I think this choice is going to keep getting harder in the coming years, with technology evolving so fast and new things coming to market so quickly. I think we’re going to see a little bit more buyer’s remorse when something brand new and exciting comes out just months after someone committed to 4-5 years with something else. Remote updates definitely help, but certain things require hardware and form factor updates, like for fitting dual hormone systems, Neither the t:slim, 770/780, nor Omnipod will ever be able to update such a pump if that proves to be the most effective system. I’m facing the same decision, being 3 months out from the end of my warranty.
Since Tandem and Medtronic reached an agreement to share patents last year, Medtronic is actually acquiring some of Tandem’s big selling points, such as mobile interface and remote updates… Making Medtronic more of a contender again after the 670G fiasco. (I STILL can’t figure out what Tandem got out of that deal, but I suspect we’ll see it in their new T:sport pump.) I’ve been trying to see how the the 780 is being received in Europe and looking at the criminal trials, and I’ve not seen anything near impressive enough to pry my Control-IQ out of my hands. I feel like the Medtronic system is trying to figure you out and force you into someone else’s pre-conceived notion of management. I think that’s comforting to doctors who want to ease their burden and treat everyone with the same formula… but it doesn’t jive at all with my Type A personality. Control-IQ isn’t trying to figure you out, but rather it does exactly as you tell it to. It makes it a little more difficult to set up, especially for those who haven’t learned to adjust their own settings. But you are 99.9% responsible for your happiness with the system. If someone is displeased, it is nearly always due to a bad settings problem. And there’s a glorious Hallelujah moment when it all falls into line. I’m open to improved options from other manufacturers, but I don’t see the 770/780 as a step forward.
The thing that seems to set Tandem’s AID apart from the other systems (including Dana’s CAMAPS FX that isn’t even in the States, but not including pipeline products that haven’t published data yet, like iLet and Tidepool’s commercial Loop)) is that Control-IQ is the only one offering a “sleep mode”, or any other option with tighter parameters. Thus, Tandem is the only one who divided TIR specs between daytime and nighttime. All three averaged mid-60 percent TIR either all day or daytime-specific hours (technically Tandem had the highest value, but it’s not an entirely fair comparison because they also started with the lowest average initial Ha1c), but Control-IQ annihilates the competition upping the nighttime average TIR to 80%, and thus more overall TIR. And of course so many of us just keep running those tighter parameters through the day, too. Note, those averages include the best and worst values, and it’s not indicative at all of the best you can personally achieve with them.
You’ve expressed a few confused comments about the T:slim.
To start with, you have to set one or more personal profiles. (You can have a profile specific for weekday, weekend, exercise, sick day, steroid shot, or whatever else you want that you can name with a T9 keypad. I just use 4: 50%, 100% and 150% of my “normal” rate, and one set to zero so I can suspend the pump without it yelling at me.). Each profile is divided into timed segments and for each and every timed segment you set a specific basal rate, target blood sugar (can’t be set lower than 110 if Control-IQ is turned on, can go down to 100 if not), correction factor, and insulin: ratio. You choose one of your profiles to be active.
There is a toggle switch for Control-IQ. You literally turn it on or off with the flick of a virtual switch. If it is off, you have zero pump automation, including no hypo suspend. It’s a "dumb"pump that is only as smart as your settings. You will still see your cgm on the screen, but aside from that, it delivers insulin exactly as you programmed in you active personal profile.
If you turn Control-IQ on, basal rates will sometimes be adjusted. It will use your correction factor primarily to determine how to do so. You can even chose to turn Control-IQ off during the day when you want to micro-manage yourself and turn it on at night to take advantage of the peaceful sleep.
While Control-IQ is turned on, you’re given a few extended parameter options called “activities”, one for sleep and one for exercise. If no activity is selected, the pump does nothing so long as you’re between 112-160. The exercise activity raises the actionable zone to try and keep you between 140-160, while the sleep activity lowers it to 112-120. Control-IQ will always reduce your basal if you’re below 112, but you can still maintain lower with adjustments to basal and correction factor settings. Control-IQ also gives 60% of a calculated correction bolus is you BG exceeds 180 in all BUT sleep mode.
If you watch the Facebook groups, people are always celebrating their Ha1c results because they’re getting low ones for the first time ever. You’ll see lots of 5’s and low 6s. I’ve gotten 5.8 on my last two tests, but Dex estimates me at 5.4ish. Before I started on Control-IQ, Dex was estimating mid-6, but lab values came back 7 and higher.
Yes, there are a few limits to the parameters, but they can be compensated for with other settings. Also, they’ve promised to open up those parameters and give more customization with the pending software update. I guarantee you they come down to a target BG of at least 100, if not better. There’s just no way they’d cede this point to Medtronic when it’s such a bone of contention.
I would say there’s awesome compensation. That rube-goldberg contraption is part of their micro-bolusing feature, which makes the pump more accurate and safer than others, because the reserve of insulin is completely isolated from you by an intermediary chamber. It’s also critical to the T:slims small size, because it eliminates the need for that giant syringe-style plunger.
And the reality is that it’s the lamest Rube-goldberg device ever. There’s no moving parts whatsoever in the cartridge. It’s a clear plastic bag in a black plastic box. You jab insulin in through a hole at the top. There is absolutely nothing DIFFICULT about it. It’s just DIFFERENT. Do it a few times and it’s second nature. If you’ve ever done MDI with vial and syringes instead of pens, it should feel perfectly familiar. You’re just stabbing a piece of plastic instead of yourself.
My problem is that I’m really interested in both Tandem’s upcoming T:sport pump (half the size, no screen, completely controlled by my phone, and with the latest update of Control-IQ? Sign me up!) and the iLet. I was really hoping the T:sport would be out this summer when my warranty expires, but looks like it’s been pushed back again. Though sounds like it was for good reason. The trial participants aren’t allowed to disclose much, but the few I’ve spoken to said they were happy to go back to their T:slim, mostly just because it wasn’t as comfortable/refined of an experience. I’m happy to hear they’re working on that. And until this week, I had written off iLet completely for this round of decisions. I really wanted to see how more people fared with the dual hormones and the new algorithms that used them. But now I’m hearing so many trial participants speak so highly and call it their favorite, that it’s become much more desirable.
But how long can I wait without a warranty for these things to work through the pipeline?? I’ve never had any catastrophic pump failures, but I have had a few warranty replacements for minor things. Being so rural and isolated, 24/7 customer service and over-night shipping is big peace of mind. I also don’t know if an out-of-warranty pump affects my Dexcom warranty. Sensor issues are the most common reason I call Tandem. Twice now they’ve sent me a new pump when troubleshooting transmitter issues… because somehow, replacing the $7,000 pump comes before replacing the $125 transmitter in their flow chart. And does the 10 day sensor warranty become null and void if my primary data collector is invalidated?
I might vary well chose the T:slim again for my next pump, but I want to make that choice because I still feel it’s the best… Not because I ran out of time!