In the words of the iconic RuPaul “You better werk!”
This is exactly what I think every time I try some new diabetes tech. You’re not reading a typo. There is work, this is the basics, the math, the engineering, the functionality of a properly functioning person or system. Then there is WERK. Werk is that “extra something”, the individuality, empowerment, creativity, and skill that someone brings to the given circumstances.
Whether a system works is easily quantifiable in studies and is touted by marketing and sales reps. In these terms all the FDA-approved hybrid closed loop systems we have stand on pretty equal footing.So what is the real difference between these systems?
This is where WERK comes in.
Werk is the individuality brought to performance. When it comes to how a hybrid closed loop system really works in our real life it is all about how we can WERK the system! The ability to optimize the system to work best for our individual needs is key to being empowered by a system rather than a slave to it. The problem is WERK can not be measured by studies or the FDA, it’s hard to quantify but we KNOW it when we see it. A system that WERKS leaves us feeling stronger and less burdened by our diabetes management.
I recently did a trial of the Medtronic 770 system in hopes that the addition of an app and a marketed improved CGM experience would improve on the user experience. Unfortunately, while the system worked, it certainly did not WERK! Were my blood sugars comparable to what I see from my manual management and use of Tandem X2 with Control IQ? Yes. However, the system was intensely burdensome. I experienced 6-9 alerts daily for insulin suspends, calibrations and system required blood sugar checks. This is on a day with 100% time in range! Every week I had to turn off the sensor entirely to get a full night’s sleep after being awakened for a calibration in the wee hours. Meanwhile, I was not able to Werk the system beyond trying to minimize calibration requests. There is no way to compensate for high fat, hormones, or other metabolic needs that increase insulin needs.
My experience with Control IQ was that the introduction of their app made a huge difference in my ability to werk the system. I was suddenly able to see exactly what the system was doing with insulin at all times with just a glance! This made optimizing the system for exercise easier and since we can override bolus recommendation at any time I was even able to fill insulin back in where system reductions or suspends were compromising post parandial results. However the 770 app offers NO additional management tools. The app offers no additional info beyond what the 670 pump screen shows. You can swipe for a report on the day’s time in range and avg bg, but is this going to help me with my day-to-day living with diabetes? No. No ability to extend boluses, no ability to impact basal delivery to anticipate changes in needs, and rigorous steps in turning the system off and back on really take any individuality and empowerment away from us and the app does not change anything about one’s individual diabetes management.
The ability to follow someone’s data can be a great tool for care providers and to provide a safety and security net for independent adults. It has also been shown in study that having someone follow one’s data leads to improved time in range. This is likely related to having added support and encouragement on taking timely corrective actions. However this in range data can be shared with other systems by using Dexcom follow apps, the only data unavailable on follow with the Tandem system is insulin data.
The big difference in living with these systems brings me some concern with Omnipod 5 coming to the market. We continue to look for ways to werk this system but these seem to be few. We can not use alternate profiles to impact basal insulin delivery. We also have no extended bolus ability on Omnipod5. The upside is that we are using the Dexcom so we are not expecting the burden of repeated daily alerts and data loss, and the system does appear to be easier to enter and exit automated insulin adjustment at will so we can take matters into our own hands when needed. The system also does have a follow app that Insulet says they intend to have available at product launch.
When looking at a system it’s important to know what we are looking for. For users who really want to be hands-off, have safer sufficiently stable control to reduce complication risks any system can work. But if we want tight control, minimal interruption from alerts, and the ability to really optimize and individualize our insulin delivery and diabetes management we need to look for a system that WERKS!
And for my fellow Drag Race fans, remember Momma Ru always tells us “If you can’t love yourself..” you know the rest!
Alicia’s diverse nursing career has given her experience with a broad range of clients and a variety of health conditions in addition to diabetes. One of her passions is advocating for the needs of her patients, whether it be in overcoming insurance restrictions, obtaining community resources, or coordinating with school systems and medical providers.