I recently had the chance to try out the latest in diabetes tech from Medtronic, conducting a 14-day test drive of the new Minimed Connect data display platform.
This new system shows both insulin pump and CGM data on a user's smartphone and also allows for text messages when glucose readings are too high or low.
I've been eager to try out MM Connect since first getting a glimpse of it at the big American Diabetes Association conference in June, leading up to its launch in late September. Basically, it's an answer to Dexcom's popular SHARE system and do-it-yourself CGM in the Cloud creations that have been around now for a few years now. In fact, this is a side-by-side comparison to the Dexcom I’m using, with an eye to how Medtronic stacks up to what I’m more familiar with and trust with my life.
- Clear insulin pump on my waist connected to the shell-shaped Enlite CGM sensor on my body
- Little black key fob for uploading Medtronic pump and CGM data
- iPod Touch with the MM Connect app
- Dexcom G4 SHARE receiver equipped with Bluetooth to talk with the rectangular G4 sensor on my arm
- Two Android phones with a pair of CGM data-viewing apps on each
- Pebble Steel smart watch with CGM data displayed
- Black zip case with meter, strips, lancing device and other D-supplies
- And if my wife was with me, we also had her purple Pebble watch showing a stream of continuous glucose data
After receiving all the needed supplies and attending a local training session, I was ready to begin my test run at the start of December. Note that I hope to keep this trial going for a bit, so this report reflects only my first 14 days of using Minimed Connect to see the data streaming from my 530G insulin pump with Enlite continuous glucose monitor, Medtronic's integrated pump-CGM system available in the U.S. for about two years now.
I tend to be Mr. Off-Label, someone who doesn’t fully follow FDA recommendations very often. But for purposes of this test drive, I put on my FDA compliance hat as much as possible (while sneaking in a few occasional off-label ripples, of course).
While Minimed Connect is great in many ways and I commend MedT for finally offering a product like this, I found it falls short simply because it’s based on the Enlite sensor that I found amazingly inaccurate, frustratingly unreliable, and way more complicated than it should be.
There are many things I like about this system, but Medtronic has got to do better before the true benefits of this data viewing and sharing can be seen. This new data-viewing tool does not yet realize its potential, as it’s held back by both little issues and the foundational technology it relies on to provide data, IMHO.
Let's dig in a little, shall we?
Data Viewing with Minimed Connect
Hands down, I love the look of this diabetes connectivity app.
The phone interface is sleek and modern, and resembles the touchscreen design of the Tandem t:slim pump. The current glucose value is shown very prominently at the top of the screen, with the glucose trend graph below.
Minimed Connect actually works through four pieces – a CGM sensor hooked on to your body that sends data to your integrated pump-CGM, which then sends that to a little black key fob Uploader (2.5 inches x 1 inch x 0.5 inches thick). Finally, that Uploader transmits the CGM data to the app on your iOS-compatible device, where you can view the data.
The system also transmits the data via Bluetooth Low Energy to Medtronic’s web-based CareLink data platform, where it updates that info each night so you can produce reports, share data with your doctor, and or send notifications to caregivers.
Here is a quick-glance Pro and Con list of my observations about Connect, as well as my suggestions for future improvements.
- Design: This is very pleasing to look at. How cool is it to be able to see your diabetes pump and CGM data on your smartphone? Black background screen with white or colored, easy-to-read font. The CGM value changes color based on your blood sugar (orange for high, red for low, and blue/green for in-range).
- Active Insulin: This is a huge boon, as it shows you how much "insulin on board" you have going at any given time. It’s shown right at the top below the CGM value.
- Touchscreen Scrolling: You can touch the trend graph at any point in the past to see what your CGM value was at that point in time. This is also very cool, similar to how you’re able to scroll back on the history of your CGM results on the actual pump screen – whether it’s the current trend, or past 3/6/12/24 hour periods. Love this and really wish Dexcom had this feature.
- Text Alerts: You can set up text messages to go out to loved ones and caregivers if you go High or Low. We did this and my wife Suzi received a notification on her Pebble watch when the CGM believed I dropped below 70 mg/dL, as well as when the pump’s Threshold Suspend kicked in and suspended insulin overnight.
- Setup: Very simple and straightforward. It took just a few minutes to download everything and pair it up, especially with handy quick guide card MedT includes in the packaging.
- Even More Data: If you touch the three-line “hamburger icon” in the upper left corner, you get even more data straight from your pump -- Uploader battery life, sensor life, and the amount of insulin left in the reservoir.
- Calibration Reminder: In the top right of the app screen, you can touch a little blood drop to flash a reminder about when you’ll need to next calibrate your CGM. A circle gradually fills in around that blood drop as you get closer to the calibration time.
- Battery Life: You have to charge the little Uploader device and I’ve done that for an hour or two every each day. It’s nice that the pump connectivity signal doesn’t stop while charging. Since I’m using an iPod Touch on loan, I can’t speak to the difference in battery life but I charge it daily, and Connect doesn’t seem to dramatically drain the battery on that mobile device or on the insulin pump itself.
- Uploader: Yes, it is lightweight and not overly burdensome to carry around. But while it is a key fob that can be clipped onto a keychain or even a belt loop if you hook up a clip to it, this is not convenient for many of us – especially those of us who don’t carry our keys around with us everywhere and keep them within the 6-foot range. Word is Medtronic is working on a case to carry both the Uploader and pump together, btw.
- Only iPhone and iPod Touch: Limited on compatible devices for now. Medtronic says an iPad version and Android are coming soon, but until then all we can do is wait.
- Not Full Data-Sharing: The app doesn’t allow easy access to caregivers who want to view the data in real time. You have to login to CareLink, and we’ve heard some don’t care for that. It would be better if the Connect app could be downloaded and easily viewed by a parent, spouse, school nurse, or doctor instead of having to login on a computer to access the data.
- Weak Sensor/Pump Signal: The regular "disconnected" alerts on the Connect app are more a sign of the Enlite system’s weakness in design, since most of the time these alerts happened when the Uploader and iPod Touch were sitting next to each other on my desk or in my pocket, and my pump was on my waistline and the sensor was no further apart than my stomach and arm.
- Enlite Data: In my experience so far using three sensors in different spots on my body (combined with crowd-sourced opinions from the Diabetes Online Community), the Enlite CGM is highly inaccurate much of the time, and is largely “hit or miss” on any given day. This of course is a fundamental flaw that holds back the potential of Minimed Connect, which relies on this data.
- Uploader: Get rid of the Connect key fob Uploader and just weave the Bluetooth into the pump itself. There is no reason we need to carry a separate device for this, as we head into 2016.
- Alarms: Why doesn’t the Connect app alarm or notify you of Lows, separate from the text notifications? This isn’t difficult, and Dexcom offers this on their SHARE app. Plus, with the whole Threshold Suspend, why wouldn’t Connect display and alert the user to that important information in real-time? Hmmm.
- Glucose Limit Lines: I would like to be able to see my glucose range lines for High and Low on the pump and app screens, but be able to turn off the specific alerts if I rise above those. I understand this may be a tricky issue with FDA (Hey, you’re Low or High, so we want you to get those alerts!). But it’d be nice to have the option to turn off the audio alerts without the lines also disappearing from your CGM trend graph.
- Transmitter Battery: Why isn’t this shown on the Connect app? This info is already available on the pump screen (at least telling you it’s good or bad), so it wouldn’t be difficult to add this to the app screen displaying Uploader, Pump and Sensor strength, even with a percentage of remaining life or countdown clock.
- Insulin & Carb Data: Integration is a big selling point for Medtronic. Yet, the Connect app doesn’t take advantage of this by including insulin bolus, basal or carb count information in the mobile app. Wouldn’t it be cool to see that info on a sleek color phone screen, giving you ALL the pertinent D-info including the Active Insulin and current CGM value?
- CGM Checks: There's a missed potential here to gather information --- if the system gave us a way to track how many predicted lows, predicted highs and Threshold Suspends actually turned out to be accurate. If there was a little box to check within the app, or even on CareLink itself, we patients could actually keep track of how accurate or misguided these predictions and insulin suspensions really are, for our own records and also for our doctors.
- More Than iConnectivity: We know it’s coming soon, but… Android compatibility please! And really, if you’re going to make this iOS compatible first, how do you not release it for iPad? That seems like a misguided sales move, as you've lost a lot of potential customers right at the outset.
- Data-Sharing: It kind of goes without saying that MM Connect would be better set up like the Dexcom SHARE system, where you have a specific app for the person who wears the CGM tech, and a different app for the person following and viewing that data. As pointed out in; the Cons above, this is currently more of a data-viewing tool than true data-sharing, especially for parents, spouses, teachers and caregivers who aren’t connected to the device and smartphone displaying data.
- Cost: The $199 for the Minimed Connect Uploader is not covered by insurance because it’s not a prescription device. While MedT has offered some specials (like an ongoing Cyber Monday deal through December for only $99), the price-point may be high for some – especially given the limitations of the technology.
- Enlite Sensor: This just needs improvements -- from how the shell transmitter slides horizontally into the sensor and creates more potential for it to come loose, to how the wire inserted into your skin is too flimsy, and how the CGM algorithm calculates sensor data results based on calibrations. Seriously, this all needs improvement from top to bottom.
It’s important to note that this is the first generation of Minimed Connect, and just like anything else, improvements can and will be made. For Dexcom users or watchers, remember how many complaints there were about the bulky, plug-into-the-wall docking station that came with the unveiling of the original Dexcom SHARE? Or how the first SHARE app didn’t have all the cool interactive features that the new G5 mobile app has? It’s all a work in progress.
Truly, I think MedT has the start of something good here and I commend the company for finally making this move into the mHealth space. It will be interesting to see what comes next.
If It Works…
Moral of the story: MM Connect could be awesome, assuming the CGM results are accurate, and you don’t mind carrying around the little Uploader as a third device on top of your iPhone and insulin pump.
Remember, this whole system is reliant on the Medtronic pump and CGM, so it's hard to review the app in a vacuum.
The 530G is the company's most recent pump generation, but the insulin delivery is no different than the previous model, Revel 723 (my pump of choice). Design’s the same, and it does the insulin dosing and delivery job well. Yet, just like with Connect, I believe the Enlite CGM sensor holds back the 530G system from reaching its true potential.
Threshold Suspend is the big claim to fame for this pump generation, as it automatically suspends your insulin if you cross a certain low glucose point (usually 70 mg/dL for most people). This is huge, as it’s the first device to read CGM data and then actually shut down insulin dosing in case of emergency. Yep, it’s the first step toward a closed loop and that’s very exciting on its face.
Unfortunately, as awesome as Connect and Threshold Suspend both are in theory, they’re pretty much useless if you can’t trust the CGM data.
During the first 14 days of my trial run, the most reliable part of my 530G with Enlite experience was that the Enlite is not reliable.
Since the whole point of this was data-sharing and that led me to watch my D-data like a hawk, I meticulously compared results of the Medtronic Enlite to those of my Dexcom G4. The MedT-linked Bayer Contour Link meter was my go-to fingerstick meter, but I also tossed in some tests with my Accu-Chek Nano and OneTouch Ultra meters every so often.
I received four Enlite sensors for this test drive, and so far have used three of them, all of which have been wickedly inaccurate most of the time. Yet my new G4 sensor (FDA-approved for 7 days) that I put on minutes before the very first Enlite sensor, has been streaming along just fine without any issues for two weeks.
- 130 Readings (13 days, 10 tests a day)
- 35 were OK, within 30 points
- 95 were off, from 30-100 points difference
- 27% accurate
- 73% inaccurate
- No, I do not trust Medtronic enough to dose insulin
- 130 readings
- 116 were OK, within 30 points
- 14 were off more than 30 points (none above 50 points, except for data loss and a few instances of ??? error messages)
- 89% accurate
- 11% inaccurate
- Yes, I trust Dexcom enough to dose insulin (even though that’s off-label, and we're not supposed to)
Looking at the 13 full days I actually wore an Enlite (since I turned it off in frustration a number of times), and based on my average 10 fingersticks a day, the MedT Enlite was off 73% of the time. Waaay off. As in 50-100 points difference -- meaning if I had relied on that number to dose insulin, I would’ve been giving myself anywhere from 2-4 units too much or too little. A majority of those inaccuracies were off-base trends where there were no outside influencers like exercise, Insulin on Board, food in my system or anything unusual to lead the sensor astray. My MedT trainer recommended 3-4 calibrations per day, and that’s what I followed.
In contrast, my Dexcom G4 was within 1-30 points of my actual fingerstick readings 89% of the time.
I also glanced at my CGM data a couple times every hour during these 14 days while comparing the two devices, and by a large margin, Medtronic was usually inaccurate, laughably at times, while Dexcom was reliable to the point where I could have dosed insulin off the results if I'd wanted to. Based on that issue, the Threshold Suspend feature was worthless for me. In fact after a week, I turned the Threshold Suspend and the Low Predictions off entirely.
Between exchanges with my local MedT rep, to customer service calls and what the user guides tell us, the theme of what I heard in response to my Enlite not working well was: “You’re doing it wrong.” Based on sensor placement, pushing the inserter too tight, not calibrating at the best time even though the pump told me to.
I think Medtronic is missing the point.
If we need to follow all of these steps in order for the Enlite to work better, and even then it may be “hit or miss,” MedT needs to look in the mirror and recognize the reality: “You’re doing something wrong in making this technology.”
Sadly, the lack of reliability in Enlite means Minimed Connect isn’t able to do the job that I need it to. So there’s no way I would buy it.
I do encourage other PWDs to try it out for themselves, though, and it so happens MedT is currently offering a free six-week trial of the 530G with Enlite.
Hopes for Medtronic’s Future
The upshot is that the newest MM Connect system didn’t win me over, and I’m bummed that it didn’t do better for me. But of course no one's writing off Medtronic as an innovator in diabetes tech.
Big news earlier this year (timed with MM Connect’s approval announcement) was how MedT has teamed up with Samsung Electronics for future data-sharing tools and solutions. We know they have a smartwatch CGM display in the works, and they are developing the Connect app for Android. We also know MedT has teamed up with Glooko for data-sharing, and before long we’ll be able to see our CGM and pump data on that platform (along with our Dexcom data, if that’s how we roll)!
We also can’t forget MedT’s announcement in April of a partnership with IBM Watson, bringing the super-smart artificial intelligence that beat out human competitors on Jeopardy into the diabetes data analytics world. That is sure to add a layer of innovation to this, we’d have to think.
The company’s also getting close to filing its next-generation 640G system that has predictive capabilities, along with an enhanced Enlite sensor that’s been many years in the making.
With these developments on the horizon, there's a lot to look forward to in the next 18 months.
With regards to MM Connect, naturally Your Diabetes (and experiences with any particular tool) May Vary. We do try to look beyond ourselves when trial-testing new stuff, to crowdsource opinions from others in the Diabetes Community.
So if you've tried MiniMed Connect, tell us what you think, please!