My MM Revel is coming to the end of its warranty, I’m really haven’t been very impressed by Medtronic. I’m thinking about getting the Tandem Diabetes TFlex but concerned about Tandem not lasting past my next warranty. Currently My warranty is up end of this month. I’m torn between MM 630g,670g, or TFlex. Any advice will be helpful. And yes I know that the 670g is not out yet. Also I do not have a CGM since I’ve been turned down from one by insurance.
Does your insurance have a favored insurance company? That might influence your decision on what pump/cgm system to get.
BTW - just because your pump is out of warranty doesn’t mean you need to freak out about getting a new pump system if your Revel is still working well. As an example, Medtronic will overnight you a loaner pump if your Revel has problems, and give you 90 days to make an upgrade decision.
Pumps are pretty reliable these days. Before I upgraded to a Medtronic 630G (with priority access to 670G whenever I get mine) I had an out of warranty Medtronic Paradigm 5 series pump. It worked fine.
I’m in the same boat. I’d point out that the Medtronics basically require their CGM system to function as designed, the 670 in particular. Dunno if that would put them off-limits but I suspect the opposite: that it would be a way to get past the CGM gatekeeping by your insurer. They are pushing really hard right now to get people to sign on to the priority upgrade deal where you get a 630 to start with and then are front-listed for the 670 when it comes out. I’ve been told I pretty much have to decide by end of next week for them to have everything lined up with my insurance in time to get in on the deal before the Apr 28 deadline.
I’ve also been considering the TFlex, particularly because it’s Dexcom friendly (I use the G5 even though I have a Medtronic pump) and because of their new remote-upgrade capability, which given the rate of technological change these days helps offset the problem of being committed to a device for 4 years. But also hear troubling things about J&J trying to sell off the company, and people reporting struggling with a lot of occlusions.
AND I’ve been considering the option @type1steve mentions: just holding off for now. I’m leery of getting the initial version of any new tech this complicated–the bleeding edge technology problem, and my current Medtronic was replaced last August, so even though my “warranty” is technically expired, the pump is actually <1yr old. I’d really like to see what the hybrid closed-loop thing is like if it works, but I also like my Dexcom and am worried that if I jump ship to the M-t system it won’t be easy to revert to Dexcom insurance-wise if I find it’s driving me crazy.
Dither dither dither…
I’m on disability and I have the Tflex and 630g available to get. No preference on pumps. I have both Medicaid and Medicare. I know that I don’t have to change but I want to get advice on different pumps for when I change.
Do you have a top-notch Diabetes endo you see? Mine is with a well established Diabetes endo clinic in the Raleigh-Durham area with an knowledgeable on staff certified Diabetes educator who also has T1D. When I was considering a pump upgrade last year I listed a bunch of requirements like acceptable CGM, good display that adapts to different lighting conditions like outdoors (I do a lot of bike riding/cycling - 50-75 miles a week), etc. I looked at the TSLIM/Dex possibility, but came away with the conclusion (for me) that the Medtronic 6 system was the way to go, imperfect as it is…as are all solutions available today. I wanted an integrated pump/CGM/meter system so the the Medtronic 6 series was the way to go.
One thing I can tell you (and I’m sure DrBB would agree) is after having T1D for 41+ years (30+ years of that on the pump) I’ve come to the conclusion that there will maybe will never be a perfect solution to managing, let alone curing (forget about that!), this disease and dealing with the day to day life challenges we all deal with. That said- we deal with the challenges the best we can. In my case, strange as it seems, LOW BLOOD SUGAR is my biggest challenge since my approach to management is tight control (5.7-5.9 H1C on average for many years) but minimizing hypoglycemic episodes. CGM had definitely helped me in that regard!
BTW - forgot to mention that I have minimal complications from T1D - a little background retinopathy which causes me no issues (see a ophthalmologist every 4 months to keep a watch on things). Otherwise perfectly normal even though I’m not! 
Steve
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My biggest concern about Tandem is what if they go out of business. Will I be able to get supplies etc. how do you like your pump? Pluses and minuses?
The beauty of putting off the decision is keeping all options open. The warranty ran out on my Ping last December. Since I’m using the hybrid Loop system, I’ve basically put off making another four-year pump commitment for the time being. I think the biggest hazard right now is that it’s a time of relatively rapid change and jumping onboard anyone’s system right now will hold you on the sidelines for four years.
Early reports on the 670G seem promising. It would be nice to know if Med-T might come out with an upgrade path for new buyers of the 670G (not the 630=>670 cohort) especially if the next generation artificial pancreas comes out in less than four years. It’s like we need an insurance policy against quick tech upgrades.
It seems that one of the factors that influenced the FDA to give quick approval of the 670G was the fast pace of technology evolution in the open-source experimental community. I believe that this influence will not slow down and will keep the commercial developers on their toes. We’ll see. It’s an exciting time to watch this develop if one can use that expression in the same sentence with diabetes!
Although you received a replacement recently, don’t assume that it was ‘brand new’. My understanding is that when you return pumps, they may fix/refurbish them, and send them back out as under warranty replacements !!
However, I do think it’s likely that an out of warranty pump will last for quite some time. I have a 522 that I recently checked out (to use for OpenAPS), and it was still operable once I put in new batteries. That pump is likely 15+ years old.
I’m willing to wait it out in regards to getting 670, and see what else becomes available in the next couple years.
My biggest issue is I won’t have access to the cgm portion because my insurance denied me from being able to get it. I have Medicare which will lock me in for five years. I don’t plan to rush in as I’m constantly reviewing what’s out there. Right now I’m going through a reservoir a day and half. Since I use roughly 200 units of insulin a day. So this is a factor. But as stated above I am basically looking into a insulin pump WO a CGM. Since my insurance won’t pay for the expenses of one.
Are you aware that Medicare will soon cover the Dexcom G5 CGM?
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Might be a good idea to keep the Tandem Tslim X2 in the running then too. But still the worry of them going out of business. Right now the only safe bet in that respect is Medtronic but insurance won’t cover the guardian CGM I believe.
Yes, that’s why I thought the T:Flex strategy was so attractive–in theory they’d be able to introduce a Dexcom-based hybrid system and deliver it via a software upgrade without a hardware change. In theory. And then there’s the Bigfoot approach, which would be a kind of subscription-based model. Intriguing economically, and they bought up Assante’s technology which had a lot of good things going for it… but it’s all pure vaporware at this point. It’s clear why M-t is pushing so hard to get people committed to the 630->670 path (I had TWO calls on my way home from work last night, even though I’ve already had a 45-minute hands-on demo with a rep and multiple emails from other reps): they’re determined to get people hooked into their whole pump/CGM ecology before these other competitors get into to the game. That’s the attraction and the problem all in one: I’m very intrigued by the 670G but I’m really reluctant to abandon my G5 CGM.
Another data point: Dexcom is obviously feeling the pressure too. There was a statement from their CEO recently not naming names but cautioning that claims of accuracy and actual accuracy of results aren’t the same thing–clearly aimed at the new M-t Guardian 3 sensors I think. And in the last several days, just like the M-t calls, I’ve had multiple calls (and a text) from them pushing their CARE services to help you optimize and customize your Dexcom CGM to your personal needs, trouble shoot etc. So clearly they’re concerned about M-t’s strategy that would break existing Dexcom users away from their G5/G4s by dangling the 670 in front of them.
Interesting times, and I feel very much the direct target of this marketing war. I’m starting to appreciate what New Hampshire residents feel in an election year…
Anyone shopping for a pump has likely seen this diaTribe artificial pancreas systems comparison of the leading efforts in the US. While this chart was last updated 10 months ago, it still has some useful info. Their projection for the Med-T 670 to start release this month, April, 2017, appears to be a good one. It’s a nice survey of what’s out there. The 2017-2018 timeframe is cited several times.
Expect to see a flurry of news/updates on pumps and AP’s around the American Diabetes Association annual scientific sessions, this year staged in San Diego in June. There are a few significant diabetes tech players in San Diego, including Dexcom.
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I very recently decided on the 630G and I am very pleased with the 2.4 gh sensor. This is my reasoning as I made that choice.
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Here’s a more current (December 2016) survey by diaTribe of the artificial pancreas systems working toward commercial release. I know this thread is about insulin pumps but the artificial pancreas systems are based on insulin pumps and this is the direction that most pump makers are moving.
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It says the 670g is only approved for type 1. I’m type 2 though
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I have no advice to add, but good luck in making your decision. My Ping has been out of warranty for a year now and I am holding off on making a decision about a new pump because of the rapid changes. At the moment, no new pump can do more than my Ping plus Dexcom G4 can (except for the Medtronic 630G with low suspend). For the past ten years we haven’t really seen any paradigm-shifting changes in pumps, but that’s likely to change in the next few years, and I really do not want to lock myself into a four-year (or very likely longer for me) pump system when I know something paradigm-shifting is on the horizon. I also agree that many pumps last a long time—I have a Cozmo pump that is over ten years old and still works fine. (Too bad OpenAPS/Loop will not work with either of these pumps!)
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The 670G is not approved yet for Medicare. The 630G pump is approved but not the Enlite sensors that go with it. if you are on Medicare my understanding is that you are not eligible for upgrade programs, so if we buy the 630G that is our pump for 5 years.
That’s a nice summary - thanks for posting @Terry4. My plan is to continue using DIY closed-loop systems with out-of-warranty MM x22/x23 pumps until a comparable or better commercial closed-loop system becomes available.
Me, too. I’m looking for a backup pump should something fail with my 12-year old 722.