New AID Integrations Abound for Tandem, Dexcom G7, Freestyle Libre and iLet

New continuous glucose monitor and insulin pump integrations are a step toward providing more choice in diabetes management.

Tandem t:slim X2 users in the US can now use either the Dexcom G7 or FreeStyle Libre 2 Plus continuous glucose monitor (CGM) to manage their diabetes as part of their automated insulin delivery (AID) systems. Additionally, people who use the iLet insulin pump can also use the Dexcom G7. These integrations represent an advancement in AID, as they allow people with diabetes to choose from different sensor and pump options.

“This is the day we have all been waiting for,” said Dr. Diana Isaacs, director of education and training in diabetes technology at Cleveland Clinic. “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.”

However, because of confusion with the Dexcom G7 packaging, some users may encounter difficulty finding the right version of the sensor that’s compatible with their pump. Many are hopeful that this problem will be resolved soon.

What are the key advantages of the FreeStyle Libre 2 Plus CGM?

The FreeStyle Libre 2 Plus sensor is Abbott’s newest CGM, a slightly modified version of the FreeStyle Libre 2. Once integrated with the t:slim X2, the Libre 2 Plus automatically sends glucose readings to your insulin pump every minute.

In contrast to the Freestyle Libre 2, which has a 14-day wear time and is approved for children aged 4 and older, Libre 2 Plus can be worn for 15 days at a time and can be used by children aged 2 and up.

Users of the iLet Bionic Pancreas will need to wait until Dec. 18 for their insulin delivery system to integrate with the G7.

What are the key advantages of the Dexcom G7 CGM? 

People who use the t:slim X2 and iLet insulin pumps will be able to benefit from the following features of the Dexcom G7:

Isaacs highlighted the ability to overlap sensors with the G7 – so no time is spent out of closed loop – and the greater flexibility for changing sensors with the grace period feature. 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.

The Dexcom G7 is available in over 10 different countries, including the US, UK, Canada, Ireland, Denmark, Sweden, Switzerland, South Africa, Germany, Austria, New Zealand, and Hong Kong. 

Tandem integrates t:slim X2 with Dexcom G7 and FreeStyle Libre 2 Plus through free software update

All in-warranty t:slim X2 users in the US will receive email instructions for the free software update to integrate the G7 and FreeStyle Libre 2 Plus. Meanwhile, new t:slim X2 pumps will be pre-installed with the software update for integration before they are shipped to new customers.

In addition to giving t:slim X2 users access to key features of the G7 and FreeStyle Libre 2 Plus, the updated software includes the following elements:

• A timer for exercise mode that allows for a duration 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

Looking ahead, Tandem said the t:slim X2 pump with Dexcom G7 integration will launch in additional countries outside of the US in early 2024. 

How to access the new FreeStyle Libre 2 Plus sensor

The FreeStyle Libre 2 Plus sensor is now available through durable medical equipment (DME) distributors. Contact Abbott’s Customer Care Team at 1-844-330-5535 to learn which DME suppliers are providing the new sensor.

Which Dexcom CGMs is the t:slim X2 compatible with? 

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 can switch over to Dexcom G7 whenever is most convenient. 

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

Despite the rollout, some clinicians are questioning how accessible the integration will 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.” 

He said the distributors are “sending the wrong G7 (the one that doesn't talk to the Tandem) to patients.” Hirsch cautioned that some users might have a hard time distinguishing the labeling of the Dexcom G7 that is compatible for integration and the G7 that is not compatible for integration.

Hirsch worried that this could lead to problems receiving the right version at the pharmacy. In the future, he said he hopes that Dexcom G7 boxes will be different colors or better labeled to help differentiate the G7 versions. 

Due in part to this complication in Dexcom CGM packaging, getting Tandem pump users up to speed with the latest sensor may prove more difficult than expected.

• 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 at right.

How to make sure you have the right Dexcom G7 sensors for your Tandem pump

Before integrating your t:slim X2 pump with the Dexcom G7, it’s a good idea to check the packaging of the G7 sensor to see if it includes the white line below the LBL number. Dexcom’s website includes a link to submit a form if your Dexcom G7 sensor is not compatible with the t:slim X2 pump. 

You can currently access Dexcom G7 sensors that integrate with the t:slim X2 pump through durable medical equipment (DME) distributors, such as Edgepark Medical Supplies, Byram Healthcare, and Advanced Diabetes Supply. The compatible G7 sensors will be available in pharmacies starting in early January 2024.

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

iLet bionic pancreas AID system integrates with Dexcom G7

Starting Dec. 18, the Dexcom G7 will also be compatible with Beta Bionics’ iLet bionic pancreas AID system. Since the iLet is the first AID system to require only one piece of input – a user’s body weight – it significantly reduces the burden of diabetes management for patients, caregivers, and healthcare providers. 

As with the t:slim X2, all you need to do to integrate the iLet and G7 is download a free software update. iLet users can use either the Dexcom G6 or Dexcom G7 continuous glucose monitor, or switch back and forth, depending on their supplies and preferences. 

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

How can I upgrade my iLet to connect with the Dexcom G7 CGM? 

If you are a current iLet user, download or update the iLet app from the Apple App store or Google Play store (available on Dec. 18). From there, you’ll be able to update the software on the iLet Bionic Pancreas AID system.

What these integrations mean for people with diabetes 

Making insulin pumps compatible with different CGM sensors is the first step toward greater choice and customization in diabetes care. 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 via AID. 

“I love giving people with diabetes more options and I am happy to see Tandem and Beta Bionics incorporate the Dexcom G7 CGM,” Isaacs said. 

Future integrations are coming, too. People with diabetes who use Insulet’s Omnipod pump should be able to use the Dexcom G7 in early 2024, and Tandem is working on integrating the t:slim X2 with other FreeStyle Libre CGMs.

"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: Abbott (top); Dexcom (all other photos).