My Insulin Pump is How Old?
Wait, my insulin pump is how old? Has it been five years already? I thought I had another year before it was time to obtain a new pump. I was wrong. In January I made an inquiry to Medtronic about my warranty and sure enough my warranty was due to expire on January 23, 2017. Wow five years went by fast.
It is a big deal to change insulin pumps and this time I intended to change brands so it was important to get moving. Last year following the Medtronic / United Health Care agreement; I intended to use the Accu-Chek pump provided when I made the change as it included a built in Dexcom feature. I thought I had a year before that needed to happen. I went to the Accu-Chek website and I discovered that effective January 1, 2017. According to Diabetes Mine, Roche was not taking new orders for insulin pumps and it was their intent to exit the business as the warranties for their products expired. Gulp!
I realized when I made my intention known last year that Accu-Chek was the weak sister in the insulin pump business but I also knew that they were a strong company, I liked the Accu-Chek meter and everyone I talked to liked their pump. Also, I like that Roche is a local employer in Indianapolis and I know and like people who work at there so that was a double bonus. For me, the local employer is a big deal and with the other things I thought well if they can integrate the Dexcom (most pump manufacturers seem to be doing that) then this looks like a winning combination. Alas it was not to be.
So my next check in was with Animas who does have Dexcom integration in their pumps, they are owned by a large company Johnson & Johnson (J&J), and again those who use their pumps swear by them. In December Animas announced approval of a new pump the One Touch Vibe. But then in January J&J signaled that their diabetes lines including Animas may be up for sale. At best it seems that J&J is examining the future product offerings or at worst, the diabetes business might be up for sale. Given the uncertainly and that purchasing a pump is a five year commitment for a person on Medicare I decided to look elsewhere.
My next stop was Tandem Diabetes. The Tandem X2 is a sexy pump and again people who currently use Tandem seem to like them. Despite its advantages, I quickly discounted Tandem as a viable alternative for several reasons. First I am concerned about the pump. As I talked to many users I found it was a love it or hate it proposition. Second, as of February 2017, Tandem is rated by Morningstar as having no moat (no moat means little room for error). Finally DiabetesMine is reporting the rumor that Tandem may be negotiating with Medtronic to sell rights to its Touch Screen technology. If this does happen one has to think it will be both good and bad for Tandem Diabetes but it might also signal the end of the company. Again that five year thing is raising its head.
Which led me back again to Medtronic diabetes. I cannot defend the Medtronic decision to enter into an exclusive arrangement with United Health Care (DiabetesMine May 5. 2016). But I also have to be rational about the personal choice of pump. Medtronic looks to be the most stable company in the insulin pump market at this moment. I also had to remind myself I did not chose this moment. It chose me. Yes I could have gone without a warranty but doing so involves risks including loss of support that I am not comfortable with. So then the question is less about what to do and more about how to get it done.
What about other options? Inhaled insulin looks promising, but I never seriously considered it. With RA and the possibility of lung infections, I did not want to toss in a different issue. Could I have waited for a different hybrid closed loop system? I love the approach that Big Foot Biomedical is taking, and I wish I felt I could wait for product introduction. But with no clear date and no certainty that it will be successful; I decided to wait until next time perhaps.
Hence on the last day of January 2017 I ordered a new Medtronic 630G pump and sensor. I did this to qualify for priority access to the Medtronic 670G system. In order to facilitate that change I am switching to the Medtronic sensor. The switch to the current Medtronic sensor will occur around the first week of April and I am hopeful to get the new 670G system in June, or July at the latest. The fact that switching now allowed me priority access to the 670 system was also a factor in my decision to switch to the current Medtronic system I have been using the new 630G for about 3 weeks now and I will review it in the future after I start the sensor.
If my investigation revealed anything it is that we may be on the cusp of a change in insulin pump technology. The current style of insulin delivery appears to be aging out of the market. Meaning the current pump manufacturers have to face one of two paths, either invest in the hybrid closed loop systems (the next generation of pump) or take what they can and do not make additional investments. Medtronic made that investment to build the 670G and while I will likely never argue it will be the ideal application it is the only current manufacturer that has come to market with its concept. I suppose in the end that was the one thing that swayed my opinion of how to proceed.
Also, in case I was wondering about the wisdom of making a change, two weeks after putting the new one on, I was placing the belt clip on my old pump and a large piece of plastic peeled off the old pump. It just reinforced that when the warranty runs out, it is best to decide to move forward with a new pump. In my case, the old pump can still be used as a backup, but it appears it has reached its well-deserved retirement pin.
So here’s to the new pump. While I do want better diabetes technology, I will acknowledge that I am happy that I still have a choice. As we stand on this cusp of changing technology, I fear we may be losing choices and if my foray into the pump sphere revealed anything; this time it is that losing choice does not feel so good to me. So here’s to more choice. Let’s hope the competition in the next generation of pump is as strong as in the current generation.