Product Review: Taking a Deep Look at the Eversense CGM After a 3 Month Trial Run
By, Gary Scheiner MS, CDE
When I took marketing courses as an undergrad (believe it or not, my first job out of college was as a copywriter at an ad agency), I learned two things about new products:
- Their chances for long-term success are slim.
- If they’re going to succeed, they had better offer something a whole lot better than what’s currently out there.
I first learned about the Eversense implanted continuous glucose sensor (from startup company: Senseonics) while attending the American Association of Diabetes Educators annual conference three years ago. My first impression was less than stellar.
Why would anyone want to have something surgically implanted when we have CGM systems that work perfectly fine without the need for an outpatient surgical procedure every three months? Then I dug into the details. Some things about it impressed me, so I decided to give it a try.
How does Eversense CGM work?
The sensor itself is the size of a skinny caplet. It uses optical/fluorescence technology to measure glucose concentrations and emit a very short-distance signal reflecting the measurement.
To insert the sensor, a trained/certified physician, nurse practitioner or physician’s assistant makes a small incision (about ½ inch) on the back of the arm and uses a tool to place the sensor below the skin. It is possible to wear the sensor on other parts of the body, but at this point the FDA has only approved the back of the arm.
After the insertion, special adhesive strips are placed on the skin just long enough for the incision to heal, which takes about a day.
Because the signal emitted by the sensor only travels a very short distance, a transmitter must be taped to the skin directly over the sensor. The transmitter essentially “amplifies” the sensor signal using Bluetooth technology so that it can be picked up by a cellphone. The transmitter also has some intelligence to it – it can vibrate to let the user know if their glucose level has gone above or below user-set targets.
Once the signal reaches the phone, an app displays the user’s glucose in graphic and statistical form, with historical data available right on-screen. Reports can be generated to share with healthcare providers.
The app comes equipped with the usual array of alarms and alerts letting the user know when glucose levels are trending out of a desired range. The data generated by Eversense is stored in the cloud, so reports can be viewed on a smart watch and shared with loved ones
Pros of the Eversence CGM:
> I suppose the main advantage afforded by Eversense is that there is no need to “change” the sensor on a regular basis, as is the case with all other CGM systems.
In the US, the sensor is approved for 3 months of continuous use, and the European version (scheduled to hit the US market in the next year or two) is good for 6 months.
What this means is that there are no “warmup” times other than the day the sensor is first inserted. I believe this type of true continuity makes Eversense an ideal CGM to use with hybrid closed loop systems which depend on sensor data to function.
> If you’re concerned about having something in your body, don’t be. The sensor is made of bio-compatible materials that cause no allergic or immunologic responses. And because there is no discernable metal in the sensor, it need not be removed during standard medical procedures.
> The accuracy of the sensor is quite good. Its MARD (mean absolute relative difference) compared to laboratory glucose values is just below 9%, which makes it the most accurate CGM on the market. By comparison, Dexcom is just below 10%; Medtronic and Abbott Libre remain in double-digits.
> The smart transmitter is also appealing. I don’t usually have my phone on me when running or playing basketball, so I found the high/low vibrations produced by the transmitter to be useful.
> The silicone-based transmitter adhesive holds it in place very nicely with a very low incidence of skin irritation. And by the way, the transmitter can be removed and replaced without losing any data.
> The Eversense cellphone app is relatively easy to use. It generates useful reports and allows for variable alert settings. Being able to see up to 90 days’ historical data, including trend graphs, right on screen is unique to this system.
Cons of the Eversence CGM:
So why isn’t everyone using Eversense? It has its downsides
> The sensor insertion procedure requires an office visit and healing time. It’s not a painful experience (numbing agents are used), but it is inconvenient and leaves a small scar. And it has to be repeated every three months.
> The system requires fingerstick calibrations at least twice daily, and the calibrations can only be performed when the glucose is in a steady-state. The app generates calibration reminder alerts twice daily regardless of whether a calibration was recently performed. That’s annoying!
> The need to have a transmitter on the skin negates many of the benefits of the implanted sensor. Keeping the transmitter working requires a daily ritual that takes about ten minutes. You must remove the transmitter from the skin, remove the adhesive from the transmitter, charge it, re-apply the adhesive, and use a locator guide on the app to re-place it directly over the sensor.
> Personally, I found the glucose trend graph displays on the app to be visually awkward. They could have taken a lesson from the other CGM manufacturers in designing their display screens. While the reports are simple to generate, there is no “overlay” report for quick detection of patterns and establishing cause/effect relationships. I also found the app to drain my cellphone battery faster than the apps for other CGM systems. And for some reason, the app does not allow the user to set their high/low alerts within their target glucose range–something the software engineers need to fix asap.
> In many instances, there is no medical coverage for Eversense. Senseonics is working on this, but they still lack the (near) universal coverage of other CGM systems. Discounts are available for those who lack insurance coverage. The system is not yet approved for use among children. It can be prescribed off-label for kids, but this may further limit insurance coverage. And at this time, there is no inter-operability with any pumps or hybrid closed loop systems. This will likely change, but for the time being, Eversense does not feed data into anything but its own app.
THE FINAL SCORE:
It was that last point that led me to discontinue use of Eversense once my three-months was up.
As a user and advocate of the do-it-yourself Loop hybrid closed loop system, I must use the Dexcom CGM to keep the hybrid closed loop humming along. Were it not for this and the daily calibrations & transmitter maintenance rituals, I would probably still be using Eversense. The accuracy was excellent, and it truly exemplifies the CONTINUOUS aspect of a continuous glucose monitor.
As a first-generation medical device, I feel that Eversense is head-and-shoulders better than anything that preceded it.
Unfortunately, other CGM systems are already on their 4th, 5th and 6th generations, which means that they have already worked out most of the bugs and shortcomings that plagued their first-generation products. The folks at Senseonics are already hinting at next-gen features such as longer sensor life, even better accuracy, fewer calibrations, and a smaller transmitter that requires far less maintenance. In other words, more upside and less burden on the user.
Will it succeed long term? I don’t know, but I hope it does. Competition is a good thing for keeping all the players on their toes and constantly looking to improve.
And that’s a major benefit for us all
Does anyone’s arm and shoulder constantly hurt. I am ending my sensor and getting ready for the 180 day. I concerned with the soreness in my upper arm.
if oyu are concerned about pain in the arm in which you are inserting your CGm I’d guess you are either having site related issues, if there is redness, swelling, or pain at the insertion site follow up with your doctor to rule out infection or localized issues.
otherwise you may be inserting your CGM into muscle which would cause anongoing ache, making sure you’re using the fat layer, not the muscle of the upper arm is key.
I have been trying the Eversense system and really hate it. Having to calibrate it twice a day is cumbersome and if you miss one, you get no readings until you enter several calibrations that must be done hours apart. The readings have not been as accurate as Dexcom G6. Having to charge the transmitter twice daily is also cumbersome and if you don’t put it back on in time, you have to repeat the initialization phase, several calibrations needed, again you get no readings. Having to have doctor visits for both implant and removal makes it even more cumbersome. It does not integrate with any pump or Loop. The app itself is a mess and needs work. The constant vibrations on my arm get to be quite annoying when either it is just to let me know something or I have already treated for a high or low and accepted the alert already. This system seams to be years behind the competition and is not user friendly at all.
We tend to agree. We love to see new options available and hope that this technology continues to develop. It’s certainly not right for everyone but can fill a really useful niche for some (Like swimmers and athletes who would benefit from alerts in situations where they otherwise don’t have a signal or receiver nearby) Definitely make sure your alerts are set appropriately so you’re not getting too many alerts, and that those alert repeats are set far enough out that you’re not getting continued alerts for the same issue. The eversense just got approved for 6 month wear, so that’s am improvement, but we hope that we can see more interoperability and better accuracy with time. Thnks so much for your feedback!
I am a T1 diabetic who has been through a lot of treatment options in my 56 years with this disorder. Most recently I left Dexcom G6 in favor of trying the Eversense system. I have found their literature to be very inadequate in explaining how to use the system. After my first insertion, when the sensor shut down on day 89, I was fine with that but my replacement session was not booked for 10 days. The “Smart Transmitter” wouldn’t quit buzzing every few minutes so I called to find out how to shut it off. Eventually, I ended up discarding it because I had not been told either by tech support or the doctor’s office that it was REUSABJE for up to 1 year! Nowhere in their printed materials, is the Smart Transmitter labeled as reusable! I am now trying to get a replacement transmitter because as of yesterday, I had a new sensor replacement. This will definitely be my last Eversense experience. In MY experience, the glucose readings were almost never as accurate as the Dexcom readings were and TWO fingersticks per day! Dexcom had NONE! Recharging the transmitter for 10 minutes EVERY day! Forget traveling and off-schedule days, they just don’t work into the plan of care! Nice technology from eversense but it needs a lot of work before it is usable in the open market, IMHO! I’m sure everyone’s experience with every system will be different, but this isn’t exactly my first time at the rodeo! My A1c’s range in the 6.x region, my last being 5.5, so I know how to intensively manage Diabetes without complications.
I have been using my Eversense since December 2019. I do like the fact I have more accurate readings than my Dexcom. The main issue I have experienced is that my skin is becoming very sensitive to the white and clear patches. I notice the more that I am taking the patches on and off, it is beginning to leave a rash and causing the skin to itch and become irritated. I also have found that the patches tend to curl or peel off if you sweat too much. Unfortunately, I work construction and I am outside all the time in the hot weather of Florida, and my sensor tends to fall off once or twice a day. I have even used Skin tac and other tacky products to help, but nothing seems to work. Wanting to know if there are any other Eversense users that have experienced this same issue.
HI David, I had the same experience with the adhesive, only it took my skin just days of wear to have issues. You can try some kind of under taping, like ahydrocoloid dressing (bandiad makes some great ones) or even good old tegaderm or IV3000 under the sensor adhesive pad (That’s right adhesive under your adhesive)
giving your skin a little break of even half a day can allow the skin to fully dry and begin to recover that protective outter layer.
I’ll be keeping an eye out for other users who might have more tips
So how do you get the insulin. I see you get the readings but does it then give you insulin?
Eversense is only a CGM, it does not deliver insulin in any way.
This is an update to my early December 2019 comments……….Eversense still does not have an individual or practice to implant the CGM in the Washington DC metro area! This is absurd.
20 minutes from their HQ and no one is home….. I’ve been waiting 6 months and now don’t even hear from my rep.
This has been one of the major problems with Eversense use. if users can not count on having providers available to implant and change the sensor the cost benefit balance is overwhelmingly tipped.
I enjoyed reading your review and always appreciate your perspective in the diabetes tech world. I’m on my 4th Eversense sensor right now which is ending soon and will be getting my 5th shortly. I appreciate your pros/cons list. It is my favorite after trying all including the Dexcom G6. My biggest con to the other products that I rarely am able to get the other sensors to last the full time they are advertised for, so Eversense is the first CGM I’ve had where I get full use of the prescribed time. (And NO, my sensors are not “burning out early” due to high blood glucose levels). I love the accuracy and the on-body alerts as well. Another plus to consider is that most CGM devices show worse accuracy on day 1 after insertion. With Eversense, I only have the first few days that accuracy is lower. After that, it is spectacular, so fewer “day 1’s!” My biggest “con” initially was the calibration requirements, but I have adapted to it well. I and I just charge the transmitter every morning when in the shower. I also love traveling with it. I carry a charger and some extra tapes! As far as all the different “hassles” we have to deal with in managing diabetes, this one addresses my most annoying hassles the best and the few that remain (as with any CGM) fit me well. I agree that it is not the best choice for everyone, but those seeking CGM or who are having other frustrations with their current product should definitely take a good look at this one!!!!
had my Eversense Implant removed after only two weeks because of the
1) The sensor data was often significantly inaccurate. At times, for no reason, it
would oscillate from high to low and back to high in a matter of minutes.
2) The support group had no clue what was going on and provided me with no
help other than saying they had escalated my case.
3) In pre-purchase literature there was no mention that it needed to be
recalibrated twice daily.
I believe a new product should improve on what is already available in the market.
The Eversense CGM fails miserably in that regard for the following reasons:
1) Eversense needs to be calibrated twice a day.
2) The transmitter needs to be removed, recharged and awkwardly
repositioned and taped daily.
3) If you let the transmitter discharge completely, you must redo the entire
initial 24 hour warm up, 4 calibration procedure.
I used the Dexcom’s CGM systems for many years with satisfaction. Then,
switched to FreeStyle 14 day CGM and was absolutely in love with it’s simplicity,
accuracy and NO NEED FOR CALIBRATATION. The Eversense has b
I had the Eversense CGM placed in December 2019. I am beyond thrilled to say the least. Using my glucometer twice a day to calibrate is not a big deal. It is much easier on the fingers than sticking at least 4 times a day. I cannot wait for the US to allow the sensors that will only need to be implanted once a year. I see this as the future of diabetes management. And after 30 years as a type 2 diabetic I finally can see the data in real time of just how well my keto diet is affecting my blood sugars. This has been a game changer and a win win for me.
I’ve been interested in Eversense for 3 months. It’s great.that you no longer need to do finger sticks twice a day and they already have clinical trials for the 180 day sensor approved in Europe!
Before you jump on-board though, make sure they have contracts and trained physicians to do the insertions.
They are headquartered just outside Washington DC and they do not have anyone in place to complete the procedure.
This has been very frustrating and demoralizing.
More doctors offices need to come on board with Eversense. My endocrinologist and insurance carrier did not include Eversense in their list of approved CGMs. It literally took 15 minutes to insert. Maybe the issue is that many doctors don’t want to be bothered with placement due to staffing. I had a 1.5 hrs drive each way to find the closest office approved for insertion. I hope you soon get a provider in your area.
Does Senseonics Eversense has finger stick replacement like Dexcom?
The Eversense cgm has been FDA approved to replace finger sticks for bolus dosing, however it does also require finger stick calibration to maintain that accuracy.
I find your review spot on!
I was having a hard time with the calibration and keeping a schedule for charging, so I ended up calibrating more often, which is the whole reason I decided to switch Eversense, ( not to poke finger a lot)
I think if Eversense can get the sensor to calibrate on its own it would be the perfect glucose meter for me.
Human just approved T1 and T2 coverage nationally. October 26th.
Medicaid just approved coverage November 1st in California.
Senseonics is actually filing the appeals for those denied coverage and they are the one incurring the expense.
here’s a great article from Diatribe on Medicaid and Medicare coverage for CGM use across the country, we look forward to further progress and reduced restriction to come!
I recommend reaching out to accucheck customer support, they can usually resolve the issue fastest.
The blutooth feature can eat batteries faster than a typical pump, but not right from the start like that!
you can also reach out to firstname.lastname@example.org anytime.