NICE recommends Medtronic pump with CGM?

Hirstygirl

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I'm highly confused by this and hope you can all help me understand just what this means?

Friday Feb 12 Medtronic post the following on their Facebook page:
https://www.medtronic-diabetes.co.uk/our-innovation/nice-recommendation

And on their website it has a box saying nice recommends Medtronic too

This reads as though NICE have recommended the Veo and 640g pump, but the NICE article reads differently

http://www.nice.org.uk/guidance/DG21/chapter/1-Recommendations

So does this mean that NICE recommend the older veo pump only?

Finally will any of this actually help gain funding for CGM (am hoping so)
 

tim2000s

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In answer to your last question, no. You will still be required to meet the NICE guidelines for CGM.

What it does do is allow for the use of pumps with CGM enabled cut off that simply weren't considered previously.
 

azure

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I think it reads the same, but Medtronic have written it creatively and are obviously promoting both pumps....

Here's what NICE say:

"The evidence for the MiniMed 640G system has not been assessed in the guidance, and the recommendations, therefore, do not relate to its routine use in the NHS"


So, no, NICE do not currently recommend the 640g as they haven't assessed it yet so can't make any judgement or recommendation.

Medtronic say:

"The NICE guidance reviewed two sensor-augmented insulin pump therapy systems and recommends the MiniMedParadigm Veo system for managing glucose levels in people with Type 1 diabetes."

So, Medtronic are saying the same as NICE :)

In their next bullet point they then go on to mention both the Veo and 640g in the same sentence. So people might wrongly assume that NICE recommends them both, but Medtronic are, I presume, simply promoting the 640g along with the Veo.
 

Hirstygirl

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In answer to your last question, no. You will still be required to meet the NICE guidelines for CGM.

What it does do is allow for the use of pumps with CGM enabled cut off that simply weren't considered previously.

I understand that I would need to meet the guidelines (and believe I do btw) I just find the whole post totally confusing??

Thanks for the last note that is a slight step forward
 

Hirstygirl

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I think it reads the same, but Medtronic have written it creatively and are obviously promoting both pumps....

Here's what NICE say:

"The evidence for the MiniMed 640G system has not been assessed in the guidance, and the recommendations, therefore, do not relate to its routine use in the NHS"


So, no, NICE do not currently recommend the 640g as they haven't assessed it yet so can't make any judgement or recommendation.

Medtronic say:

"The NICE guidance reviewed two sensor-augmented insulin pump therapy systems and recommends the MiniMedParadigm Veo system for managing glucose levels in people with Type 1 diabetes."

So, Medtronic are saying the same as NICE :)

In their next bullet point they then go on to mention both the Veo and 640g in the same sentence. So people might wrongly assume that NICE recommends them both, but Medtronic are, I presume, simply promoting the 640g along with the Veo.
Yes but isn't the veo an older version of the 640g? That is what I'm confused by, is it still available? Or has the 640g replaced it totally? In which case nice are recommending an old technology??
 

azure

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Yes but isn't the veo an older version of the 640g? That is what I'm confused by, is it still available? Or has the 640g replaced it totally? In which case nice are recommending an old technology??

I think you'd have to check with Medtronic. I've never used a Medtronic pump so I don't know much about them, but I find in general 'old' pumps are hidden away on the pump websites (but still available) while only the new, more expensive ones are promoted. But then, I'm a cynic ;)

I put 'old' like that because my last pump was 'old' but a thousand times better than the latest model I was offered, in my opinion...

I would hope the NHS wouldn't recommend something that you couldn't get, so I suspect the Veo is still available, but that's just a guess :)
 
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tim2000s

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Veo is the predecessor to the 640G. When the NICE assessment started the 640G wasn't available. That's the issue with the length of time these things take. Whilst the assessment was going on, the 640G was released, but until it has been in the wild for a reasonable period of time, there isn't enough data for NICE to use.

As a result you end up with recommendations for defunct products. In a year the 640G will be obsolete and they will still be recommending the 530 Veo.
 

CarbsRok

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Basically when the original report was written the 640 pump did not exist hence why only the veo and vibe had a mention and not the 640.
 
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Hirstygirl

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Veo is the predecessor to the 640G. When the NICE assessment started the 640G wasn't available. That's the issue with the length of time these things take. Whilst the assessment was going on, the 640G was released, but until it has been in the wild for a reasonable period of time, there isn't enough data for NICE to use.

As a result you end up with recommendations for defunct products. In a year the 640G will be obsolete and they will still be recommending the 530 Veo.

That makes sense thanks tim2000s
 

irrationalJohn

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The 640g is great though haha! Just saying ;)
Just to clarify, which of the two below are you saying ...
  • Are you using the 640G pump without the CGM and you're (very?) satisfied with the results?
or
  • Are you using the 640G with the CGM and you're (very?) satisfied with how both the pump and the CGM have been working for you?
Or is there another option that I didn't think of?
 
D

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Just to clarify, which of the two below are you saying ...
  • Are you using the 640G pump without the CGM and you're (very?) satisfied with the results?
or
  • Are you using the 640G with the CGM and you're (very?) satisfied with how both the pump and the CGM have been working for you?
Or is there another option that I didn't think of?
Mine came with the cgm but I don't think i have full funding of it....it worked absolutely fine! I just don't use it all the time because then il become addicted as the only accurate place of blood is our finger tips which is why I don't use it all the time but other than that it was/is great!
 
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irrationalJohn

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I just don't use it all the time because then il become addicted as the only accurate place of blood is our finger tips which is why I don't use it all the time but other than that it was/is great!
o_O If CGM for you actually was "great" then why not wear it all the time? Your claim that the only accurate source is a BG meter contrasts with the experience of a lot of folks who find their CGM & BG meter results are quite close.

And wouldn't you do a BG test anyway before acting on your CGM? I certainly do. The advantage which CGM gives you is that it gives you insight into when you need to test your BG. It potentially lets you know when things might be going off the rails.

I think you are also missing the point about CGM. It is natural to initially view CGM as some sort of enhanced BG meter. After all, a BG meter is what we are most familiar with. But after using it for not too long, my perspective on this changed.

CGM ... when it works for you ... give you a much more realistic overview of your entire BG history & patterns. It also gives you more insight into things such as how quickly an insulin bolus kicks in and what your duration of insulin activity might be. It allows you to use techniques such a pre-bolus with less risk of a hypo.

And in the case of the 640G's predictive basal suspend it offers one of the best tools currently on the market for avoiding a hypo, especially when you are sleeping or even just distracted.

At the very least I would think you would want to get more answers about whether or not you actually are funded. If you do have funding and if the Medtronic CGM actually does work for you, then I am a bit gobsmacked that you would not use it.

I personally feel that CGM has been a game changing improvement in my quality of life with D.
 
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Hirstygirl

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o_O If CGM for you actually was "great" then why not wear it all the time? Your claim that the only accurate source is a BG meter contrasts with the experience of a lot of folks who find their CGM & BG meter results are quite close.

And wouldn't you do a BG test anyway before acting on your CGM? I certainly do. The advantage which CGM gives you is that it gives you insight into when you need to test your BG. It potentially lets you know when things might be going off the rails.

I think you are also missing the point about CGM. It is natural to initially view CGM as some sort of enhanced BG meter. After all, a BG meter is what we are most familiar with. But after using it for not too long, my perspective on this changed.

CGM ... when it works for you ... give you a much more realistic overview of your entire BG history & patterns. It also gives you more insight into things such as how quickly an insulin bolus kicks in and what your duration of insulin activity might be. It allows you to use techniques such a pre-bolus with less risk of a hypo.

And in the case of the 640G's predictive basal suspend it offers one of the best tools currently on the market for avoiding a hypo, especially when you are sleeping or even just distracted.

At the very least I would think you would want to get more answers about whether or not you actually are funded. If you do have funding and if the Medtronic CGM actually does work for you, then I am a bit gobsmacked that you would not use it.

I personally feel that CGM has been a game changing improvement in my quality of life with D.
Thankyou for writing this irrationalJohn, very interesting read. I think CGM I'm my own case would be a very valuable tool and will try for funding if not successful with that then I would be happy to self fund even if just for say the first 6months of pump use
 

irrationalJohn

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I would be happy to self fund even if just for say the first 6months of pump use
The only caveat I would add is that CGM does not work well for everyone. Hence my use of the phrase "if CGM works for you".

Unfortunately the only way that occurs to me to find out is actually try it and live with it for at least a week or six.

If you do decide to try CGM, I always encourage people to consider how they will get their money back if they try it but it doesn't go as well as they hoped. Always try to see if you can get them to sponsor a free trial of some sort. Failing that, make sure you are able to return for a refund and know what the terms of that agreement are.

I wish CGM were easier to obtain and more readily available to everyone. However, it seems to still be viewed as "experimental" and hence dubious by whomever decides these things. I believe that will change, but unfortunately will probably not change quickly.
 
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anniehi41

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Mine came with the cgm but I don't think i have full funding of it....it worked absolutely fine! I just don't use it all the time because then il become addicted as the only accurate place of blood is our finger tips which is why I don't use it all the time but other than that it was/is great!
If you have the CGM and are not using it are you aware that the transmitter could run out in 6 months and the shelf-life of the sensors can be less than a year? With the transmitter costing £350 and the sensors £50 each it would be a shame to waste them.

If you had funding for the CGM from the NHS I am sure you would know about it you would have to have an account set up.
 
D

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If you have the CGM and are not using it are you aware that the transmitter could run out in 6 months and the shelf-life of the sensors can be less than a year? With the transmitter costing £350 and the sensors £50 each it would be a shame to waste them.

If you had funding for the CGM from the NHS I am sure you would know about it you would have to have an account set up.
No I know that I've not had it long my consultant wants to wait to use it! Yeah it says that I have to pay for them!
 

irrationalJohn

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Yeah it says that I have to pay for them!
If you have to pay for the Medtronic CGM, then all the more reason to make sure you get your money's worth when you use it!

With the Enlites I use in the US, there is 180 days between the date of manufacturer on the box and the day the sensors are as dead to Medtronic (aka the expiration date). The warranty period for the transmitter is 1 year.

I am assuming, but actually do not know, that the same periods apply in the UK.

The Transmitter:
My (US) experience is that Medtronic automatically starts the transmitter warranty clock ticking on the day they ship your transmitter to you. However ... there is a fudge factor which I advise you to pursue.

I learned that Medtronic will adjust the start of the warranty date for the transmitter if you can prove to them that you started to use it later than what they have on record. One obvious way is to point them towards the UPS or FedEx or whomever's shipping record and ask them to use the delivery date, not the shipping date as the warranty start.

In my case there was period of two weeks or so before I was trained. I did not start using the transmitter until after this training. I was able to prove when the training was via an email I had received from my trainer scheduling the appointment . I was able to use that to have my warranty start date adjusted.

This was important in my case because my transmitter died. I tested it and it failed to pass Medtronic's diagnostic tests. When I called this in to their HelpLine, it was only one day before the adjusted end of warranty date.

If I had not been able to move the end of warranty date, then the transmitter would have been out of warranty & I would have been out of luck and forced to obtain a new transmitter on my own. :eek: But since I had updated the warranty end date, Medtronic overnighted me a replacement transmitter under warranty. :wacky: :)

If you are paying for this out of your own pocket, I encourage you to get those warranty dates sorted while you still have proof at hand for when the transmitter was first used. In particular, if your consultant is holding off on your CGM and you have not actually started using it, then get your transmitter warranty date moved out to when you actually are trained and start to use it.

The Enlite Sensors:
The expiration dates for the sensors are important because if you do not get a full six days of use out of a sensor you can call this in to Medtronic and they should replace it for you at no charge. They'll want you to ship back the "bad" sensor in exchange for the replacement/RMA one.

Calling it in is typically tedious because you have to walk them through the failure. But, to repeat, if you are paying for this yourself, then it pays to do this, no?

With all my other meds I tend to build up a small "cushion" of extras. I like to be slightly ahead of my needs so that if "life happens" I won't end up forced off the pump because I ran out of supplies.

But the time before the expiration date to use a sensor is short. Usually when I get "new" box of sensors there is only about 4 months (or even less!) left before that box "dies".

So I have learned to not try to "cushion" my supply of Enlites. I try to run closer to empty with them. There is simply no advantage to buying ahead of time. Something closer to an old school "just in time" approach is a better fit IMO.

Currently I am trying to keep at most one open, partially used Enlite box plus one unopened box in the house at the same time. I reorder one box at a time and do so only when I have two or three unused Enlites left.

One final note. You can (maybe) extend the time you use an Enlite beyond six days. The sensor will be out of warranty if you do this, but if you can get more than six days use out of an Enlite, you will help lower your average cost. But if you are able to do this it is another reason why you would not want to keep "too many" Enlites in your home storage.

Oh. One additional "final" note. You can still use expired sensors. No, you can't get replacement support for them from Medtronic. But just because the date says they are expired does not mean they won't work at all. Something to consider asking the staff of your consultant about. If they happen to have ostensibly "expired" Enlites on hand and are willing to give them to you, that can also cut down on your total cost. When it comes to CGM, my feeling is any little bit can help, no? :rolleyes:
 
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