Hi
@BadaBing thanks for all this info, re the signal strength, this is really important I understand, something I was looking at with my daughter the other day. Is particularly important as can limit sites for pump and sensor and really have to alternate sites a lot otherwise causes problems. More sites is more time for sites to heal and still place where is sensible and convenient for everyday wear.
Based on what I've read on this and other forums, if I were your daughter I would try to stay on the Omnipod 5/Dexcom G6 hybrid closed loop combination for as long as possible.
And I am a diehard Freestyle Libre fan because I know that it works well with my body chemistry.
No one (except Insulet and Dexcom) know for sure, but from what I've read the Omnipod 5/Dexcom G7 hybrid closed loop won't be available in the UK for many months. There is also initial anecdotal evidence that there are still some issues that need to be fixed with the integration of the Dexcom G7 with the Omnipod 5 in terms of connectivity with the Omnipod 5 (Bluetooth on the G7 not quite as good as the Dexcom G6 for some people reportedly), and reportedly the G7 not lasting the full 10 day wear time.
The good thing about Dexcom cgms is that they are licensed by the UK medical devices regulator to be used on other parts of the body other than the lower upper arm.
The bad thing about the Libre cgms is that they are
only licensed by the UK regulator for use on the lower part of the upper arm . To me this seems to be one reason why a significant number of people who are currently using the Omnipod 5/Libre 2 Plus hybrid closed loop combination are having connectivity issues between the pump and the cgm when the Omnipod 5 pump has to be moved every 3 days to lessen the risk of site infection, etc.
And that the Bluetooth signal on the Libre 2 Plus is reportedly not as strong as it needs to be.
I’m unsure how it works re Dexcom vs Libre sensors on the NHS, I’m wondering if some of it is choice for local authorities. My daughter has not long entered adult clinic, currently they are offering Omnipod with Descom 6, but g7 looks a big improvement.
Although the latest NICE technical appraisal document implementing hybrid closed loops uses wording which talks about using the products that are best for the patient, generally, ultimately (as one would expect in a taxpayer-funded system) yes if one's local health authority is picking up the bill, they will be looking to do so within the budgets they have allocated.
It doesn't help that the Omnipod 5 pump and the Dexcom cgms are supposed to be the most expensive for the NHS to buy from their manufacturers.
That said, some English health authorities (ICSs/ICBs) are "going the extra mile" and making sure their diabetic patients have access to the best hybrid closed loop kit available (in the case of patch pumps the Omnipod 5 and Dexcom G6 cgm). My DSN told me she was aware that some health authorities (ICSs/ICBs) had negotiated price reductions for the Dexcom G6 cgm that were significantly lower than NHS England had managed to negotiate centrally with the manufacturers.
Ive no doubt that there is a significant factor on cost, but also safety, I.e. what is proven to work. i guess what is frustrating is the time it takes for a product to be available on NHS, and with this technology, it’s evolving quickly. That said, competition in this respect is a good thing. Just hope the NHS can keep up, ultimately costs will be reduced as the newer technology should decrease later complications as better helps to manages diabetes.
Yes, in theory and practice ensuring that these products are safe for patients to use is the paramount concern of the Medicines and Healthcare Products Regulatory Agency, which is the UK regulator and an agency of the NHS. The way the system works is that the MHRA relies on the pharmaceutical companies to provide them with the clinical trial data. The MHRA is also relying on pharma companies to report all adverse incidents they are told about by diabetics using their products, as well as diabetics reporting adverse incidents direct to the MHRA (the latter is my personal preference).
The products (pumps and cgms) on the NHS's list of recommended hybrid closed loops are (relatively) so new that I suspect it will be many years before we have a proper picture of precisely how safe they are.
I agree, genuine competition in any market can only be a good thing and will ultimately keep the costs of these devices reasonable.
i think the other issue is, as you touched on, is interoperability with pump systems and sensors. Hence the Libra PLUS’s. For me this is where the industry needs to work together when building new or updated products… perhaps a set of standards, will help with earlier adoption by health authorities and working together but without impeding innovation…
There are some standards already, aren't there? I'm not sure about the pumps, but certainly for the continuous glucose monitors they have to comply with such things as the "mean absolute relative difference" standard which gives the end user an idea of how accurate a cgm is.
Ultimately it is for the UK regulator, the MHRA, to satisfy itself that the pumps and cgms meet minimum standards regardless of whether the standards are national or set internationally.
I don't believe standards do stymie innovation. They are in place to keep patients safe after all.
Apple, watch and phone for example, and Samsung and others could then build in features to support the systems, imagine heart rate, monitoring, blood sugar monitoring, exercise levels, AI with calculating carbs for a lunch or dinner, temperate, as impacts insulin required, all these things together,
It's an interesting idea, but I suspect both Apple and Samsung would (probably) want a share of the profits the likes of Dexcom and Abbott make from their cgms IF they did build in features to their smartphones and smart watches to support Dexcom and Libre cgm use.
In any event, I suspect that closer collaboration is unlikely (unless of course Apple or Samsung were to buy one of the big cgm companies). Both Apple and Samsung have been trying to become potential competitors of the likes of Dexcom and Abbot for years.
Apple and Samsung have been working for many years on giving their smartwatches the ability to check and display a smartwatch wearer's glucose by having their watches use some form of light (I think) that provides a glucose measurement from skin cells in the epidermis. They have been unsuccessful in doing so so far because the science isn't anywhere near accurate enough (yet) to be relied on to make treatment decisions.
At least if one is an Apple smartwatch wearer (I'm not) it is now possible to get glucose data direct to an Apple smartwatch if one uses the Dexcom G7. Abbot do not offer the same facility for
any of their Libre cgms.
interested in your thoughts, not pie in the sky, although it could control that as well!
I'm hopeless at predicting what the future will bring. My main hope is that medical science will in my lifetime come up with a genuine cure for this gruelling disease.