More Choices Available for Abbott, Dexcom, Tandem, and iLet

Key takeaways:

• Recent integrations between continuous glucose monitors and insulin pumps are allowing diabetes tech users to choose between more options.
• Tandem t:slim X2 users can now use either the FreeStyle Libre 2 Plus or the Dexcom G7 as part of their automated insulin delivery system. 
• The latest: Beta Bionics is integrating its system, the iLet Bionic Pancreas, with Abbott’s FreeStyle Libre 3 Plus starting in the fourth quarter of 2024.

More options than ever before are available for users of continuous glucose monitors (CGMs) and insulin pump automated insulin delivery (AID) systems.

New options for the iLet Bionic Pancreas

The iLet Bionic Pancreas received FDA clearance in 2023. Like other AID systems, it utilizes software with an adaptive algorithm to communicate between a CGM and an insulin pump delivery system. It differs from other AID systems, however, by only requiring one piece of data input – a user’s body weight – to significantly reduce the amount of time users need to spend programming the system.

Abbott’s Freestyle Libre 3 Plus 

Beta Bionics announced it will be partnering with Abbott to allow iLet Bionic Pancreas users to choose the FreeStyle Libre 3 Plus for their CGM.

The FreeStyle Libre 3 Plus sensor, which was unveiled in June, is the modified FreeStyle Libre 3 sensor that was cleared by the FDA to integrate with AID systems. The Libre 3 Plus is indicated for use by people 2 years and older and is the size of two stacked pennies. It also has a longer wear time of 15 days.

Scheduled for late 2024, the FreeStyle Libre 3 Plus will be available through pharmacies and durable medical equipment suppliers, the iLet Bionic Pancreas will be the first insulin pump to use the FreeStyle Libre 3 Plus CGM to become available in the U.S. The FreeStyle Libre 2 Plus is not currently available for use with the iLet Bionic system.

Dexcom’s G6 and G7

The iLet Bionic Pancreas has been compatible with the Dexcom G6 since its launch in May 2023. Last December, Beta Bionics announced integration with the Dexcom G7 as well, giving wearers the option of a much shorter sensor warm-up time. iLet users can currently use either the Dexcom G6 or Dexcom G7 continuous glucose monitor, or switch back and forth, depending on their supplies and preferences. 

How to use the iLet Bionic Pancreas with the Dexcom G7 

Current iLet users who want to use the Dexcom G7 will need to download a Beta Bionics software app update, which is free in the Apple app or Google Play stores.

“Our goal is to give our patients choices with their CGM technology and to be able to update quickly and easily without new hardware or additional costs,” Sean Saint, CEO at Beta Bionics, said.

Bionic Pancreas users will need to update their iLet mobile app to use the Dexcom G7, and presumably will also need to update the app to use the FreeStyle Libre 3 Plus when it is released later this year. 

In addition to more CGM options, updating the iLet app will also give users access to other newer features, such as mirror display and the ability to pause insulin delivery.

More options for the Tandem t:slim X2

Users of the t:slim X2 insulin pump can now use either Abbott’s FreeStyle Libre 2 Plus or Dexcom’s G7 continuous glucose monitors.

Abbott’s Freestyle Libre 2 Plus

The FreeStyle Libre 2 Plus sensor is the modified FreeStyle Libre 2 sensor that was cleared by the FDA for use with AID systems.

In June, Abbott unveiled the FreeStyle Libre 3 Plus, which offers an extended wear-time of 15 days, and which the company called “the world’s smallest CGM sensor with future AID compatibility.”

In addition, Abbott is in the process of enabling its FreeStyle Libre 3 Plus sensor to be used with Tandem’s t:slim X2 insulin pump system; for the time being, the Tandem t:slim X2 insulin pump will only work with the FreeStyle Libre 2 Plus sensor.

Dexcom’s G7

Compared to the G6, the G7 also offers improved accuracy and more customization of alerts, such as the ability to select glucose values for the quick rise and fall alerts.

“This is the day we have all been waiting for,” Dr. Diana Isaacs, director of education and training in diabetes technology at Cleveland Clinic, said of the Dexcom G7’s U.S. partnership with Tandem. “With an additional CGM choice to work with, we are one step closer to the true vision of allowing people more choice in their diabetes technology.”

What to know before using the t:slim X2 with the Dexcom G7 

 Dexcom’s G7 integration, which rolled out in the U.S. in December of 2023, arrived with much anticipation yet also considerable confusion. Because two different Dexcom G7 versions – one AID compatible, and one not – were circulating at that time, some users found it difficult to identify the correct version to use with their Tandem AID systems. 

Some clinicians initially questioned how accessible the integration would be for people with diabetes. 

“Everyone has been waiting for this integration for a long time,” said Dr. Irl Hirsch, professor of medicine at the University of Washington. “Everyone should be happy, but they are not.” 

Hirsch said that the distributors were “sending the wrong G7 (the one that doesn't talk to the Tandem) to patients.” He also cautioned that some might have a hard time distinguishing the labeling of the Dexcom G7 that is compatible and the G7 that is not compatible, leading to confusion not only for users, but also for pharmacy technicians.

Dexcom’s G7 sensors that don’t work alongside insulin pumps have been phased out, according to Dexcom, meaning that this should be less of an issue moving forward. 

Users will now know that a G7 sensor is compatible with the Tandem t:slim X2 insulin pump if the side of the Dexcom G7 box has a manufacturing date of 2024 or later, as well as a white line below the LBL number (contact Dexcom customer service if a Dexcom G7 sensor is not compatible).

In January of 2024, the t:slim X2 pump with Dexcom G7 integration launched in South Africa as well as more than 10 countries across Europe.

Current t:slim X2 pump users will be able to use either the Dexcom G6 or Dexcom G7 CGM for their diabetes management. Dexcom G6 users have the option to switch to the Dexcom G7 whenever it is most convenient. Dexcom G7 sensors that integrate with the t:slim X2 pump can be found through durable medical equipment (DME) distributors.

All in-warranty t:slim X2 users in the U.S. should have received email instructions for a free software update to integrate the G7 at the time of the rollout. New t:slim X2 pumps will be pre-installed with the Dexcom G7 integration before they are shipped to new customers. 

In addition to giving t:slim X2 users access to key features of the G7, the updated software includes the following elements: 

• A timer for exercise mode that allows for a duration of 30 minutes to 8 hours 
• Additional tones for pump alarms and alerts, such as for the bolus, quick bolus, CGM alerts, and fill tubing notifications
• A “Select Sensor” screen so users can switch between using Dexcom G6 and G7 hardware

Tandem t:slim users should also be aware of different software requirements between the Dexcom G7 and the G6:

• The t:slim X2 pump (software version 7.3 or later) is compatible with all versions of the Dexcom G6 sensor. 
• The t:slim X2 pump (software version 7.7 or later) is only compatible with certain versions of the Dexcom G7 – specifically, sensors that have a white line below the LBL number at the bottom of the packaging, as shown in the image below. 

Before starting the software update, you’ll need to complete training. You can find a helpful checklist and preview the update process here.

What these changes means for people with diabetes 

Making insulin pumps compatible with different CGM sensors is the first step toward greater choice and customization in diabetes care. In addition to Tandem’s t:slim and Beta Bionics’ iLet,  Omnipod 5 maker Insulet announced it had fully integrated with the Dexcom G7 in addition to the G6.

Ultimately, experts envision a world in which people with diabetes can choose from different CGMs, insulin pumps, and insulin delivery algorithms to manage their diabetes.

"When it comes to diabetes management, we don’t believe it is one size fits all,” Elizabeth Gasser, Tandem’s Chief Strategy Officer, said. “Our continued goal is to provide people with a portfolio of options that they can choose from.” 

Learn more about automated insulin delivery: 

• AID Systems Hit Impressive Time in Range Targets, Large Studies Show
• Closed Loop Technology is a Success in Kids
• FDA Clears Freestyle Libre 2 and 3 for Use With Automated Insulin Delivery

Photo credits: courtesy Abbott (top right); Beta Bionics (iLet); Tandem (t:slim X2); Dexcom (G7 box).