Please answer the poll - All-in-one or CGMS only?

[Dewey]

Ok, got a call from the MM rep. today, questioning just what I want to do. I told her I was interested in the CGMS system only (the Guardian). However, I could understand the thought behind people wanting to wear one pump, with the CGMS integrated into it.

My question to you is:

If you were on another pump that isn't out of warranty, would you opt to continue wearing your current pump & go for the CGMS system only (to wear with your pump), or would you change to the company that has the CGMS & pump all-in-one (regardless of insurance coverage)?

Personally, All I want is the CGMS. I love my Cozmo and have no desire to switch companies. However, on the other side of the coin, I can understand that wearing two systems can become a little bulky, and now that users can get Thinset reservoirs for the MM (which allows for luer-lock sets to be used), the prospects of wearing the all-in-one are a little more appealing.

I really love the features of my Cozmo more than any pump I've ever used. What are your views on this, and what would you do if posed with the question? I know what I'm going to do, but just wanted other people's input here, to help others who may have or who are facing that kind of dilemma. Thanks so much for your help!

[Carwy]

I think you should go with the way that makes you happy.

[Dewey]

Yeah, but the thing is, this is to help others. I know what I want to do....I just want to hear from others on what they chose & why. No answer is a wrong one. Just was looking for people to share what they chose & why they chose the way they did. Never know, their answers may help many prospective pumpers make their ultimate decision. :thumbsup:

[greengirl]

CGMS only for me. I just had to make this decision since I have a pump out of warrantyy. Even though my insurance would cover everything I need for the all in one Minimed Pump/CGMS I decided not to go with it. For me it was bad customer service reminicent of when Disetronic started to go "down" and that others I have come into contact to have more problems with customer service than what I have encountered learning about the other 2 pump companies. Pumps are small enough now that I would wear a second one if needed to. The minimed pump did not have many of the features I wanted and the Cozmo did. So I went with the Cozmo.

Other than the all in one systems pump lacking in features, I didn't like that the pump isn't waterproof when shipped. I also do not plan to wear cgms all the time. I think I would probably wear it no more than a week or two a month, so I would only need to wear/carry the cgms receviver then. Plus I wasn't go to get a pump just so I could have an ll in one system where the cgms might not even work well for me. I know I will always be wearing the pump, so that carries the most weight with me.

[JediSkipdogg]

I personally think the pump options should be #1. The pump is technically what keeps you alive. You can live without a CGMS, but not without a pump (unless you go back to shots.) So you need to look at what pump you want to use and go from there. That is one reason why I'm staying with Animas and getting the CGMS only.

I love Animas and have nothing against them and thier service. They also write my 80% insurance payment off as 100%. If I switch to MM I'd have to pay 20% which would then eliminate me even getting a CGMS due to funding.

There is also for most people, like me, a $1200 vs $200 expense based on 20% of pump vs CGMS. So that was a huge consideration for me.

I think only you can make the ultimate decision. I've heard the Guardian is better than the pump CGMS because it has more graphs, stats (you can add all your pump info into it...such as carbs, meals, etc wtihout having to have it stored as a bolus or something in the pump), etc. built into the unit itself and also the alarms are about twice as loud. Again, that is what I've heard and not experienced.

[someone]

Well, I wear both and I find it no problem. The new MM CGMS is not bulky at all. It fits fine in the same pocket as my pump. Additionally, the CGMS is wireless. I usually either leave it on my desk, or at night leave it on a night table. What you should be worried about is wearing a sensor and an infusion set, which you will have to do either way. I say save the $7000 or whatever it costs for a new pump, and go with the standalone unless there is a reason other then CGMS that you want the Minimed pump. To me, the CGMS is much worth carrying around an extra device.

[frige]

It's a tricky question.

You have to hand it to MM for coming out with what looks to be like the best cgms on the market. And then pairing it with their pump.

I would be scared that a better cgms would be on the market, shortly after I got a pump/cgms combo.

I'm sure better cgms is around the corner. I doubt the Cozmo will be able to integrate nicely with cgms. Take a look at the jumbo belt clip that comes with it. The bg monitor seems like a serious after thought. [my opinions]

-john

[Lloyd]

It's a tricky question.

I'm sure better cgms is around the corner. I doubt the Cozmo will be able to integrate nicely with cgms. Take a look at the jumbo belt clip that comes with it. The bg monitor seems like a serious after thought. [my opinions]

-john

The cozmo will integrate with the freestyle navigator, when that is released.

-Lloyd

[someone]

I would be scared that a better cgms would be on the market, shortly after I got a pump/cgms combo.

Very good point. If you just get a standalone, you can always get what is best on the market, without feeling like you have to use the MM one since that is what is built into your pump.

[Funnygrl]

=

I'm sure better cgms is around the corner. I doubt the Cozmo will be able to integrate nicely with cgms. Take a look at the jumbo belt clip that comes with it. The bg monitor seems like a serious after thought. [my opinions]


I'm actually suspecting the Cozmo to integrate quite nicely with the navigator. And the navigator is suppose to be better than the current CGMSs. We shall see.

In terms of the belt clip- I don't understand your point. Yeah, it sucks, so? I use a cell phone case.

And the Cozmonitor? That was an after thought. It was released a year after the Cozmo. And it works fine, it's just a tad bulky. It needs to be removable so the pump can be waterproof.

[Lloyd]

In terms of the belt clip- I don't understand your point. Yeah, it sucks, so? I use a cell phone case.



I agree, I use a cell phone case too.

"Cozmo pumper, in purple"
Hey Funnygrl, you're not purple anymore, are you? :)

-Lloyd

[Funnygrl]

I agree, I use a cell phone case too.

"Cozmo pumper, in purple"
Hey Funnygrl, you're not purple anymore, are you? :)

-Lloyd
Yes, I am, actually.

[notme]

Why am I always the one that thinks differently than everyone else??? Ok. Don't answer that! :T

I love the pump. I have only used MiniMed and I have always been happy with the pump and the options and its function. However, I would switch if I were using CGMS and had two wear two devices. As much as I love the pump, I do find it hard sometimes to find a place to put it. Women, more than men struggle with this issue. Dresses are impossible and some skirts are so light that it drags the waistband down to far. Pants are low rise for women and the pump or tubing is always hanging out. I would find it really frustrating to wear two devices. So.... I am vain and frustrate easily. I would switch.

[Funnygrl]

Yeah Nancy. You have some good points there. The nice thing about the CGMS though, is that you can easily go off it for a few hours, or even a day, if there is a reason to.

[rmccully2000]

I would choose CGM over pump in a heartbeat, esp for a child. A pump is just another form of insulin delivery but direction and rate of change is only available through a CGM.

For young children, I would also consider that it is very convenient to have a CGM receiver that is separate from the child (not attached, like a pump would be). Esp. as they increase the range that the receiver can pick up signals from the transmitter.

Think baseball fields, basketball courts, playgrounds, hallway outside the bedroom. You can keep an eye on little ones much easier by keeping the receiver in your pocket.

Becky, Mom to Mason, 7 Dexcom, Iport

[greengirl]

The cozmo will integrate with the freestyle navigator, when that is released.

-Lloyd

How did you find this out. I was told by the rep it would not be integrated just last Friday. From what I understand it'll still be as if you had a seperate cgms for quite a while after release.

[jenet]

I might consider switching to an integrated CosMo/Navigator CGMS whenever it comes out, but the MM pump just doesn't have the right combination of features I want in a pump. (As always, YMMV. I'm happy for those of you that love your MM pumps. :) ) And of course, there is the cost factor. My pump is only a year old, and I don't know if my care team would be able to convince my insurance that it was medically necessary, or what the out of pocket would be for that.

So with today's options, I'm staying with my Animas pump, and seriously thinking about the Guardian RT standalone. My insurance won't cover the CGMs or sensors yet, so I could only afford to wear it every other week or two, but I do think it would be immensely helpful to fine-tune my pump settings.

I was hoping the Navigator would be out by now, and I'm not sure how much longer I want to wait and bypass the possible benefits of getting one this spring/summer instead of next winter. Decisions, decisions...

j

[camjen1]

And the navigator is suppose to be better than the current CGMSs. We shall see.


Trying not to go into pump bashing and all but how exactly do you know the Navigator is going to be better then MM? Is this just your opinion? I'm just trying to understand where some people get their facts.

[Funnygrl]

Trying not to go into pump bashing and all but how exactly do you know the Navigator is going to be better then MM? Is this just your opinion? I'm just trying to understand where some people get their facts.
I'm basing it on studies. I read a study that compared the accuracy of the Guardian vs. the Navigator and the Navigator preformed better in the hypoglycemic range, though both preformed well in the euglycemic range. Further, I'm basing it on the fact that Abbott went to the FDA with 5 day sensor use. I know most people using CGMS do more than that anyhow now, but basing it on actual recommended use, that's an improvement. Before the release of the Minilink I would say that I was basing that on the replaceable batteries too, but Minimed has now taken care of that issue.

[Funnygrl]

I'm basing it on studies. I read a study that compared the accuracy of the Guardian vs. the Navigator and the Navigator preformed better in the hypoglycemic range, though both preformed well in the euglycemic range. Further, I'm basing it on the fact that Abbott went to the FDA with 5 day sensor use. I know most people using CGMS do more than that anyhow now, but basing it on actual recommended use, that's an improvement. Before the release of the Minilink I would say that I was basing that on the replaceable batteries too, but Minimed has now taken care of that issue.
I can't find the actual study, but the article in this PDF, "Farewell to fingersticks?" discusses it briefly.

http://cme.yale.edu/diabetes/2005/ADA1-June11-SanDiego.pdf

Farhy et al. from Charlottesville, VA com-
pared the accuracy of two continuous glucose
sensors, the FreeStyle Navigator™ (Abbott
Diabetes Care) and CGMS
®
(Minimed), which
were concurrently placed on 16 Type 1 diabetes
patients (394-P). Patients underwent two hyper-
insulinemic clamp studies, each consisting of
70-210 minutes of euglycemia (goal 110 mg/dl)
followed by a 1 mg/dl/minute decrease in blood
glucose to hypoglycemia (goal 40 mg/dl).
Arterial blood glucose was measured every five
minutes. While the performance of both sensors
was similar in the euglycemic range, the FreeStyle
Navigator appeared more accurate in the setting
of hypoglycemia (82.4% vs. 61.6% with CGMS,
p<0.0005) (Table 2).

[Cyborg]

I like the all-in-one idea myself. It's hard enough to find a spot to put another set, little lone a set and a CGMS. Too many holes and not enough skin!

[Funnygrl]

I like the all-in-one idea myself. It's hard enough to find a spot to put another set, little lone a set and a CGMS. Too many holes and not enough skin!
Cyborg, I'm sure you realize that even if you have a pump that will read the CGMS data, you still need a second "site" for the sensor, right? This is just about less "belt gadgets" not about fewer sites.

[FrankDr]

Well, this is timely . I just sent my order for the MM Guardian today. It should be here later this week.

I'm using a Cozmo pump, and I wouldn't trade it for a MM integrated solution even if it didn't cost extra. I think of this as the 'best of breed' solution for what's currently available. I do like the integrated reporting though . .

I've been patiently waiting for the Navigator to arrive on the market, and I finally got tired of waiting. The other 2 vendors have already released their second point upgrade of their CGMS systems and Abbot still hasn't got their first version out yet. There are only so many early adopters who are willing to pay out-of-pocket for the latest technology, and if Abbot doesn't hurry, there won't be many left. I've got a feeling that a lot of people who have been 'on-the-fence' about CGMS systems are likely to jump on the MM system if people report good results.

As for the 'integration' of pump/CGMS systems - Right now the integration only means that the pump is a data collection and display device. But, since the CGMS system is wireless, unlike a pump which is 'connected' with tubing, you can put the CGMS receiver in a coat pocket, purse, on the desk / nightstand, etc.

I believe there is a 30 or 40 minute buffer, which means that the transmitter will hold data in memory if it's out of range of the receiver for a while. So, for short times, you can even leave the receiver behind without losing data. Again, I'm not 100% certain about that part, but I'm sure I heard it mentioned somewhere.

[camjen1]

I'm basing it on studies. I read a study that compared the accuracy of the Guardian vs. the Navigator and the Navigator preformed better in the hypoglycemic range, though both preformed well in the euglycemic range. Further, I'm basing it on the fact that Abbott went to the FDA with 5 day sensor use. I know most people using CGMS do more than that anyhow now, but basing it on actual recommended use, that's an improvement. Before the release of the Minilink I would say that I was basing that on the replaceable batteries too, but Minimed has now taken care of that issue.

If that's all that makes a Navigator "better" then I see really no difference between the two. I would think if one company got approval for a longer sensor wear then all the companies would get approval. MM was slacking on the recharging ordeal but has that fixed. Now all that there is left is accuracy, and by the way people have been reporting it, it has been fairly accurate. So now where is the Navigator? If it's better then MM and has all the same features then why are people still desperately waiting for the release? A release I remind you that won't happen for at least another few months if that.

[Funnygrl]

Sandi, I know you love your MM pump. That's great. I also know many people have had great luck with the guardian. That's great also. If I could afford a Guardian right now, I would get one in a heart beat. I didn't mean to start CGMS "bashing" I was simply stating why some people are particularly optimistic about the Navigator. There are studies to show it is even more accurate, which is exciting in the world of CGMS. That's all. You asked me where I got that information, I showed you.

[JediSkipdogg]

If that's all that makes a Navigator "better" then I see really no difference between the two. I would think if one company got approval for a longer sensor wear then all the companies would get approval. MM was slacking on the recharging ordeal but has that fixed. Now all that there is left is accuracy, and by the way people have been reporting it, it has been fairly accurate. So now where is the Navigator? If it's better then MM and has all the same features then why are people still desperately waiting for the release? A release I remind you that won't happen for at least another few months if that.

I think alot is based on pre-Guardian RT. The Guardian RT I believe (don't quote me) has predictive alarms. The MM pump doesn't (to my knowledge.)

The problem with Navigator is they went straight for 5 day wear and have not stood back from that. MM and Dexcom are both attempting 5 day wear as well, and have been for about 6 months, and neither of them are getting anywhere. Once one gets approved, all three will be approved. The problem is there is no knowledge of when that will happen. The FDA is just so stubborn on this 3 day only wear even though for 3 years or so the Navigator has has evidence that 5 day wear is safe. I guess they just don't want to be like MM and Dex and go 3 days then try for further approval for 5 days, since that will require a unit upgrade for reprogramming most likely at a cost to the end user.

I give up though and if I posted my most recent CGMS stories, I'd write a novel. I may never see one now.....

[Cyborg]

Cyborg, I'm sure you realize that even if you have a pump that will read the CGMS data, you still need a second "site" for the sensor, right? This is just about less "belt gadgets" not about fewer sites.

To tell you the truth, I thought it was a hypothetical question regarding the all-in-one CGMS. My answer remains the same though. The least I have to carry around with me, the better...

[Funnygrl]

To tell you the truth, I thought it was a hypothetical question regarding the all-in-one CGMS. My answer remains the same though. The least I have to carry around with me, the better...
Yeah, good point.

[Dewey]

Like Frank, I got tired of waiting for the release of the Navigator, so I've made an appointment with my endo to get the paperwork started for a Guardian CGMS. Today must have been a bad day (Monday) for me or something, but things are just irking me today (i.e. the way the rep behaved when she called - I know precisely what I want & need and that's exactly what I'm going after).

As Frank also stated, I too, believe that the MM Guardian CGMS & Cozmo pump are both 'best of breed' on the current market. From all I've read & researched online, the only pro the Navigator may have over MM's CGMS is that readings are taken by the minute, rather than x amount of minutes apart. Other than that, I don't see anything (accuracy or otherwise) that would make me willing to wait till December to get the Navigator.

Each pump, CGMS & company has their share of pros & cons. NO company is exempt! This includes Abbott, Smiths, Animas, MiniMed and any other company out there. There are going to be some who have great experiences & others who do not. Please remember that folks.

[FrankDr]

so I've made an appointment with my endo to get the paperwork started for a Guardian CGMS..
The MM rep here is taking care of that for me. He knows the endos at my Dr's office and is going by there tomorrow. Hey - you gotta make 'em work for their money :)

Each pump, CGMS & company has their share of pros & cons. NO company is exempt! This includes Abbott, Smiths, Animas, MiniMed and any other company out there.
I always try to remember that features I find useful or important may not matter at all to someone else.

I also checked on the pricing. The MM rep I spoke to on the phone said that the $1039 price was for upgrades from the previous Guardian model only . . darn

[JediSkipdogg]

I also checked on the pricing. The MM rep I spoke to on the phone said that the $1039 price was for upgrades from the previous Guardian model only . . darn

I was not mentioned that at all when I called. Sounds like I may need to dig into files here at work and find our phone recordings....now to just remember what day I talked to them.

From all I've read & researched online, the only pro the Navigator may have over MM's CGMS is that readings are taken by the minute, rather than x amount of minutes apart.

I'm kinda debating if that is a pro or con. The reason I say that is all CGMS units take a reading every minute. The Dexcom and MM just then take those 5 readings, average them, and then show you that average every 5 minutes (which is another reason it lags behind in changes, because we know an average the lowest or highest number in a slope change will have a noticable effect.)

I guess what I see is say your BG is 101....well, there is still some alotment for error in there. If the device picks up a 100, 106, 97, 103, 101 in a 5 minute period, I don't know if I'd want to see all that variation or if I'd be happy with the 101.

[NoelD]

I think alot is based on pre-Guardian RT. The Guardian RT I believe (don't quote me) has predictive alarms. The MM pump doesn't (to my knowledge.)


Are you talking about the 2 arrows up or down and high/low alarms?

[JediSkipdogg]

Are you talking about the 2 arrows up or down and high/low alarms?

No....well wait...maybe....LOL on the arrows thing. I just thought I heard something about the Guardian being predictive but then again, so would the Paradigm.

As for the alarms...reviews have showed two fold that the Guardian audible alarms are twice as loud as the loudest Paradigm alarm.

[NoelD]

yea, the paradigm alarm is not loud at all. It doesn't wake me up. It did a few times in the beginning, but not now.

[JediSkipdogg]

yea, the paradigm alarm is not loud at all. It doesn't wake me up. It did a few times in the beginning, but not now.

Pump alarms are well...how do you say it nicely...****? I'm glad the Animas beeps and then goes into vibrate mode and back and forth till you acknowledge it. Not sure if other pumps do that or not.

[Dewey]

It sounds to me that even though the poll may say otherwise, the general consensus is to stay with the current pump & get the CGMS separately. One thing that I found especially interesting, is that users state that the Guardian's alarms are louder than those of the Paradigm. Very interesting, indeed.

[Lloyd]

How did you find this out. I was told by the rep it would not be integrated just last Friday. From what I understand it'll still be as if you had a seperate cgms for quite a while after release.

All I know is from the reports that I have been reading from people who have been in contact with Abott and Smiths Medical. I read everything I can find on the subject, but reports are sketchy, this is info on an unreleased product. Sometimes additional gear comes out after the fact, also.

First hand reports by beta testers of the navigator are very favorable. Here is an interesting study:
http://www.thieme-connect.com/ejournals/abstract/ds/doi/10.1055/s-2006-943954

Conclusions: "The stability of the FreeStyle Navigator continuous glucose monitoring system allows accurate sensor use over a measurement period of 5 days".

Hopefully, a few studies like this will convince the FDA.

We'll just have to wait and see. I personally have concluded that neither of the existing CGM's are accurate enough and reliable enough to justify what their cost would be for me.

YMMV

-Lloyd

[someone]

Well, this is timely . I just sent my order for the MM Guardian today. It should be here later this week.

Good for you. It really is a good system and you will be surprised by its accuracy. Were you able to get any insurance coverage?

I believe there is a 30 or 40 minute buffer, which means that the transmitter will hold data in memory if it's out of range of the receiver for a while.

That is correct. The transmitter will hold 40 minutes of data if it is out of range of the receiver.

No....well wait...maybe....LOL on the arrows thing. I just thought I heard something about the Guardian being predictive but then again, so would the Paradigm.

The Guardian does have a predictive alarm option where you can tell it to alarm you based on how quickly your BG is dropping or rising.

[FrankDr]

Pump alarms are well...how do you say it nicely...****?
My Cozmo doesn't wake me up - but it wakes my wife up - then she wakes me up (or at least tries to)

Were you able to get any insurance coverage?

I'll send it in once I get the bill. Our company uses UHC - I'll probably have to appeal it to our company. Of course, I'm in good with our benefits manager - maybe that will help :)

[Doug]

My Cozmo doesn't wake me up - but it wakes my wife up - then she wakes me up (or at least tries to)

I'll send it in once I get the bill. Our company uses UHC - I'll probably have to appeal it to our company. Of course, I'm in good with our benefits manager - maybe that will help :)
Yeah and once Frank gets his approved - they best set aside some more $$ cause Ill be right behind him... Its great letting the kids do all the leg work...

[condensr]

Just talked to my doc this morning. She'll be faxing an RX to Minimed for the Guardian RT. Just waiting to hear from their insurance/billing folks, hopefully soon..

[Dewey]

Just talked to my doc this morning. She'll be faxing an RX to Minimed for the Guardian RT. Just waiting to hear from their insurance/billing folks, hopefully soon..

Good luck, Shane! Please keep us posted on how things go. It sounds like the big question now is, "Will insurance cover our CGMS systems?" Here's hoping they will! :thumbsup: