I've chosen to buy a Tandem t:slim insulin pump.
Whoa, you might be saying aloud or under your breath... is this the same guy who published a critical review of the Tandem pump a few months ago? And now he's going to buy one? Huh?!
Yep, that's me.
Rest assured, I've thought about this a lot and weighed all the options. I've decided that when it comes down to it, the t:slim is the pump that will be best for my diabetes care going forward.
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- The design is modern, and as I noted in last week's "dream device" post, the t:slim looks and feels like a medical device should in 2013. When comparing it to other pumps on the market, I feel it beats out the competition in some of the most important form factors.
- I'm excited about Tandem's bright future for this product, from upgrades and CGM integration to exciting developments like device connectivity, the eventual introduction of a dual-chambered pump, and even a closed-loop system that's in the works.
- Tandem is listening to our patient voices, and when they hear us griping about their insulin pump or company, they're making changes to address those issues -- everything from return policy to how the device actually functions. That's encouraging.
- And on the regulatory side, Tandem isn't afraid to engage with the FDA and talk openly about what the agency needs and wants from them. There doesn't seem to be any finger-pointing and "who knows what happens behind the mystical walls of regulatory uncertainty?" that so often seems to be the tune others sing... No, Tandem plays well in the development sandbox and seems to have established a healthy interactive dialogue with the FDA.
When I wrote my critique of the t:slim pump and a few other posts back in September, you'll likely remember that I hadn't yet made a decision about my next pump move. I wanted to take more time to explore other models. These are my thoughts on various pumps (and my thoughts alone):
I've been using Medtronic Minimed pumps for more than a dozen years, and I've always found the various versions to be reliable, trustworthy and something I could feel comfortable with. While I'm sure that would still be the case if I were to use their newest iteration of insulin pump, as a consumer I have lost faith in the company itself.
Within a week of writing my post about exploring new devices in September, the new Minimed 530G system got FDA approval here in the States. It was a long time coming, and very exciting in that it's the first-ever device here to automatically suspend insulin delivery if your blood sugar dips too low. I'd been waiting for this FDA approval for a long time, after hearing it was "coming soon" for years (even though it wasn't even submitted for regulatory review until June 2012).
But as often is the case, that approval came too late and I'd already made the decision to go with Medtronic's competitor in the CGM world -- Dexcom.
The fact that Medtronic wants to package the pump and CGM together, making it so you can't just get a pump or CGM as a stand-alone device any longer, really bothers me -- especially since I'm now a Dexcom G4 user and have no interest in switching my CGM, especially when prevailing data shows that the Dex sensor is more accurate than even the latest MedT Enlite sensor. Even if I did want to sacrifice a little accuracy to go with the combo device, I'm sure my insurance company wouldn't be too hip to reimbursing me for yet another new CGM just six months after paying the tab for my G4.
So sadly, thanks to the company's business decisions, I'm saying goodbye to Medtronic and will no longer be one of their pump customers.
That leaves the Animas Ping pump-fingerstick meter combo, which I'd never used before but some of my good friends in the DOC talk highly of. With the G4-integrated Animas Vibe submitted to FDA earlier this year and likely coming to market by the middle of 2014, I figured it'd be worth checking out. I was fortunate to be able to try it out for the first time ever for a few months after testing out the t:slim, and factor it into my pump decision-making.
Turns out, the Ping and I just didn't ping.
Just trying to see the screen and navigate the menus drains life out of me, and I feel like I've taken a step back in time. And then there's that annoying "safety feature" where it stops a bolus if you hit a button at any point. I like to pull the pump out of my pocket or from my belt-line holster at times, and when I enter a bolus and then try to put it away, an inadvertent button push means I have to start the bolus process all over. It's very annoying. Sure, I do like the remote control aspect of the OneTouch Ping meter, but even that isn't enough to put the Ping to the top of my list.
My main gripe is that the reservoir size is SO VERY SMALL, somewhere around 180 units, compared to the 270-300 units I can get with other pump models. Hell, that's another full day of wear that I don't have to go through the refill process.
These are some of the main points that put the t:slim ahead of other pumps on my list. I haven't tried the OmniPod and personally have no interest in the tubeless option, especially since there's no plan to integrate with Dexcom any longer. And to be honest, the Accu-chek Spirit and Asante Snap pumps just don't interest me personally (the Snap did at first based on a couple of reports, but there are a few failings that fellow D-blogger Kim Vlasnik pointed out recently that just make it a no-go for me: it's Humalog-only, doesn't integrate with any CGM or other device currently, and for some crazy reason the pump doesn't have a vibration mode, so you have to rely on audio alerts only).
That brings me back to t:slim.
Going for the t:slim
Not everything is perfect here; I'm a little suspicious of the cartridge and how I can't see inside to confirm that it's air-bubble-free or even cranking insulin into me when it's told to, and I also have a concern about whether there's enough force pumping the insulin through the tubing at all times... especially when I've seen higher blood sugars a few times in a way that I've never, ever experienced with another pump. I assure you it's not user-error, as I've been doing this long enough to know what's going on. Still, as it turns out, these issues aren't enough to dissuade me from ordering a t:slim.
Overall, I believe the t:slim is the best pump for me right now and has the brightest future, both near-term and long-term. Sure, Tandem's decision to go public on Nov. 14 delayed the FDA filing for integration into early 2014, but I'm still optimistic that's coming within the next year and that there will be some kind of upgrade program for those of us interested in taking the next step. And the t:connect software that I've played around with is impressive and I think something that will allow me to fully dig into my diabetes data and more clearly see my BG and D-management nuances in relevant, meaningful ways that help me and my healthcare team actually use that data effectively.
Lots to look forward to.
Disclosure: It's probably worth noting that Tandem is a sponsor of the DiabetesMine Innovation Project, and I'm sure contributes to my paycheck to some extent. But that doesn't factor into my decision-making at all here, just as it didn't factor into my initial critical review of their pump a few months ago. I want the device that feels best and works best for me as a person with diabetes, right now and in the time period that I'll have to bridge before going through the whole insurance approval process again. If I didn't think t:slim was the right device for me, then it wouldn't be my choice. Simple as that.
Once the new year rolls around, and I'm able to find a new endo (that's a story in itself), I plan to work with that new doc to make sure I've got adequate blood sugar trend data gathered to get this process rolling.
Then, hopefully in the coming weeks, I'll have my very own Tandem t:slim to go along with my G4 that's now about five months old. Woot!
Getting geared up with new D-tools is an exciting way to start the new year, and I can't wait!