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The Insulin Pump “Pick Six”

By Gary Scheiner MS, CDE

Back in 1994, the diabetes clinic where I worked needed someone on staff to develop hands-on insulin pump expertise so that we could develop a pump program for our patients.  Being the token type 1, I was the guinea pig. In those days, there were only two types of pumps: MiniMed (now Medtronic) and Disetronic (now Roche). Since our clinic had a working relationship with the MiniMed representative and none of us knew anything about Disetronic, the choice was more or less made for me. Not that I’m complaining – it was a good experience that led me on a path to better control and quality of life. Since then, I’ve worn 26 different pump brands and models, and I’ve had a chance to train clients on each of them and even consult the companies who make them.  I’ve also had the opportunity to learn firsthand the unique qualities of each pump and the companies behind them. And believe me, there are some major differences.

It amazes me that so many pump users are still given little to no choice when it comes to selecting an insulin pump. Their healthcare team simply gives them a single brochure or puts them in touch with one pump company representative to place an order.  For those whose pumps are out of warranty and are in a position to order a new one, many are automatically upgraded (or pressured to upgrade) by their existing pump company.  Given that we now have six pump companies on the market, each with its own unique set of advantages and drawbacks, it makes much more sense to invest some time in comparing the various devices.

Given that we now have six pump companies on the market, each with its own unique set of advantages and drawbacks, it makes much more sense to invest some time in comparing the various devices.

One way to compare pumps is to attend diabetes conferences or trade shows and visit with the representatives in their booths. This gives you a chance to play with the devices and gather detailed information. You can also visit the pump company websites, but be aware that the material on the websites, as is the case with their brochures, is going to be weighted heavily in their own favor. Going to support group meetings or visiting third party blogs and chat rooms that are unaffiliated with pump companies can give you a chance to rub elbows with people who use a variety of insulin pumps. Ask them what they like and don’t like. And if you’re lucky enough to work with a diabetes specialist who has experience with multiple pumps, by all means, ask for their input.

My company’s website (www.integrateddiabetes.com) contains detailed comparisons of the six insulin pumps that are currently available: www.integrateddiabetes.com/p_compar.shtml. For each pump, we list positive and negative features that can be attributed to that pump. Features that are common to multiple pumps (such as having multiple basal patterns) are not mentioned. The lists are based on our clinical team’s experiences wearing each pump as well as training and managing patients who use them. In case you’re wondering, all of the diabetes educators on our staff have type 1 diabetes and wear a pump.

Here are just a few of the highlights, with pumps listed in alphabetical order by manufacturer:

Animas OneTouch Ping

Key Advantages:

  • Bright full-color screen

  • Cartridges are easy to fill without air bubbles

  • Plans are in place to integrate with the Dexcom continuous glucose monitor [Editor’s Note: The Animas Vibe is currently under FDA review. This could launch sometime in early 2014.]

Key Disadvantages:

  • Pump programming requires multiple steps and many button presses

  • The OneTouch Ping meter-remote uses outdated testing technology

  • No averages, statistics, or blood glucose/carb history accessible on the pump itself

Asante Snap

Key Advantages:

  • Uses prefilled insulin cartridges and disposable “pump bodies” – very fast and easy to change out

  • Lowest up-front cost of any traditional full-feature pump (approximately $775)

  • Large, easy-to navigate display

Key Disadvantages:

  • No option yet for downloading data stored in the pump [Editor’s Note: Asante has recently announced partnerships to download data from the Snap to Glooko and Diasend; release is expected in late 2013. See Adam’s test drive in this issue.]

  • Only Humalog (insulin lispro) cartridges can be used in the pump

  • Somewhat noisy bolus delivery

Insulet OmniPod

Key Advantages:

  • Small, tubeless and very discreet

  • Simple, fully automated infusion cannula insertion

  • Relatively low up-front cost for personal data manager (handheld component) and initial order for pods

Key Disadvantages:

  • Must have remote-control Personal Diabetes Manager (PDM) to deliver boluses or make any setting changes

  • No “disconnect” option. Must remove and replace pod if disconnection is required

  • Only one infusion device option (angled plastic cannula)

Medtronic Paradigm Revel

Key Advantages:

  • CGM Integration – pump serves as display for Medtronic’s continuous glucose monitor

  • Company has longest/most experience in the pump industry

  • Excellent web-based downloading program, CareLink

Key Disadvantages:

  • Pump is not waterproof

  • Alarms/alerts may not be loud enough to hear/feel

Roche Accu-Chek Spirit Combo

Key Advantages:

  • Full-color meter/remote offers excellent flexibility in calculating boluses

  • Intelligent insulin-on-board adjustment based on expected effects of bolus insulin

  • Holds up to 315 units of any type of insulin

Key Disadvantages:

  • Pump does not calculate bolus doses; must use meter remote to perform calculations

  • Must check blood glucose using the Accu-Chek Combo meter; cannot manually enter blood glucose for bolus calculations

  • Pump screen is small and has limited contrast

Tandem t:slim

Key Advantages:

  • Full-color touch-screen programming technology

  • Most compact design of any traditional full-featured pump

  • Plans in place to integrate with the Dexcom continuous glucose monitor [Editor’s Note: FDA submission is expected by the end of 2013, meaning approval could come sometime in 2014.]

Key Disadvantages:

  • Bolus calculator does not “reverse correct” unless blood glucose is in hypoglycemic range

  • Very slow, multi-step cartridge change-out/priming process

  • Making changes to basal/bolus settings can be complex

I bet you didn’t know there were so many differences among systems! And this is just the tip of the iceberg. There are dozens of pros and cons for each pump listed on the website noted above. The best approach when choosing a pump is to consider which features are most important to you and narrow your choices feature by feature. For example, if you will have a large copay and can’t afford a lot of up-front cost, you might focus first on pumps with the lowest initial pricing (Insulet’s OmniPod, Asante’s Snap). If you spend a lot of time in and around water, you should eliminate those that are not watertight (waterproof pumps include Insulet’s OmniPod and Animas’ OneTouch Ping).

The best approach when choosing a pump is to consider which features are most important to you and narrow your choices feature by feature.

Some pump companies (and company reps) will allow you to borrow a pump and wear it with saline as a trial run. Take advantage of those opportunities! But try not to be swayed too heavily by fancy brochures, flashy videos, or smooth-talking salespeople. Make your decision based on the facts. 

If after making a thorough set of comparisons you still can’t decide, just go with the one that feels most comfortable to you personally. All pumps are well-built, well-supported devices that have a set of core features in common and should serve you well. Worst-case scenario: If you find that you made the wrong choice after the pump has been paid for, most pump companies offer a 30-day money-back guarantee. Check with them when making your purchase to find out the terms. 

Happy Pumping!

Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services, a private practice specializes in helping children and adults transition to insulin pump therapy and gain the most benefit from using an insulin pump. He is the author of Think Like a Pancreas and Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care. Gary is also the recent recipient of AADE’s prestigious Diabetes Educator of the Year award. He and his staff of Certified Diabetes Educators provide consultations worldwide via phone and the Internet. For more information, visit www.integrateddiabetes.com, e-mail info@integrateddiabetes.com, or call +1 (610) 642-6055; within the U.S. call toll-free (877) 735-3648.

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