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1a.: Re: My trial of Medtronic and Dexcom CGM Systems From: Elizabeth Blake

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1a.: Re: My trial of Medtronic and Dexcom CGM Systems

Posted by: "Elizabeth Blake" poodlebone@yahoo.com poodlebone

Sun Dec 27, 2009 9:36 pm (PST)

Jeff,

Thanks for your comparison of the two systems. From your data, it looks like Dexcom is doing a much better job but it could also be that there was a problem with that particular Minimed sensor. I rarely see such big differences like that anymore. I do find that MM lags too much in detecting lows and that's why I have my low alarm set for 78. I do end up getting annoying alarms when my BGs are stable. I see nothing wrong with steady readings in the 70s while I'm awake and not doing anything strenuous. I also find that it doesn't catch my highs well when I'm asleep but does much getter when I'm awake & moving around. Minimed's sensors do not seem to like inactivity.

I'm looking forward to Dexcom integrating with Animas in the future. I would be willing to switch from a Minimed pump, although I have been very happy with both of my Minimed pumps so far. I have pretty good luck with the MM CGMS but I'm wondering if my insurance would cover Dexcom when my transmitter finally stops working. I've been using it for 1 1/2 years and I know it doesn't have that much time left.

--
Liz
Type 1 dx 4/1987
Minimed 722 + CGMS

>
>From: "Jeff Nathan, Award-Winning Author" <jeff@incredibleassemblies.com>
>To: diabetescgms@yahoogroups.com
>Sent: Mon, December 28, 2009 12:20:39 AM
>Subject: [diabetescgms] My trial of Medtronic and Dexcom CGM Systems
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>I just completed a trial of the Dexcom Seven Plus and the Medtronic
>Paradigm CGMS. I chose not to evaluate the Navigator because of its size. I
>was asked to provide a report on my findings here when I was done, so here
>goes:
>
>Comparing CGM systems
>Before starting a trial, you need to ask yourself,
>"What is the MOST CRITICAL assistance that YOU need from a system?"
>
>For me, that was pretty easy. I have hypoglycemic
>unawareness and, after finding myself behind the steering wheel on one of
>Boston's busiest highways during rush hour with a blood glucose level of
>24 mg/dL, I knew I needed help. (Actually, I didn't know I needed help
>then – I had to raise my blood glucose level first.) My most dangerous
>scenarios are when I am driving and when I am sleeping.
>
>My top 5 priorities fell like this:
>1)
>Accuracy, especially in low range
>a.
>I need to know that I am about to be unfit to drive
>BEFORE I am unfit to drive. I need to be woken up and told that I am in danger
>of hitting a low from which I will NOT wake up---BEFORE I get to that point.
>2)
>Consistent discernable warning when sugar falls below
>50
>a.
>False alarms are better than missed alarms
>b.
>Easy to understand, even if I'm very low
>c.
>Ability to ignore future alarms, if it is stable or
>trending upwards
>d.
>Warning for highs, but accuracy there is not as
>important as it is for the lows
>3)
>Good use model for sleeping
>a.
>No loss of transmission while sleeping. Alarm if that
>happens, but I don't want extra wake-ups if it can be avoided.
>b.
>Alarm that will wake me
>4)
>Not too uncomfortable
>a.
>I don't want to feel it day in and day out
>b.
>Low insertion pain (Okay, I'm a wimp and I like
>to avoid pain whenever possible.)
>5)
>Durable and abuse-able
>a.
>Survives my school visit floor-diving, etc.
>b.
>Survives in basketball and winter ultimate
>So, how did they do? They both did fairly well and
>I'll include additional categories in addition to MY top 5.
>1) Accuracy, especially in low range: advantage
>DEXCOM
>Medtronic explained that the
>technology measures the interstitial fluid glucose level, which lags the blood
>glucose level. If that were the whole story, I would expect to see the 2
>systems with the same delayed response. I did not see that. I'm not going
>to deal with the difference in lag time, per se. As users, the time domain
>needs to tell us trends, but that needs to be coupled with the key question,
>"where am I at RIGHT NOW?" One could argue that this information
>comes from a blood glucose measurement, while the trending information comes
>from the CGMS. I would argue that it would be nice to get both pieces from 1
>source and use the blood testing as the reality tether. That is exactly how I
>plan to use my new DEXCOM system.
>I am including data from my trial.
>BE CAREFUL NOT TO INFER THAT THIS REPRESENTS HOW THE SYSTEMS WILL PERFORM IN YOUR >BODY. Everyone is different.
>Data (all readings are mg/dL):
>DexCom Medtronic Blood
>test finger stick Time
>46 92 63 5:17P
>D1
>51 78 46 6:30
>166 118 171 8:00
>61 84 71 10:27
>173 142 192 5:15A
>D2
>151 131 157 8:00A (recal.
>MM only)
>51 76 32 4:40P
>60 65 57 5:32P
>224 165 221 9:12P (recal.
>MM only)
>63 104 40 10:29P
>59 84 60 11:16P (recal.
>MM only)
>54 91 45 11:52P
>80 85 62 12:40A
>D3
>47 77 44 6:14 (recal.
>MM only)
>86 74 77 10:07 (no
>recalibration)
>53 67 43 11:40
>70 60 66 12:20 (no
>recalibration)
>97 75 84 2:25P
>49 66 43 10:03P
>117 115 109 7:49A
>D4 (no recalibration)
>51 75 52 8:35 (recal.
>MM only)
>68 69 50 10:20
>59 81 64 12:20 (recal.
>MM only)
>52 68 52 12:40 (recal.
>MM only)
>42 57 49 1:22 (no
>recalibration)
>
>2) Consistent discernable warning when sugar
>falls below 50: advantage DEXCOM
>Though both systems were set to
>alarm when I hit 60 or below, I got low warnings from the Dexcom system before
>the Medtronic EVERY SINGLE TIME. In fact, I got no warnings from the Minimed
>system until after recalibrating a couple of times because it didn't
>think I had gone that low. Both systems were easy enough to understand. The
>Dexcom system offered a simple adjustment of the "snooze" feature
>(not bothering me for another half-hour or another 5 hours if my sugar is still
>low).
>
>3)
>Good use model
>for sleeping: advantage
>DEXCOM
>I was able to lose transmission
>with BOTH systems while in bed, pushing the transmitter into the mattress by laying
>directly on it and, for Dexcom, putting the receiver between 2 pillows. Communication
>problems seem to be plausible for both systems. The Dex automatically
>reconnected as soon as it could. The Minimed would have wanted me to go through
>a "find lost sensor" routine while I was sleeping.
>Both alarms can wake me up, but I
>found the Dexcom combination of sound with vibration to be the best solution.
>
>4) Not too uncomfortable: advantage
>DEXCOM (daily), advantage Medtronic >(insertion)
>This is definitely an individual
>issue. You need to try this for yourself.
>For me, the Minimed sensor started
>itching the 2nd day it was in, and it was a very bothersome
>annoyance until I took it out on day 4. The Dexcom sensor started itching on
>day 8 but the itching was mild, recurring maybe once or twice in a day.
>Minimed had the insertion advantage.
>Insertion angle is critical for Minimed, but they have a spring-loaded
>inserter. Dexcom expects you to push theirs in like a syringe. The Dexcom
>sensor is a smaller gauge needle, making it less painful, but the Minimed
>inserter makes things easier and reduces the pain.
>
>5) Durable and abuse-able: advantage
>BOTH
>Both systems were able to survive
>my floor diving and basketball clumsiness. I was unable to play winter ultimate
>during the trial to test that environment.
>
>6)
>EASE OF USE: advantage DEXCOM
>The ability to calibrate anytime,
>stable or unstable, is a distinct advantage for Dex. Medtronic advises to
>calibrate only when stable and that does help with their product, but the 7+
>doesn't care as much. I ran into calibration issues with both systems
>(calibrating Medtronic while unstable and calibrating Dexcom with very high BG
>and not recalibrating as I got lower).
>Transmission loss: After 40 minutes
>or so, Medtronic requires a "find lost sensor" routine. Dex simply
>reconnects automatically and moves on.
>Dex has no worries about ISIG
>numbers or insertion angles or stability for initial calibrations.
>
>7)
>Customer support:
> advantage MEDTRONIC
>Medtronic has a 24/7 help line,
>staffed, for the most part, with people who really want to help. In late hours,
>Dexcom has people on call. I tried this route and was unable to get a call back
>before I had to leave my house. Live people were helpful and courteous.
>
>8)
>EASE OF EVALUATION: advantage MEDTRONIC
>The first thing I want to say is
>that the Clinical Specialists who trained me on each of the systems were
>WONDERFUL. Both were very knowledgeable, friendly, and accommodating.
>Dexcom forced my doctor's office into giving up a room (and they are very
>short on space) and I had to drive there. Medronic made it easy and came right
>to my house.
>I did run into 2 bad DEXCOM sensors
>to start off the evaluation period. This turned out to be a blessing in
>disguise, as it forced me to evaluate the two systems head-to-head, or
>stomach-to-stomach, as it were.
>
>The Medronic system had better transmission range. If you
>are going to perform a trial with both systems, isolate them on different sides
>of your body. I did find that the Dexcom receiver seemed to suffer from some
>interference when placed too closely to the Minimed transmitter (sensor). On
>opposite sides of the body, they each did fine.
>The Dex transmitter has an internal "2 year"
>battery and does not have to be removed for recharging. The Dex receiver needs
>to be recharged every few days. It does function while it is charging but its range
>is reduced.
>
>The Medtronic system means less hardware to carry around,
>but I find the accuracy difference worth the extra piece of hardware. One other
>interesting note: my Medtronic pump can receive data from my blood tester. I
>was told to turn this off when using their CGM (otherwise it would recalibrate
>at every reading, which is non-optimal) whereas I can use this Medtronic
>feature if I DON'T use their CGM. Had their engineers added an OPTION to
>use the transmitted value for calibration (as they have done for the
>hand-entered values), they would not have created an advantage for their
>competition.
>
>Ideally, I would want an alarm that combines level and
>trend. Neither system offered that to me, but even just a level-based alarm is
>a huge life-saving leap over what I had before.
>
>So that's the info from my eval. Now, I am going to
>bed (with my Dex trial sensor still in – 12th day –
>telling me that I am at a stable 91 mg/dL and my finger stick reading just 3 mg/dL
>higher).
>
>Warm regards to all,
>
>-jeff toll-free:
>1-888-967-3386
>Award-Winning Children's Author, Jeff Nathan, presents
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