twiist
Freestyle Libre 3
Summary
The twiist AID system was cleared by the FDA for use with CGMs that have received FDA designation as integrated continuous glucose monitors (iCGMs). As the twiist AID system gets closer to commercial availability, Sequel Med Tech will publicize the list of compatible CGM
*Recently FDA approved for people with type 1 diabetes ages 6 and up.
The FreeStyle Libre 3 is the smallest, thinnest, all-in-one glucose sensor/transmitter CGM and lasts 14 days. This sensor sends minute-by-minute glucose readings to a compatible smartphone app and only needs fingersticks as backup. Optional low and high blood sugar notifications are available for this system.
FDA approved for insertion on the back of the upper arm (ages 4 years and older).
MARD of 7.9%.
Components
Infusion Set
An infusion set contains the thin plastic tubing that delivers insulin from the pump to the body.
Controller
Pump is controlled by the twiist app on an iPhone. Data from both the pump and CGM are viewable on the twiist app Home Screen.
Pump
Pump can be worn with a pump clip, adhesive patch or in a pocket.
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
This system automatically adjusts insulin delivery according to continuous glucose monitor (CGM) readings and predicted blood sugar levels. It is the first FDA-approved AID system with Apple Watch compatibility.
Smallest, thinnest, all-in-one glucose sensor/transmitter with low and high blood glucose alarms can be worn on the upper arm.
Affordability and Access
$$$$
No insurance coverage data. Anticipated to be provided through Pharmacy.
$$$$
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
Sensor automatically sends data to the user’s LibreView account which enables sharing with HCPs and caregivers.
Data View Options
Yes
Data is stored and can be viewed directly from the twiist app on the mobile device (iPhone), and can be linked to an Apple Watch for viewing data as well.
Yes
Freestyle Libre 3 app or Libre by Abbott provides glucose readings and alarms, multiple data views, the ability to share glucose data and real-time alarms with LibreLinkUp, and the ability to connect to a clinician's practice through LibreView.
Duration and Storage
3-day pump 10-day sensor
Sensors last 10 days, and transmitters last 90 and work at 50ºF – 108ºF. The reservoir holds 300 units and is disposable, and the pump can be used for up to 3 years.
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
YES text to speech
YES vibration alerts
A LOT of dexterity needed
NO text to speech
YES vibration alerts
A LOT of dexterity needed
Patient Considerations
Active Lifestyle
Waterproof. The pump, when connected to the cassette, has a rating of IP28, indicating protection from continuous immersion in water. The pump can tolerate immersion to depths of up to 12 feet (3.7 m) for 1 hour.
Water-resistant for up to 3 feet deep for 30 minutes and light on the body, does not get in the way of activity.
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.
Optional glucose alerts for low and high glucose levels. Trend arrows show the direction glucose is heading, with the rate of change.
Comfort
Low-profile. Low profile with an adhesive design that prevents the pump from catching on other objects.
Lowest profile sensor and smallest adhesive (about the size of two stacked U.S pennies).
Easy Insulin Dosing
Customizable. Can bolus from phone, smartwatch, or directly from the device without needing to be attached to your phone. The device also directly measures the volume (amount) and flow (speed) of insulin delivered with every micro-dose
Sensor trends can be used for dose adjustment.
Easy to Use
Watch compatible. The twiist AID system is the first FDA-approved AID system that can be directly controlled from an Apple Watch.
No scanning required. Minute-by-minute readings are sent directly to the mobile app.
Fewer Fingersticks
Factory-calibrated sensor. Fingersticks needed for backup only.
Factory-calibrated sensor. Finger-sticks needed for backup only.
Privacy
Discreet. The pump is in two pieces - the top (algorithm and battery) and the bottom (insulin chamber and AVS technology)
Hypoglycemia safety alarm. Discreet size but built-in hypoglycemia safety alarm alerts users when glucose is below 55 mg/dl and is always on.