Tidepool Loop
Freestyle Libre 14 Day
Summary
Tidepool Loop is the first fully interoperable automated insulin dosing app that originated as a patient-led initiative.
Background: A diabetes non-profit called Tidepool decided in 2018 to officially support Loop and shepherd it through the FDA process. Tidepool Loop was cleared by the FDA in January 2023 with plans to launch with Dexcom and other alternate controller-enabled (ACE) pump partners (RileyLink will no longer be necessary).
2023 Updates from Tidepool:
- Medtronic and Tidepool have decided to discontinue the development of a Medtronic insulin pump system compatible with Tidepool Loop.
- As Omnipod 5 is now commercially available, Insulet is devoting all available resources to their Omnipod products, including the global launch and further development of Omnipod 5.
- Future ACE Pumps that will be commercially compatible with Tidepool Loop will need to be FDA-cleared for use with third-party interoperable automated glycemic (iAGC) controllers.
The FreeStyle Libre 14-day is an all-in-one glucose sensor/transmitter that lasts for 14 days and only needs fingersticks as backup. . This sensor is a flash glucose monitor that requires scanning using a compatible smartphone app or a handheld reader.
FDA approved for insertion on the back of the upper arm (ages 4 years and older).
MARD of 9.4%
Components
Controller
Smartphone or smartwatch receives CGM readings and automatically adjusts insulin delivery via insulin pump.
Sensor
Sensor uses a thin, flexible filament inserted just under the skin to measure glucose levels every minute. Push-button applicator allows sensor to be placed on the body in one step.
Receiver
Conveniently access glucose readings using a reader, smartphone, or both. Available for both iOS and Android devices.
Device Details
Overview
Tidepool Loop is the first fully interoperable automated insulin dosing app that originated as a patient-led initiative.
All-in-one glucose sensor/transmitter can be worn on the upper arm.
Affordability and Access
$$$$
Pump and CGM supply information is not yet available. iPhone is not covered and must be set up independently.
$$$$
Widely covered. Provided by pharmacies. Price range; $0-$100/month. Often the cheapest and easier to access sensor.
Data Monitoring Options
Yes
Compatible with Tidepool - a web-based diabetes data management system.
Yes
Automatic data transfer to LibreView each time Freestyle Libre 2 sensor is scanned. LibreView gives clinicians and users relevant glucose reports. Glooko and Tidepool can also be used to view data.
Data View Options
Yes
Data can be viewed on an iPhone.
Yes
Freestyle LibreLink app displays glucose readings directly on the patient's compatible smart device.
Duration and Storage
Pump and CGM information not yet available.
14 Days
Sensors last 14 days and work between 50ºF - 113ºF. They are shipped in orders of 1-3 months at a time - which is 2-6 boxes at a time.
Vision / Auditory / Dexterity
NO text to speech
YES vibration alerts
A LOT of dexterity needed
YES text to speech
YES vibration alerts
A LOT of dexterity needed
Patient Considerations
Active Lifestyle
Automatic responses. Can set custom blood sugar targets and insulin and carb sensitivities based on type of activity. App automatically responds to blood sugar changes during activity.
Water-resistant for up to 3 feet deep for 30 minutes and light on the body, does not get in the way of activity. The reader must be within 1.5 inches of the sensor to scan it.
Avoiding Highs and Lows
Automatically adjusts insulin delivery. Increases or decreases insulin delivery to meet glucose targets. Insulin delivery settings can be aggressive or conservative.
Alerts are not available. High or low glucose alarms are not available. Trend arrows show the direction glucose is heading, with the rate of change.
Comfort
Low-profile mobile app. Dosing and other adjustments can be done directly on the mobile app.
Lowest profile sensor and smallest adhesive.
Easy Insulin Dosing
Customizable. Can bolus from phone or smartwatch and all settings are expected to be customizable. More information on modifications to insulin delivery will be available soon.
Scanned sensor readings can be used for dose adjustment.
Easy to Use
Easy dosing. Software makes most dosing decisions easy to do on the fly.
Requires scanning. Self-application and manual scanning every 8-hours are required. Easy self-application.
Fewer Fingersticks
Factory-calibrated sensor. Fingersticks needed for backup only.
Factory-calibrated sensor. Finger-sticks needed for backup only.
Privacy
Discreet. Ability to give insulin via watch or phone. Ability to check sugar on phone or watch. Alerts available.
Somewhat discreet. Scanning feature makes it easy to monitor blood glucose levels discreetly.