumental in helping users (and their clinicians) learn from the data and make therapeutic adjustments. Technically-oriented users may enjoy these and other features of the Medtronic system.
Because out-of-pocket costs guide many of our health care decisions these days, it may be helpful to know that the Dexcom G5 and Freestyle Libre are covered by most private and public health insurance plans (including Medicare). Medtronic and Dexcom G6 should be covered by most private plans, but not yet by Medicare.
To learn more about the various CGM options and determine which system best suits you, feel free to contact our office and schedule some time with one of our CGM-wearing CDEs.
I have only ever tried Libre, and it works fine. My sensor stays on for the full 14 days, and it does probably under-estimate at the lower end, so really low readings have to be taken with a grain of salt. (Those whose sensors fall off: scrub the site where you plan to fix it really well; get someone else to do it, if it’s hard to reach. Then wait until the alcohol completely dries. Then punch the application in firmly; it’s only a fiber, not a needle, and won’t hurt you.)
The wait time is only 60 minutes, y’all; what’s this nonsense about 12 hours? I understand the disappointment about the inaccuracy at the lower end, and even the price. But the warm-up time hasn’t been 12 hours since I was using the system.
Thanks for the balanced observations Arch.
I would caution scrubbing a site as this removes natural skin oils and protective outter layer that can increase irritation or allergies with use. Glad the Libre is working well for you, it really is a great tool! We are always glad that we have options!
Hi there, Nemaura Medical just got the CE approval for their non-invasive SugarBEAT CGM. It seems promising. Anyone have any details research on this?
We’ve been keeping an eye on this tech for a while. it really lacks the accuracy that other CGM options provide for insulin dosing. BUt having a non invasive option is amazing for some populations and the Type 2 community could definitely benefit.
I have been using the Freestyle Libre 14 day sensors for a year now. Using the Libre system I have now got my A1C to 6.1, The warmup period for the sensor is 60 minutes . I don’t mind having to physically scan for a glucose reading, because I use the phone app and my phone is always near me. I love having the tight control over my blood sugar with the Freestyle Libre System. Great customer service also !
Very well written and informative review/comparison. Do you have any info on the eversenxe system?
keep an eye out in the coming weeks, Gary is writing up his review after using it. Following our social media is a great way to get our most up to date reviews.
I’m using 630g mini med and was using the enlite sensors. Had problems keeping them on and not very accurate and had to calibrate 3 times a day. Also very costly.
I am now trying Libre with no calibration but also is not very accurate because I check bs occasionally. Usually 30 to 40 points off and to me that’s not acceptable when Libre shows 50 and it’s really 90.
I just want something more accurate with less finger sticks. Any real ideas out there??
Hi Clara,
Your Libre experience is common. I would think you’d likely benefit form and enjoy the Dexcom CGMs rather than the Libre, they are more accurate and have the added bonus of real time alerts for high or low blood sugars available.
I found the Guardian sensors to be only marginally better than the enlights sensors. Still too far off to be of real value. For me, constantly woken up with pump alarming that I’m hypo when I am not.
I turned down the hypo setting to 50 to try for better results and still wakes me up. I find Minimed to be an arrogant company to deal with. This does not work for you, you must be the problem.
Yesterday’s phone call the rep kept wanting to go over best practices. After the second time, I asked her what am I doing wrong? No answer, tells me I’m doing it all correctly. They want me to put the sensor in my arm. I tell them I’m willing but I can’t insert and tape it by myself. They have nothing to offer. So after hanging up, my take is I’m doing nothing wrong but it is still my fault according to Minimed. I hope they lose market share and support because of this attitude. being proprietary didn’t help the old mainframe computer companies.
I’m locked into this junk for the next 4 years minimum.
your transmitter should actually only be locked in for one year. when it is time for a new one you should be able to opt for whatever CGM you can get coverage for. Pumps are usually the part that is locked in for the 4 year warranty period. so hopefully there’s a light on the horizon (And yes only an octopus could do all that taping on their arm!)
After working with the Dexcom G6 for a little over 100 days now, my current opinion is one of disappointment.
There are some features that stand out such as the Sensors run for 10 days and transmitters need no charging, as they run for 90 days. Also, they let you set up both the Dexcom receiver and your cellphone or smartwatch to receive data and warnings. All positive features.
So what is so disappointing, you ask? This is strictly my interpretation of Customer Service instructions and my personal experience. Namely, the readings from the G6 can be up to 30% different from your blood glucose meter’s reading and still be acceptable, no callibration required nor should you do one. Callibrate only if the difference between the CGM and BGM is GREATER than 30%.
In fact too many callibrations may cause sensor errors and you may need to replace the sensor early. A 30% difference is a huge predictor between having a very low or very high reading or, indeed having a sudden hypoglycemic reaction (one great resource for having a CGM—to prevent such situations. That being said, I am learning to rely on blood glucose meter more often than anticipated since callibrating the G6 too often can be problematic.
While I understand the basis for testing glucose is different for each monitor type (interstitial fluid vs blood) I would think after an initial callibration after the warm up period would help remedy that issue. Being that G6 is still new, I hope Dexcom will resolve this issue soon as I am aleady looking at alternative CGMs.
Amigo Juan
Te saludo muy afectuosamente desde Arequipa- PERÚ, soy un paciente con más de 30 años con Diabetes Tipo 2, vengo utilizando insulina desde hace 8 años; te cuento que últimamente estoy leyendo sobre los Monitores de Glucosa Continuos y especialmente sobre el Kit DEXCOM G6, me ha interesado este equipo en vista que tengo problemas para regularizar mí Glucosa en la sangre.
Quiero agradecerte infinitamente por la ayuda que me puedas brindar, especialmente sobre la forma, lugar de adquisición y su posible costo de este equipo.
Hello Lucio,
We work with patients around the world, and even have an educator who is fluent in Spanish. If you need assistance with diabetes management or technology use feel free to reach out for an appointment.
May I ask where is your reply to John April 2019 ? I have stayed with G5 till now July 2020 but will not be able to get them after December. I am hypoglycaemic unawares and brittle I need the alerts to be accurate! A 30% higher than true value could kill me . Why has dexcom taken G5 off the market? When this problem still exists???
HI Janice,
most users do not observe more than a 15% accuracy discrepancy with the G6, though some people have struggled with the system. The G5 was discontinued to make room for the coming G7 product and more advanced interoperability products as technologies companies all do.
We can not speak for Dexcom directly as we simply review and educate on devices we have no role in their production marketing or sales.
I think Libre should be out of the question for most users. I find it almost useless without the alarms for lows and highs. Needing to scan the sensor on demand has no traction with me.
Dexcom G6 is what I would get if the transmitter was smaller. I really don’t mind sticking fingers. I do not have any kind of needle phobia. It would be nice to have Dexcom with its alarm system and a sensor the size of Libre’s. That I would go for.
From what I understand Libre 2 was just approved in Europe and it brings alarms to the table. Whoohoo! Then, Dexcom also announced their new version called, you guessed it G7. It won’t get approved by FDA until late 2020 from what I heard, and it introduces a much smaller transmitter.
I’ve been T1 for over 10 years and I use test strips. However it would be nice to know when I get lows and prevent them. I hate the bulky transmitters/sensors and dread bumping it off…
the G6 transmitter is only a little thicker than the libre, it does not stand up over the sensor cradle at all, which makes it a lot smaller and easier to wear than the G 5, but we are also looking forward to smaller technology, the less obtrusive it can be, the better!
BUt we agree, and studies agree that alerts are central to improving blood sugar management, safety, confidence and quality of life! Flash meters like Libre have their place not they just don’t give most intensive insulin therapy users what we need.
Ive heard that medtronic CGM is now covered by medicare. The cost of CGM is prohibitive for me so that would be helpful. Ive been on medtronic pump for about 20 years i think and im not very tech savvy so it serms like the simplest system for me. My pump is due for replacement so id like medtronic information but nobody calls me back. Ive tried the first CGM they offered but it was a pain to insert, i like dexcoms inserter is the medtronic CGM easier to use now
Medtronic, Dexcom and Libre are all covered by medicare.
Medtronic’s CGm is pretty labor intensive(lots of requests to calibrate, lots of button pushes), Dexcom G6 is by far the simplest but is not distributed to medicare patients YET.
I agree with Alicia as far as price management. I worked so hard to get a Medtronic 670g in Oct. 2018 and really loved it!!! Lowered my HbA1c by 0.7. Insurance rolled over this year and now I can’t afford the sensors. Insurance will only cover 60% after deductible and forced to go through 2nd party supplier who marks up a month’s worth of sensors to $728. If I get all of my supplies and sensors – $1000/month (pre-deductible) – $600/month after I meet my deductible. The cost from Medtronic is currently $121/sensor – not $80. ($608 per box of 5) – check the website for current pricing.
I have an autistic and mild MR nephew with diabetes. He does not have the ability to test, monitor or inject himself. He refuses testing, and he is now on metformin and other oral meds but I see the insulin injections are coming and that’s going to be a real problem for us. I’m looking for monitoring equipment and possibly an auto- injection system for his soon to be required insulin.
He has Medicare and medicaid but I am retired and on a fixed income without much surplus.
Can you recommend a monitoring system that could later be coupled with an insulin pump or auto- injection apparatus?
I sincerely appreciate your time and effort writing this comparison, it’s the only article I’ve found, and the open comments help too.
DExcom and Libre are both approved by medicaire, thought medicaid coverage would differ by state and MCO. I would recommend reaching out to a case manager with his MCO for more guidance there. The Dexcom pairs with the Tandem X2, and in another year may also pair with the Insulet Omnipod (Pending medicare approval).
He might also benefit from an insulin pump, which would reduce the interaction with needles to once every three days, but these also have draw backs for patients with behavioral concerns. The Tandem X2 and Medtronic 630 are medicare approved, however pumps are not typically medicaid approved devices, so again this would be important to discuss with a case manager.
Another option might be using an injection port such as the Medtronic Iport. this is a device that is inserted once every 3 days and insulin can be injected through that port.
I strongly recommend that you reach out to a case manager or social worker with your local diabetes clinic or hospital system to help you navigate the insurance and price management piece of diabetes. This can be a bigger challenge than the disease itself!
I use a Dexcom G5 and am very satisfied with it. HOWEVER…the inefficiencies of the Dexcom ordering and shipping process are serious and require constant attention and phone calls for the user. I also find it to be utterly ecologically irresponsible with their wastefulness in packaging and shipping. Who designs this stuff with the endless cardboard and the repeated sending of plastic-wrapped old literature with every box?
I’ve been using the Freestyle CBGM since November 2018. I’ve not lost any sensors in that time. (I always clean off the site before I apply.).
The accuracy is questionable at times. Freestyle once measured LOW, I didn’t feel low. Did a blood test and it measured 3.9 (70.2). This amount of disparity is unusual, when I’ve compared, I often find the BG a unit higher (e.g. 5.0 on the Freestyle CBG vs 6.0 BG ). The Freestyle now only requires 1 hour after applying to start doing tests.
I’m getting my sensors at Costco (it’s closer than the Pharmacy attached to my doctors office.) It was very easy to switch to Costco, I just took the box from my last order to Costco pharmacy and they did the rest). They have to order them, but I think in only takes a couple of days). Still not cheap, but most of the cost is covered for me.
I don’t need to buy many test strips now. (I only test if I find the results questionable.)
P.S. I’m on an Omni Pod pump.
Can’t wait for some one to have one device (without cords) to do Pump and CBG.
Now what! Have had issues contacting Dexcom tech support for different sensor issues, (been on hold for as long as 1 hour and 15 minutes) Now I hear they are moving the entire tech support out of the country. Unlikey I’ll ever be able to reach them again. Wish there was a company that cared more about the people and less about the dollar.
What about eversense? Isn”t it good for 90 days
At the time his article was written eversense was awaiting its 90day wear approval from the FDA, which is now has! Eversense is a great CGM option with the best accuracy available on the market at this time.
I have been a type 1diBetic for 48 year and have a 14 year old daughter who has had diabetes for 12 years. I use the Mini Med 670 pump and com and she uses the Dexcom’s G6. With an old Mini Med Pump. The Dexcom’s G 6 is more accurate than the Guardian sensor there for we are in the process of getting my daughter the T Slime pump that connects with the G 6..The G 6 last longer and is anode accurate sensor then and of Mini Meds.
Cary
Thanks for sharing your experience Cary
I have been using the FreeStyle Libre 14 Day since Nov. 20018 and it is NOT accurate at ALL. my sensors fall off in 3 days. and the only give you 1 box of test strips for 3 months, but the monitor is always asking you to test your BG level. PLUS, you have to test cause it is NOT accurate any way. Out of 7 sensors (3 month supply) I think I’ve only gotten 1 or 2 sensors to stay on for the whole 14 days.
I have been Type 1 since 1978 or for the last 40 years. My HgA1c used to be between 6.0% and 6.8% most of the time going back and reviewing my A1c test results from decades ago.
In January 2016 I switched to a very High Protein, very Low Carbohydrate diet with negligible Fat, bringing my A1c consistently between 4.9% and 5.1%.
I use MDI (multiple daily injections) up to 13 per day with Humalog, Humulin R and Lantus. The application of Dexcom G5 since mid 2016 definitely is a very valuable addition although I can NEVER rely on Dexcom readings when injecting Humalog, and/or Humulin R. I measure my BG 5 to 8 times a day including middle of the night.
I greatly appreciate Dexcom technology as it is today and hopefully, in the next 7 to 10 years, some company will develop Continuous Blood Glucose Monitor (CBGM) that will obsolete interstitial fluid CGMs.
How does the new Libre 14 day system compare to the 10 day system?
accuracy is reportedly the same
I’m back to say I am receiving a Medtronic Connect CGS system this week.
I had tried the Dexcom G6 last month, and was excited over the ability to see my numbers without all the finger pricks. However, my insurance company does NOT cover it at all. Nor will it cover the Libre system.
I must say the people I have dealt with at Medtronic have been wonderful, working with me in order to receive it before the end of the year in order to minimize the cost to me.( I do not work for any of these companies.)
I’ve been t1 for 25 years, and am looking forward to working with the latest technology to improve my control.
Just curious how you liked the Medtronic device compared to the Dexcom. My daughter was just diagnosed with T1 and I am trying to figure out what CGM to get. I am leaning toward the Dexcom but want to make sure to do my due diligence. Any thoughts comparing the two would be greatly appreciated.
can the Dexcom G6 send live updates and alerts to phones outside the range of the transmitter (if the user has a phone on them with the app) or is that a function solely available on the Medtronic?
both the medtronic guardian cgm and dexcom cgms have the ability to share alerts and data with other care providers who do not need to be in range, they and the user simply need a cellular internet or wifi connection (Depending on how the app is set up)
can the Dexcom G6 send live data and alerts to phones out of range from the user (the user has a phone in proximity with the app), or is that an option solely available on the Medtronic?
dexcom cgms have the ability to share alerts and data with other care providers who do not need to be in range, they and the user simply need a cellular internet or wifi connection (Depending on how the app is set up) and a companion app.
PLEASE READ MY COMMENTS UNDER MY NAME REGARDING DEXCOM & ONE OF THEIR SUPPLIERS. SOME INSURANCE COMPANIES SUCH AS MINE WILL ONLY COVER MY DEXCOM PRODUCTS THROUGH SOLARA.
SINCE YOU HAVE RECOMMENDED DEXCOM, I FEEL ITS ONLY FAIR TO KNOW EVERYTHING. The ratings for both are pretty poor as well as on YELP for the things I & others on this sight speak of. It’s only fair for you to inform your readers of both sides as well as it is for you to recommend their products.
Thank you
Denise, we don’t make any blanket recommendations for any products, we share the information available. We do not review third party suppliers or insurers, just the devices themselves.
T1D for more than 40 years. Pumper for 25 years. Have been using MM 670G with CGM for 18 mos. My control is great but it can be labor intensive. I’ve also worn about 10 Dexcom G6s. LOVE IT!! I’ve compared the G6 without finger stick data against my 670G CGM with multiple finger stick data and they are very close. In target 83% for both and graphs are very close. MM was first to get to the hybrid closed-loop. Henceforth, in target 83% with 1-2% mild hypo and an A1c of 6.5-6.8%. They took the hit to get it approved by the FDA and there were extra layers required by the FDA adding to the work load of the patient. Now, FDA has approved upgraded transmitter that MM will replace for free in the next 6 mos as they get their inventory. Still finger sticks though. For now. Competition is good! Now I want a 670G with Bluetooth and no finger sticks. And to address alarms from my phone. And charging once a week is way cheaper than replacing every 3 mos with Dexcom or every 2 weeks with Libre.
Now for the Libre…..Not worn but only because of what their literature states. That 40% of the time that it reports hypoglycemia when you scan, your sugar is actually normal. And it tends to fall off before the 14 days. NO way!!
FYI, I don’t work for any of the companies.
Thank you for doing this research. So far, this is the only available article I’ve come across comparing the available CGM’s…
I am trying the Dexcom G6 for a week through my diabetes center. I love it, but the cost, even with insurance, is prohibitive. I’m considering using the Libre system. Even without the real time data, I think it will help lower my A1C.
My question..why are the Dexcom and the Medtronic so expensive? I understand the companies need a profit, and money for research. However, as many t2s and t1s as is in the population, I think using a cgm would be a HUGE help in in the public health sector, lowering the cost of complications and number of deaths.
Ah, well..I’ll keep my fingers crossed that sometimes the cost will come down.
Thank you for the information!
Great article I ‘ve been diabetic for 45 years My first insulin pump was a destronic and took special insulin which most of the time was on back order. Used a minimed next, the Medtronic for 15 years, then Omni pod which I really didn’t like had no control and now in search of something new again. Taking Tresiba and approx. 4 injections of Novolog a day I think I would like to try the Minimed 670G now lets see what my insurance says about this I have worked in the medical field for 26 years and have crappy insurance and this past year had 6,000 dollars out of my pocket and cost me about 900 a month out of my pay check O well I know there are much worse off people out there Wish me luck on my search for a better healthier life.
This is great info! Just found out I have diabetes by my new doctor that I found through Insurance Line One. Thanks for the info and post.
I’ve used the Dexcom G4/G5 off and on for several years now. There are a few issues with it that I can’t believe the company won’t fix. One is that you cannot turn off the low alarm. In your article you say that it’s a problem for the Pibre that there’s no automatic low alarm. I cannot overstate how wonderful that would be. With the Dexcom, it often has a false low (it tells me I’m below 50 when my body and my meter says I’m at 90). There’s no way to turn it off, which means either I eat something to trick the system but then end up with an avoidable high blood sugar, or I sit and stew while multiple LOUD alarms go off, or I do what I typically do and take the receiver or phone and go hide it in a drawer on the far side of the house. How does that make my life better or control tighter? And all they have to do is make it so that I can turn that alarm off if I want to. I can’t wait for someone to dethrone Dexcom as the “best” CGM company. They don’t seem to care much about their customer’s quality of life at all.
My cvs pharmach was told there is only 12 pharmacies in the USA that is allowed to carry the Free Style Libre. Is this true?
That may be true, but some are huge pharmacy chains like CVS.
After 11 days with the G6, I am not impressed. The new receiver is HUGE compared to the G5. I am consistently places where cell phones are not allowed, so am reliant on the Dexcom Receiver. It does not fit into the pockets of ladies slacks nor can it be attached to a waistband.
The pop-up 1, 2, okay menu when there is any kind of alert or need to access the menu is beyond annoying. I have my numbers set to very narrow parameters to give me tight control of my glucose level. (My last A1C was 5.2.) I want to see not only the current glucose number but the trend line. To do this, I have to tap, tap, tap the screen. Once the trend line is visible, there is still more tapping to get to the correct trend line. There is much less choice here.
The readings on the G6 are no more accurate than those of my G5. I am still doing finger sticks occasionally to check the accuracy. I am also having issues with multiple signal losses that I only occasionally experienced with the G5.
The transmitter is only negligibly smaller. One end of the G6 is a tiny bit smaller; the other end is exactly the same size. The sensor is actually larger for the G6 than the G5.
I experienced very little pain with insertion of the G5 so am not impressed with the “less pain” touts for the G6. The first sensor bled so much that I didn’t think I would ever get all the blood off the transmitter when I removed it after 10 days. The second insertion was VERY painful and also bled. This is something that I rarely experienced with the G5.
The G6 sensors do not adhere as well as the G5. I removed the first G6 an hour early to get myself on a better schedule than the one that resulted from the upgrade kit arriving late. Even removing it early, the sensor was already starting to peel off. This despite the fact that I use Skin Tac. When I inserted the third sensor (more to this story below), it did not adhere would probably have fallen off early if I had not had to remove it due to failure of the system. Again, this is despite the fact that I use Skin Tac.
So, now for the real news. After removing the first sensor, inserting the second G6, and beginning the 2-hour warm up, I received a message that there was a sensor error, please wait. So I waited. In about five minutes, I received a message that the sensor had failed. “Replace it now.” So I did, inserting my last sensor! The same thing happened with the third and last sensor. I immediately called Dexcom support and spoke with a very nice representative that informed me that “this has been happening to other users, too.” After over an hour on the phone (not counting the 50 minutes on hold just to speak with a rep), she informed me that there was nothing else she could do. They would ship 2 new sensors to me overnight deliver. BUT!!!!! The supplies are low and there will be about 7 days before they even ship the thing! Of course, she assured me, once it is shipped, it will arrive the next day.
This rep also told me that there have been many consumer complaints about the new G6 system. Who tested this next generation?! From what I have read inn reviews and been told by the rep, the G6 DOES NOT WORK AS ADVERTISED. I do not recommend the G6. Hopefully Dexcom will fix all the problems before phasing out the G5.
I will probably spend most of my day on hold today with Dexcom reps trying to go back to the G5 system. Overall, it works much better than the G5. Sure, the receiver requires calibration, but al least it is dependable. I never had problems like this with the G5!
I have also had major problems getting my supplies from Dexcom. They claim that it is due to the release of the G6. Whatever the reason, when I have to call multiple times for my order, with an average hold time of about 40 minutes, and my supplies arrive on the afternoon of the day my last sensor dies, that is unacceptable.
Can anyone say IF they have they improved since this post?
Hi Kip, I think the issues Dith was having are probably pretty individual, some people have issues, others don’t. Dexcom has been making efforts to improve customer service and wait times are coming down but are still, unfortunately high. adhesive issues are also quite individual. reciever size has not changed as most users use the phone app.
Im a type 1 diabetic have been since I was 6 ( Currently 41). For years the best I could do was a a1c of 6.7-6.9. most people would say I was in the 6 range and that was good. It was August of last year when I found out my friend ( who was diagnosed with type 2 diabetes in 2000 ) had went completely blind, lost some toes and is on kidney dialysis all this had happened About 5 years ago. It was devastating to see him like this ( he was not overweight ). However he did not check his blood sirgars how he should and it finally caught up to him. It was about that same time last year I started getting a warm sensation in my feet. After this I wanted to get as radical as I possibly could with the a1c. I had been checking my blood about 12;times a day and was so tired of trying to stay ahead of the game I researched and got a dexcom. I set the low level at 70 and the high at 130 and have watched my carb intake to a new degree. Within 3 months, my A1c had dropped to a 5.8!! You read that right the warmth in my feet is gone and has not returned in the past year, my levels are now at 5.8- 6.1. The Dexcom is a huge benefit for me and I think every diabetic should get some type of cgm.
Great article, but here’s a thought about ‘qualifying’ for Medicare. I’ve been a Dexcom user since the G4 Pre-Medicare days. I am a Senior T2, with T1 dependence after an auto accident left me concussed (Mild Traumatic Brain Injury (MTBI)). This was BEFORE Medicare approval. Well guess what, we can put a man on the moon, but NOW, between my Health Carrier, Dexcom, and Medicare, after a year and eight months (post-Medicare acceptance) I still have never had a “Medicare Bundle” shipped from Dexcom.
Here’s Why. Dexcom is the ‘defacto standard’ for CGM, but that’s all they do. FreeStyle and Medtronics have a Medical-savvy parent Corp structure that has protocols in place to deal with the likes of “The Government” and the Health Industry in general. Obviously, little ole Dexcom has the dubious ‘instant success’ (with stock jumping through the roof with the G6) of moving up the ladder so quickly that, in spite of having “Medicare Specialist”, and dedicated Health Plan Liaisons on board, they still can’t administratively position themselves to be a efficient as their CGM.
Don’t get me wrong, when it comes to dealing with the Feds (any entity), it takes some doing, but there will be pain (even for Medicare guys to understand their very own regulations). To understand, you have to make, like me, many, many phone calls to Dexcom, Medicare and my my numerous Health Plans, and talk to many different associates within those organizations, to experience hopelessness of getting different answers and reasoning regardless to virtually the same ‘customer service/care’ questions within that same organization. Something is wrong in Denmark.
You’d think that the ‘hard part’ would be to develop the CGM, getting it out to diabetics on Medicare should be easy. Since Medicare CGM approval, 18 months ago, I’ve only known of one successful placement of a Medicare qualified CGM order placed of three Endocrinologists I’ve visited – Health Plans just can’t seem to get on the same page with Dexcom, which in turn makes Dexcom even more ‘reluctant’ to submit claims to Medicare, instead of submitting a claim, getting a written rejection, then correcting the reason for rejection, then successfully re-submitting for approval – simple.
I have an endo in Las Vegas that had no problem getting me on the Dexcom G5 with Medicare when I was re-diagnosed with type 1 diabetes about a year ago. Everything is paid for through my Part B Medicare plan including insulin and my pump supplies. My gripe with Medicare is that they do not cover the Omnipod Pump except through part D and my Part D provider doesn’t have it on their formulary. If it was, it probably would be a tier 4 which I couldn’t afford the co-pay. Why Medicare only covers Medtronic pumps on Part B is beyond me.
I have been going through the same thing with regards to Medicare and my insurance company. Many different answers from many different people. Bottom line is that Medicare and insurance covered the reader and the first two sensors for the Freestyle Libre. After that they said it was not covered under the DME rules for durable medical equipment. So, I’m SOL.
sensors for the libre have moved to pharmacy benefit coverage, so depending on your Medicare part D and supplemental drug coverage would determine availability of CGM technology.
Searching online and can’t find the size and weight of each of these to compare. Would be a great addition to this article to compare. I’d imagine the longer the battery life and/or addition of bluetooth the larger the transmitter.
great question, we will look into these specs. They are all relatively the same mass and cover roughly the same area, but the exact differences would be interesting.
I have the Libra BECAUSE I am reactive hypoglycemic on top of early LADA. I also pay out of pocket. The Libra drove me crazy because it was so inaccurate and could not be calibrated. Solution? I now use a MiaoMiao to read it every 5 minutes (an upgrade from the NightRider I initially bought) and the Spike app for I-phones so I can calibrate it. The only thing I don’t like is that I can’t figure out how to store and print out the graphs with all of my notes, but someone a bit more tech savvy probably knows how. This has made a more accurate and cost effective solution for me since there’s no way I can afford either of the other two options.
Thanks for the great article..
but as always.. people living outside the us are having a tough time living with t1d and no luck at all with any of these companies.
I live in Egypt.. and I have to tell you.. managing my diabetes is extremely hard while I can barely afford my pump disposables and such..
and to top that off.. most of the said companies dont even bother getting their cgm systems here at all :)
hope this changes some day…
Hosam, we agree! We work with patients around the world and it can be really difficult to get the care, medications and technologies needed.
Thank you for the GREAT article. My Medtronic insulin pump is up next February and I’m looking. Pump is great. CGM helped me learn what was happening in my body the first year or so. But issues with readings and 6 days at most for me of accurate readings was very frustrating. Have been able to stay close to 7 without it so gave it up a few years ago. But I really miss the predictive lows (Type 1 for 51 years) so hoping Dexcom G6 and pump will be better for me. Really appreciate the thorough review and great highlights!
Love my Freestyle Libre
This is an excellent article. I recently did all this research on my own. The cost for the Medtronics CGM was out of the question for me because of its cost, even though it’s probably the best closed loop for the Medtronics pump.
Since now I’m on Medicare, I had to really decide between the Dexcom & Freestyle.
Since I’ve been on the pump for about 20 years and monitored my sugar aboutv6x/day, I did not want to be bothered with all the alerts.
Since I have the Libre, I check my blood sugar twice as much now and it’s so much easier for me. I feel much more in control and my AIC is finally under 7
Enjoy your CGM no matter which one works better for you.
Both the Dexcom and Freestyle are covered by Medicare, and the Dexcom, I believe can communicate with the Tandem pump.
Silvia