Wow. This really shows how far AI has to go yet. It glanced right over all the nuances, and the nuances are where the major differences are.
The algorithms are all vastly different between the 3. One size does not fit all. Both Medtronic and Omnipod 5 use learning algorithms to try and figure you out. They pretty much throw your basal settings out the window and give you very little control over how the systems work. That’s an awesome thing if you struggle with setting appropriate pump settings, but might also trap you in a box that doesn’t quite fit your needs. Learning algorithms are also slow to adjust. They make conservative changes where there are persistent problems. It can take weeks to adapt to changing nsulin needs. That might be an acceptable weakness for some, but it also might be completely inadequate for others whose insulin needs change often.
Between the two, Medtronic’s algorithm is more advanced. It actually tries to recognize your patterns and assign different basal rates throughout the day. It’s biggest shortcoming is the CGM sensors, not the algorithms. Medtronic always seems to lag behind the competition on sensors.
Omnipod 5’s algorithm is the simplest one out there. It really doesn’t learn. All it does is look at the average total daily dose your last pod delivered, and designates half that to be your daily basal for the new pod. So, the hourly basal rate is preset at 1/48th the average total daily dose of the previous pod, then It uses 60 minute predictions to adjust the basal from there. It never gets any smarter than that. We’re back the old assertion that your insulin should be a 50/50 split between basal and bolus, which is a box many can’t fit in. If you take more basal insulin than bolus, like I do, then you’ll struggle to get the insulin you need out of 05. If you don’t need much basal and your daily split is heavy on boluses, then you’ll likely have the opposite problem of fighting lows. The closer you match Omnipod 5’s idea of the “average diabetic”, the better it works, which is why O5 has such mixed reviews. Basically, it’s awesome if you’re “average”, and insufficient if you’re not.
If you happen to love Omnipods, but not the O5 algorithm, then you might want to consider one of the DIY Looping options. They’re a lot more advanced than ANY of the commercial options, but not really sanctioned by the government. You also have to purchase a different model of pods, called Omnipod Dash instead of Omnipod 5.
Tandem is my personal preference and a popular choice on this forum, though not necessarily the best fit for everyone. I think it’s for Type A personalities. The people who want to control all the things and not be left to the mercy of their pump. It does not learn. Not at all. It does exactly what you tell it to do. You are completely responsible for it’s performance, good or bad. It’s largely idle, watching over you from the sidelines. It simply delivers your programmed basal rate until your BG starts to misbehave, then it’ll step in to assist. It uses your programmed correction factor (called ISF elsewhere) to adjust insulin delivery. It’s the most difficult to set up, because it takes some time adjusting the basal and correction factor settings before it really purrs. And it does purr when it’s happy. I think Tandem has to most potential, if you can harness the power it gives you. It’s pretty easy to manage HbA1c s in the 5s with Tandem and good settings. However, it’s a right mess with bad settings. Either you or your endocrinology team really need to understand how to adjust the pump settings to get the most out of a Tandem pump. If your doc has unfavorable or mixed opinions about Tandem, it’s probably not a good choice if you need adjustment help.
This synopsis also completely failed to mention Tandem’s second pump option, Mobi. I’ve used both T:slim and Mobi, and my preference is definitely for Mobi. It’s half the size and 1/4 the weight of T:slim. It’s more water resistant. In fact, it has the same water resistance rating as Omnipod. It can also be affixed to you for the “nearly tubeless” experience, like Omnipod, rather than stuffed in a pocket or clipped to your clothes. Though you can wear it that way too, if you want. It’s nice to have options. It charges lightning fast wirelessly. The cartridge is easier to fill and load. And you have complete pump control from your phone. Unfortunately, there’s only iPhone compatibility right now, with Android expected early in the coming year. It does hold less insulin than T:slim, 200 units vs 300 units, but that shouldn’t be a concern if you’re considering Omnipod. One big advantage Mobi has over Omnipod is a multi-function button on the pump itself. It allows you to maintain a lot of control over the pump when you’re away from the phone/PDM. You can bolus with that button, through a series of button presses, as well as snooze alerts and even check the current pump status.
All those differences and I didn’t even go down the rabbit holes of infusion set/cannula options, insurance coverage, DME vs pharmacy channel decisions, warranty commitment period before your eligible for a new pump again through insurance…
This list doesn’t even mention iLet, which is another top 5 contender. This is the easiest, most stress free option. No settings to futz with and no carb counting. You pretty much just tell it what you weigh and announce when you’re eating. You say whether it’s a small, normal, or large amount of carbs, compared to what you’d usually eat, but no need to be more specific. It handles the rest from there. It has the same slow to adjust and learn you caveat as the other learning systems. It’s not been well-received by experienced pumpers who didn’t like being told you can’t bolus when/if you’re high, but first time pumpers seem to really enjoy it. If you feel burdened from managing your diabetes and just want to significantly lighten the load, then it might be a really good fit.
This is probably getting long enough, but there are other pumps either already FDA approved or pending, due to be released any daynow. You waited this long, maybe your dream pump is a just a few more months away? Modular Medical’ Modd1, Pharmasens Niia Essentials, Sequel Med Tech’s Twiist pump… Tandem also has a fully tubeless infusion set option for Mobi and an updated version of the T:slim, as well as a major Control-IQ update, planned for 2025.
