Monday, 19 January 2015

It's a System Not a Pump. Apparently!

No new blog for months then two in a week! I know, it doesn’t make any logical sense but enjoy it while you can!

On Friday I caught a ridiculously early train to visit Medtronic in Watford as a get-together for some bloggers and other more important people than me.

(I’ll be up-front and tell you they paid for my return train trip and lasagna and profiteroles for lunch. As the return train journey totalled seven and a half hours sitting in a variety of uncomfortable seats to a single destination with no detours I’ll leave it to you to decide whether I was ‘wined and dined’ to a level that might affect my impartiality!)

The purpose of the day from Medtronic’s side was to get feedback from various parts of the diabetes community without outside healthcare professionals to inhibit free speech – not that that is normally enough to make me bite my tongue!

The main subject of the day was their “biggest product launch for ten years”, the imminent arrival of the MiniMed 640G System. There were plenty of facts and as other people made more detailed notes than me, and manage to summarise details in a concise way I struggle with, I’ll point you to them rather than repeating stuff already said.

Go, please do. I won't be offended. But come back!

OK now you’ve read them welcome back and I’ll add bits I picked up.

System? I thought you were going to see a new pump?
I think brainwashed is the term. Just like I know all the words to Let It Go (it wouldn’t be one of my blogs without a Disney hyperlink!) because it’s been repeated so many times in my vicinity; Andy, Mike and the other Medtronic UK people were very well prepared in (nearly) always calling it a system not just a pump. The thinking is that the inbuilt technology is so integrated into their Enlite CGM that they are keen it’s not just a pump upgrade, it’s a new way to approach pump therapy.

Where did the name come from?
OK, I’ll admit it’s not the biggest question for most people but product naming always, worryingly, intrigues me. So here goes:
6 - Sixth variety of MiniMed pump from 1983 onwards.
4 - Fourth CGM algorithm since 1983.
0 - To allow incremental tweaks i.e. next could be 641G.
G – CGM enabled. Why not 640C or 640M? Shrug.
Having said that I like proper names. Veo has the ring of a space-related hero. Hey-ho; numbering it is.

How and when do I get one?
During the last year Medtronic have been testing them around the world and some people (this might be UK-only info) towards the end of last year who began pump therapy on the Veo were given the option to automatically upgrade to the 640G. These auto-upgrades (if eligible you’ll already know) will be started this week. The official worldwide launch begins on Monday 2nd February in four countries only; UK, Australia, Sweden and Denmark. Other countries will then be rolled out but this is subject to local medical approval and hoops to jump through.

Are they replacing existing Veos?
No. A juicy rumour I saw this weekend was that all existing Medtronic Veo users would get an automatic free upgrade. This is not true. Swaps will be down to your usual local pump replacement policy. Your local healthcare provider buying the new system from Medtronic will drive this and supplying you, as happens currently. Sorry.
Initially in the UK they’ll be provided in parallel to the Veo while local commissioning groups get their systems updated but within a short time (about 6 months) all new Medtronic pump supplies will be the 640G system.

Have sensors improved as historically they have a reputation for average performance?
This is an interesting one. The latest version of the Enlite CGM sensor (version 4) was built with this pump in mind. The improved algorithms in the 640G mean that CGM performance of the current Enlite sensor is noticeably improved when used with the Veo/530G.
Personally, as I’ve said previously, I’ve had an OK experience with the Enlite with a reasonable success rate. Others I know have fallen out with it so this improvement ‘might’ tempt them back.

Would I want one if no CGM?
Yes. This is because I’m a bit of a gadget geek and any extra features are always tempting. For me the key (non-CGM related features) are:
  • Waterproof – Splashing about by the pool on holiday with no stress about having to disconnect if popping in and out etc. Official rating of IPX8. This translates as "IPX-8 Protected against water submersion - The equipment is suitable for continual submersion in water under conditions which are identified by the manufacturer (typically 3m)." As a comparison the Libre is IPX7 which is up to 30 mins in up to 1m of water.
  • Battery back-up – The 640G has a built in rechargeable battery than can provide up to 8 hours of use if the replaceable AA (instead of the Veo's AAA) battery runs out. This is pretty cool, as currently my emergency kit bag has to contain a battery as the warning on the Veo can be as small as two hours. Also, a big plus, the type of AA battery used now includes rechargeable for the first time.
  • Set-change alerts – After mistakenly reaching five days on a set recently I love this development. The ability to set an alert automatically to come on at either 2 or 3 days after a set change is one of those features that’s so blooming obvious, yet simple!
  • Bolus from meter - The new Bayer Contour Link XT meter acts as a way to bolus without fishing out the pump from the pocket or dress (at the weekends). The bolus wizard isn't accessible but you can give normal, square or dual-wave boluses. The pump also acts as the USB transmitter for the (soon to be improved) CareLink software for downloading pump data for clinic appointments etc along with the blood glucose readings from the meter.  

Is SmartGuard helpful in real-life use?
We’ve all seen brochures and advertising and taken everything with a big pinch of salt. The promises offered by SmartGuard in reducing the number of hypos and providing a safety mechanism against severe ones sound fantastic. But will it work? For this we have to take the experiences of Sue from Dasang and Helen a person with T1 who also works for Medtronic. I can see the skeptics now saying we can’t trust Helen as she works for ‘them’ so she would say that wouldn’t she? Well, no. I don’t think she would. The official Medtronic peeps said that if Helen or us wanted they’d leave the room they would but no one felt any pressure so we carried on. Helen gave some real-life examples of where the SmartGuard kicked in without her realising and the insulin delivery had already been suspended before she realised there was a possibility she might be going low. The ability to turn the alarms off meant there were times when it stopped then restarted without her knowing at all!
But what about for me? Well this weekend I was doing my usual weekend tasks and junior football stuff and whilst I kept my BGs up by topping up with Fruit Pastilles. The value of something that would have kept me at a slightly higher level without having to stop and test would have been priceless. Yes, the Libre would also have been useful for easy tracking but the idea of the 640G system ‘managing’ me just blows my mind. Temporary basals, again could have been used but for some periods I wasn’t sure how much activity I was doing as it slowly increased until I started so by that stage it was too late.
Once again I’ll admit to being a bit of a techy geek and shiny new things always tempt me but I do believe that, for me, the 640G would be a good replacement for my current Veo. I’ll come back to this though.

I currently extend my life of Enlite (against Medtronic advice). Can I still so this?
A lot of “no comments” and “we do not recommend this” when this idea was suggested. Medtronic could only obviously discuss the 6-day use of the Enlite. If someone found a way to extend it and did so they would need to do this at their own risk. No change there then! 

Will Enlite sensor price be changing on launch of the 640G?
No. Despite other promotions elsewhere, Medtronic UK are not going to be changing the price of the Enlite sensors in the short to medium term. Parallel to this there is running a NICE consultation on the use of Sensor Augmented Pumps. Until this has been completed and published in around October Medtronic will have a limited understanding on potential future volumes and therefore possible mass production volume savings. This is a bit of a disappointment with other subscription promos around the world but this is where we are at the moment.
One slight change is that a MiniLink transmitter and one Enlite sensor will be provided with each 640G system. This removes the initial start-up barrier of the transmitter of £350 for new users.

I’ll admit to being smitten with the 640G system. It’s got a lot of new features that match the competitors’ offerings but I genuinely believe the SmartGuard sets it apart – if the sensor costs are affordable!

Roll on November when I hit 4 years with the Veo and then I wait patiently for Red, my Veo, to break outside its warranty! (Assuming other new technology doesn't cause me even more quandaries!)

Until the next time. Stay safe, enjoy life and try and stop humming LET IT GO!

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