I had to laugh recently. Various advertising from diabetes companies comes through my feeds, and this time it was an ad from Medtronic Australia, touting the improvements in TIR (Time In Range) for their 670G pump.
Here it is reproduced in its entirety:
I’m not sure exactly where they sourced this data, but presumably from various clinical trials they’ve conducted. I’m going to assume they’re talking about the percentage of time spent within the classic “in-range” blood glucose definition of 3.9-10 mmol/L (70-180 mg/dL).
There are two “take-home” points they’re making:
- The TIR of many people is…. sub-optimal.
- The TIR using the 670G pump’s Auto Mode can be a lot better.
It’s hard to argue with those points. Any tools that can help people improve their glycaemic control are welcome. And Medtronic have certainly been able to deploy lots of 670G pumps.
My own reaction
I do have to laugh when Medtronic is proud of getting people to 70 or 75% TIR. This is certainly better than 50%, but not aspirational. I’m sure the average TIR of the T1D population is not up to the 70% mark yet, but our reactions are always coloured by our own experience.
With my own T1D I currently use an Accu-Chek Combo pump and a Dexcom G5 CGM, controlled by AndroidAPS. This is “DIY” tech. Open source, bespoke, customisable, whatever you want to call it. And as such it’s not yet approved by the regulators. But it is accessible to many people.
Incidentally, before the Combo pump I used to use an old Medtronic pump and the OpenAPS system, with similar results.
So what TIR do I get with minimal effort? I went to my Nightscout site and generated a Distribution report for the last 90 days using the 3.9-10 range. The answer: 95.4%.
This is actually a bit low: usually I average up around 97%. But there’s always variability in diabetes and life (even averaged over 90 days) so I’m not surprised by this figure. 5% of a day equates to 1.2 hours out of each day that I haven’t been in this range. Often it’s a lot less than that, but we’re talking about long-term averages.
Admittedly this is a case of n=1. Just me: not the average of a large clinical trial cohort. I presume there are some “outliers” on the Medtronic system, and I know there are people using AndroidAPS with larger (and smaller) TIR than me. Some of the data reported at openaps.org/outcomes mentions mean TIRs in the 80%s. There are outliers everywhere: even some MDI users manage a TIR of 90+%.
But even so I thought it might be interesting to see this graphically alongside Medtronic’s clockfaces:
Pictures can tell quite strong stories. And this one made me laugh!
The tagline on Medtronic’s video is:
Get Back Up to 45 hours every week with the MiniMed 670G System.
What about this?
Get back up to 82 hours every week with an open source APS.
Just a cheeky thought…