I was at my check up with my PA at the Joslin Clinic yesterday. I said - “anything new”? She said - new insulin pump - co-created by Dean Kamen (according to him, the creator of the original insulin pump). The pump is called 'twiist"; the company is Sequel.
One of the major innovations is in the distribution method - which is all pharmacy based - ie no DME stuff. Also, it just works with Libre - no Dexcom compatability. Interesting…
I spent some time on the site but was left with the impression that there wasn’t any real information as to what makes it better at managing BG than existing pumps.
What I mean is that the site was heavy on marketing and light on technical facts.
Plus it’s an “A” model. It’d take time to be able to make a good comparison with existing pumps.
That’s my take currently. It is likely to change over time.
I was curious why it will be paired with Abbott Libre and Eversense but not Dexcom. Here is what I found out from an AI search about total users for each CGM brand: (sorry about the formatting…)
Estimated Usage by Brand (2024)
Precise user numbers by brand are not publicly reported, but we can estimate based on market share and revenue:
• Dexcom: Likely holds 40-50% of the U.S. CGM market among insulin users, translating to approximately 0.8-1.25 million users (assuming 2.1-2.5 million total insulin-dependent CGM users). Its lead is driven by Type 1 diabetes patients and integrations with insulin delivery systems.
• Abbott: With sales close to Dexcom’s, Abbott likely accounts for 35-45% of the market, or roughly 0.7-1.1 million users. Its FreeStyle Libre is widely used by both Type 1 and Type 2 insulin users, boosted by affordability and OTC availability.
• Medtronic: Estimated at 10-15% market share, or 0.2-0.4 million users, primarily among users of its integrated insulin pump-CGM systems.
• Senseonics: Likely under 5% market share, or 0.05-0.1 million users, due to its niche implantable technology.
I doubt that Eversense will pick up many converted Dexcom users but Libre might. If the Twiist algorithm gets good reviews from reliable sources, I would be willing to switch from Dexcom to Libre in order to try it and many others might too. If Medicare covers it via pharmacy there will be little risk in giving it a try.
Last visit, in April this year, with my endo I was asked about Twiist. Kinda, “Have you heard of it.”, or “Take a look at this.” The person asking is a T1 and is the guy in the practice who is up-to-date with the tech; IRC he is using TidePool but don’t quote me on that.
I admit I didn’t bother checking it out; I’m a happy Dash/AndroidAPS user and it’s not broken enough yet for me to want to fix it.
Ok. I just did; first time I’ve seen a mensch for Twiist on FUD or TUD. My state of mind immediately before writing the following is, “Damn good marketing.” I used the AI to get this website, which seems possibly reasonable:
Working through their points (well presented up to a point, apposite.)
Pump: Insulet, it’s the pump that adheres, Twiist; canula, we added double sided adhesive tape to the pump.
Sensor: Insulet, a G7 (no choice yet), Twiist; it’s an iPhone, connected to a sensor (more choice).
Control: Insulet, built-in, Twiist; apparently it’s all in the iPhone.
So nope. Insulet as still king of the high with the O5. For comparison with my setup:
Pump: Dash pod stuck to me.
Sensor: Android 'phone running xDrip+ and then AndroidAPS; lots of sensor choices.
Control: AndroidAPS
Conclusion: Twiist is not a step up from TidePool/AndroidAPS/anything you want to write. Oh, except they paid the FDA enough to have the best approval money can buy. Yet, of course, TidePool are approved by the FDA, but only on systems that aren’t sticky?
Tubeless pumps (like the Omnipod 5 system) have a different design, with the pump and reservoir being directly attached to the skin via a pod.This design requires additional testing and evaluation to assess the safety and effectiveness of this approach.
That’s the best I can find. My misgivings about patch pumps have to do with my clumsiness. I’m sure I would knock it off on a door frame or something. The other is the lack of optional infusion sets. I had to go through several before I found what worked best for me.
fyi - I asked my PA about her experience with the Libre. She said she liked it - it was fine. Lots of us are on the Dexcom because that was what was available when we started up the CGM - we were pre-Libre. Seems like it’s okay as well.
(I also asked her about moving to the G7 from the G6. She said the G7 users reported a lot more connectivity issues than those using the G6.
@CarlosLuis It’s anecdotal, but while I understand concern of knocking off a pump on a doorway/etc., I have literally “never” done it. The only time I lost a pod was after having gone ocean, pool swimming, and in a hot-tub 4-5 times in less than a day, the adhesive gave out and that was without any additional pump cover. I’ve also stopped using the over-patch with the G7. It’s possible it’s a body chemistry thing, less sweating, etc. It would seem both the pump and infusion set have to be tested so that all seems a wash to me. The concept of optional infusion sets, though, is a definite valid and understandable consideration! @bostrav59 You raise a good point, many of us have stuck with what our doc started us on, whether its “better the devil you know”. I’ve not tried Libre as the G6, now the G7, have worked for me…despite shortcomings of loosing signal despite being within ≤2’ and some “wonkiness” on day 1 or day 8-9 at times, though some of this seems to have resolved over time (this may be perception vice reality as we get used to events). I think the only other reasonable considerations are need to calibrate, 1 vs 5 min reporting issues, compatibility with other devices, and the pain it is to arrange a swap out (stopping one script, starting another with potential “unknown” result/FOMO). I think most of us tend to stick what we have unless we perceived a significant gain by a switch, whether insulin’s, CGMs, or pumps; that said, I enjoy having the reports of so many others here on FUD and elsewhere as to what works and the “options” discussion, gives me material to discuss with my doc!
I’m convinced that the only times I experience poor results with Omnipod (unexplainable soaring high BG) result from problems with the infusion cannula. Also, sometimes it hurts like all get out and needs to be swapped out for a new site. I think it would improve Omnipod reliability for me if Insulet would make a pod with a little short tube to use a variety of infusion sets. That would be the best of both worlds but might never happen with Insulet, and now Twiist and Mobi are moving in that direction.
The link provided by @bostrav59 (Thanks!) says Twiist is not yet covered by Medicare. I am tempted to give it a try once it is approved for Medicare.
I’ve been waiting for release of this pump, but I agree there’s nothing special about the pump itself. It’s actually thicker than the T-slim and bigger in all dimensions compared to the Mobi.
For me, the attraction is a better AID algorithm in Tidepool Loop without having to use an Omnipod (the do-it-yourself compatible option in the US).
It sounds like many people really prefer Omnipod to tubed pumps, but I just don’t think I could wear it comfortably. Clothes are frequently tight on the parts of my body that have enough fat for an infusion site - even Autosofts/Mios are irritated by this in some locations. I think I would end up over-using my arms, and still be uncomfortable b/c I sleep on my sides. So I’m excited for a tubed option that isn’t Control-IQ.
I was also a bit worried about the Libre-only compatibility, especially considering that I’ve heard the Libre tends to “read low”. It sounds like Sequel does hope to partner with Dexcom too, but they’re a small company and just haven’t gotten there yet.
I found this blog really informative about the Libre and also found a few other data folks doing side by side comparisons. I think I’m going to give the Libre a shot - the form factor is definitely nicer than Dexcom if it turns out to work well!
@Mary55 The claim to fame for Twiist is Kamens mechanism for flow. It’s supposed to be the most accurate currently possible and detects occlusions the quickest; lastly, I understand it has Tidepool Loop in firmware. Other than that, I agree the size is off and round just seems odd. I’ll remove final judgement pending user reports.
They advertise that it’s also supposed to be more sensitive to occlusions, but I think that accuracy and occlusion sensitivity is probably only relevant to people on really really low insulin volumes.
Especially since AID, I don’t really think inaccurate delivery is negatively affecting my BG unless it’s due to a failed site. And failed sites wouldn’t be detected since the pressure and volume are measured inside the pump rather than at the cannula.
My understanding is that the form factor of the pump and probably the pumping mechanism are recycled from an older pump for Remodulin, which is an infused drug for PAH:
I’ve knocked my Omnipod Dash off when I bump into a wall or a doorway - think it’s happened about 5 times in the past 3 yrs. Have to learn to be more careful!!!