By David Ahn, MD
In late August, the FDA approved Tandem Diabetes’ long-awaited first software update for their X2 Insulin Pump that enables Dexcom G5 integration. With a FREE simple software update performed in the comfort of their own home, thousands of X2 users can now display CGM data (from the Dexcom G5 Mobile System) directly on their Tandem pump screen.
In the world of smartphone apps and hybrid closed loops, viewing CGM data on a pump screen might not appear at first glance to be groundbreaking, but Tandem’s software update will provide meaningful benefits not only for Tandem customers, but for the entire industry of people affected by diabetes.
First time a software update has added a new feature to an insulin pump
“The pump that gets updated, not outdated” is appropriately Tandem’s marketing slogan for their X2 Insulin Pump. A longstanding frustration for pump owners has been that insurance companies will not replace or upgrade most insulin pump hardware until the 4 year warranty period expires.
Therefore, while you might be buying the latest and greatest pump on the market right now, it will likely be outdated within 18 months. By the time your 4 year warranty period expires, you might be two or three generations behind. And as we draw nearer to a fully closed-loop artificial pancreas, those two or three generations might make a huge difference.
However, Tandem’s X2 platform has been built with the future in mind. People who received the very first X2 pumps nearly one year ago now have the same new Dexcom G5 integration available in the latest version shipping today with a simple convenient software update. Adding completely new features via software update has never been done in an insulin pump before.
Tandem X2 is now the only pump that integrates with Dexcom G5
Dexcom integration with Tandem pumps might seem like old news because their T:Slim G4 pump (released in September 2015) similarly displayed CGM data from the Dexcom G4. However, the T:Slim G4 did not include the advanced software 505 algorithm, leading to less accurate readings than on a later Dexcom G4 or G5 model. Second, the T:Slim G4’s lack of bluetooth functionality prevented integration with the Dexcom G5 and its popular ability to transmit CGM data directly to smartphones.
Therefore, prior to this G5 software update, Tandem and Dexcom customers were stuck with a dilemma: purchase the older T:Slim G4 and forego the amazing smartphone feature OR go with an X2 and forego the ability to view CGM data on the pump. With the new G5 software update, this dilemma is solved and the X2 is the only pump that directly integrates with the Dexcom G5. (The Animas OneTouch Vibe Plus was planning to integrate with the G5 but Johnson and Johnson decided to exit the pump market).
Dexcom G5 integration is a godsend for many Android users
While G5 owners with iPhones have long enjoyed the luxury of viewing their CGM data on their phone or Apple Watch, Android users have only been recently granted access. And only Android users that use certain models. For example, owners of the highly-rated Google Pixel smartphone or other non-Samsung Android phones will not find the Dexcom app in their App Store. (Workarounds do exist, but are at your own risk).
Therefore, insulin pump users that own Android phones not supported by Dexcom would previously have to resort to carrying around their insulin pump controller AND their Dexcom receiver. Not fun.
With the latest software update, X2 owners can leave their Dexcom receiver at home AND take advantage of the advanced software algorithm and smartphone-sharing capabilities of the G5 Mobile.
The update points toward even better upgrades in the future
Tandem has already begun the pivotal study for their next significant software update, PLGS (predictive low glucose suspend). PLGS will allow the X2 pump to automatically suspend insulin delivery when its advanced software algorithm predicts that the blood sugar will sink below <80 mg/dL in the next 30 minutes, significantly reducing dangerous hypoglycemia. This feature also aims to reduce hyperglycemia as users will be less fearful of low blood sugars limiting proper bolusing.
Tandem Diabetes has indicated that the PLGS software update will apply to the current X2 pump, so all existing X2 owners will be able to add that feature when the company hopes it will be released in Summer of 2018. (Unlike the free G5 software update, the PLGS software update might require a one-time cost).
Conclusion: Pump competition is good for consumers
Unfortunately, the pump market is currently getting smaller with the exits of Asante, Roche, and Animas in the past several years. No matter which remaining pump company you find yourself rooting for, having options when it comes to insulin pumps is important for several reasons.
First, competition breeds innovation. In the smartphone market, if it weren’t for Google and Samsung, Apple would have very little reason to continue adding new features to the iPhone year after year. In fact, many features such as the “Plus” form factor and the rapid evolution of voice assistants such as “Ok Google,” Alexa, and Siri are likely a direct result of competition in the market.
In the insulin pump market, Medtronic pumps looked largely the same and only added minimal new features until other players in the market came along.
Second, competition brings down costs. The cost of living with Diabetes is already ridiculous as it is, the last thing we need is for a single company to monopolize the pump market. In fact, Tandem Diabetes is offering all owners of their previous T:Slim pump an upgrade pathway, costing $399-$799, which is dramatically lower than Medtronic’s upgrade cost of either $599 or $3100.
Lastly and most importantly, competition brings choice. People with diabetes aren’t all alike and their needs might change over time. When starting a new patient on a pump, I like to present the wide variety of pumps on the market, each with their own strengths and weaknesses. Medtronic has the only hybrid closed loop on the market; Insulet’s Omnipod is the only tubeless patch pump available; Tandem’s X2 has the only touchscreen pump.
With Tandem’s X2 ability to add new features via software update, patients have an option that will remain up-to-date over the next few years.