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Diabetes Technology Update: The Latest Continuous Glucose Monitors and Insulin & Glucagon Delivery Devices

New insulin pumps, infusion devices, continuous glucose monitors (CGM) and smartphone apps continue to hit the market. The latest technology offers various options for people living with type 1 and type 2 diabetes, depending on needs and preferences. The following information is provided for educational purposes only. The content does not represent endorsement of any vendor or product.

Continuous Glucose Monitors (CGM)

“Continuous glucose monitors are constantly improving. The latest technology offers various options and benefits including alarms for highs and lows. Many of our patients, with both type 1 and type 2 diabetes, have experienced drastic improvements to their blood glucose control by starting to use a CGM.”

Cheryl Barry, RN, MS, CDCES, Diabetes Education Manager at the UMass Memorial Diabetes Center of Excellence.

Dexcom G7

The G7 is Dexcom’s most accurate sensor yet. The device is available for type 1, type 2 or gestational diabetes. The sensor is 60% smaller than its predecessor, the G6. It’s worn on the upper arm but children ages 2-6 should wear it on the upper buttocks. It delivers real-time glucose data to your smartphone or smart watch with no fingersticks required. Like the G6, it should be replaced every 10 days. The all-in-one sensor and transmitter takes 30-minute to warm up compared to the G6 that requires two hours. The sensor continuously measures blood sugars and transmits real-time data every five minutes and sounds an alarm when readings go too high or low. The G7 introduces a Quiet Mode and Delayed 1st Alert feature as well as the Urgent Low Alert that is also available on the G6. It has a 12 hour grace period (after 10 days) before it will stop working.

Dexcom G6

G6 integrates with the t:slim X2, Omnipod 5, and iLet insulin pumps (described below) and is an option for people who integrate their CGM with an insulin pump or insulin pen.

FreeStyle Libre 3

This 14-day sensor is available for ages 4 and older and provides blood sugar data every minute without finger sticks. It’s smaller, easier to set up, and more accurate compared to past models. The Libre 3 is worn on the upper arm and sends real time readings to a smartphone app. Medicare covers this device so long as you get the Dexcom reader that is available through durable medical equipment (DME) companies. Libre 3 offers the option to turn on alerts for high and low glucose levels. The alarm for urgent lows (55) cannot be turned off. This CGM is not integrated with insulin pumps. The smartphone app allows data to be shared with family and/or care team members.

Eversense 3

This sensor gets implanted into the upper arm by a physician. It must be changed every 180 days. The system includes the implantable sensor, a transmitter worn above where the sensor is implanted, and a mobile app. The transmitter must be charged daily and calibrated with a fingerstick. It’s approved for ages 18 and older.

Insulin Pumps

Some insulin pumps automatically adjust background (basal) insulin based on sensor glucose readings to prevent both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).

t:slim X2 Insulin Pump with Control-IQ Technology

This touchscreen insulin pump integrates with the Dexcom G6 & G7 CGM to predict and help prevent hypoglycemia without finger sticks. Free upgrades are available to download using a computer. There may be a charge for some upgrades.

The Control-IQ closed loop feature predicts glucose levels 30 minutes in advance (using the Dexcom G6) and automatically adjusts basal rates to prevent both hyper and hypoglycemia. It can also give an automatic micro correction bolus every hour.

Tandem's t-connect mobile app displays your insulin pump screen on your smartphone, showing current glucose and insulin on board. The latest version allows you to administer a bolus from your phone. Data automatically uploads to t-connect so your care team can access it during office visits or if you call with a question.

First FDA Approved Smartphone App to Program Insulin Delivery

The Food and Drug Administration (FDA) cleared the t:slim X2 mobile app for both iOS and Android to be used to deliver insulin. Users will be able to program or cancel bolus doses of mealtime insulin using a smartphone. Tandem plans to launch the bolus delivery update for select users.

Coming Soon: Tandem Mobi

The FDA approved the world’s smallest durable automated insulin delivery system for ages 6 and up. The Mobi insulin pump is fully controllable from a mobile app. It uses Control-IQ technology paired with the Dexcom G6 to predict blood sugar levels 30 minutes ahead of time. It then adjusts insulin delivery every five minutes to help prevent both high and low blood sugars levels. The system also delivers automatic correction boluses of insulin for up to an hour to help prevent high blood sugars. The user can still manually bolus for snacks and meals. It contains a 200-unit insulin cartridge despite being less than half the size of the T:Slim X2 pump. Detachable infusion sets are compatible with all existing Tandem infusion sets, allowing users to mix and match infusion sites and tubing length combinations for greater flexibility. Users have the option to bolus using their smartphone. A limited release is expected in late 2023 with a full commercial release planned for early 2024.

MiniMed 780G Hybrid Closed Loop System

This device is approved for people with type 1 diabetes seven years and older. The system delivers basal insulin every five minutes and constantly self-adjusts to help avoid highs and lows. It features Medtronic’s SmartGuard technology and the Guardian Sensor 4, their most accurate CGM to date. It connects directly to compatible smartphones and the iWatch allowing users to view blood sugar trends and insulin delivery status. Bolus delivery is not available using the smartphone app.

Omnipod 5

This tubeless automated insulin delivery system is approved for ages two and up with type 1 diabetes. The pump integrates with the Dexcom G6 CGM. It's compatible with certain Samsung smartphones to automatically adjust insulin based upon a predicted glucose level in 60 minutes and helps to protect against highs and lows. The pump is controlled by either a separate controller device or select smartphones. Approval for use with the iPhone is pending FDA approval.

OmniPod DASH

This tubeless, waterproof wearable pod provides up to 72 hours of non-stop insulin and works with a touch-screen Personal Diabetes Manager (PDM) that looks like a smartphone. It’s covered by pharmacy benefits with many insurance companies, including Medicare, as opposed to traditional Durable Medical Equipment (DME) coverage.

Beta Bionics iLet

This new insulin-delivery system fully automates 100% of insulin doses. It offers a choice of three insulins, Novolog; Humalog; and Fiasp Pumpcart. The iLet is paired with a Dexcom G6 or G7 and manages glucose levels with only a meal announcement. All that is required for set-up is the user’s weight. No carb counting is necessary. Bolusing, correction factors, insulin-to-carb ratios, and pre-set basal rates are also unnecessary.

Other Insulin Delivery Devices

InPen by Companion Medical

This “smart insulin pen” is a reusable injector that interacts with smartphones. The ½ unit refillable pen helps to calculate doses and keeps track of injection data. Using information provided by the user, it calculates dosages based upon insulin-to-carb ratios, meal size, or number of servings.

This pen is an option for people who take multiple daily injections but don't want to wear an insulin pump. It can also be used as a pump backup or by people who want to take a pump break.

V-Go Insulin Delivery Device

A patch pump for people with type 2 diabetes who require multiple daily injections. Medicare covers the V-Go under Part D, and "disposable patch-like devices" are included in the American Diabetes Association’s Standards of Care for type 2 diabetes.

CeQur Simplicity Patch

A three-day wearable patch that delivers injection-free mealtime insulin. One click delivers two units of rapid-acting insulin for on-demand meal dosing and bolus correction. Users must still take basal insulin in addition.

Glucagon Delivery Devices

Glucagon is the standard of care for treating severe hypoglycemia (low blood sugars). Lilly’s standard mix kit was the only source of glucagon for decades, but is no longer available. It's been replaced by the following products.

Gvoke HypoPen Glucagon Injection

An EpiPen-style glucagon rescue pen by Xeris Pharmaceuticals. It's available by prescription to treat very low blood sugar (severe hypoglycemia) in adults and children with diabetes ages 2 and up.

BAQSIMI Nasal Glucagon

This nasal glucagon by Lilly treat severe low blood sugar by spraying dry powder into the nose using a portable, single-use, ready-to-use device. It's approved for ages 4 and up.