Lemonade Life

Friday, December 16, 2005

The Guardian: Minimed's Perspective

On Thursday, I interviewed Kendall Cook, a Diabetes Management Consultant from Medtronic Minimed here in Portland, Oregon. He helps people who are looking to get on a pump work with their doctors and insurance companies, and he also trains patients, doctors and diabetes educators. I wanted to talk to him about Minimed pumps and what is so great about them for an upcoming article on Diabetes Teen Talk.

We started to talk about the Guardian RT and I thought some of what Kendall said was really important and that I would share some of what I learned with all of you. Hopefully this will fill in some gaps.

My first question was, obviously, when do we get the Guardian? Kendall said, "We don't know when we will market to the whole country. We are in a controlled market because we want to build knowledge. They are expensive, and there are no medical codes for the products. Everything is out of pocket." He said the trial that Print and others are to help "build a case for insurance companies" and to also help Medtronic Minimed work out some of the kinks in the system.

"We are doing it in cities where we have good managed care [i.e. excellent doctors and health care systems], and there are sensor specialists in these cities," Kendall said. "It would be unethical [to give people the Guardian in Portland] because we don't know the technology yet."

At this point, I thought of Sandra Miller and mentioned to Kendall that there was a mother I knew who wanted to put her son it. He simply shook his head.

"Because there aren't any specialists in these other cities?" I asked.

Kendall nodded. He said that the sensor technology was new and that a lot of the Medtronic Minimed employees were not yet familiar enough with the technology. The limited markets are designed to help establish a strong base of people who are experts with the Guardian and who can help those starting off. Until there are experts in all of the cities, like there are experts about pumps, it is very risky and, as Kendall said, "unethical." He added that it wasn't a good idea for people to use the technology unless they were "very competent with diabetes." As we have seen with Print, the technology is not perfect.

"What everyone has to realize is that the sensors don't replace finger sticks," Kendall said. "You don't have to check as much, but at least two, probably 3-4 times a day."

I asked for a better explanation as to how the sensor actually works and why, as Print has illustrated in detail on his blog, there are such vast differences between the meter and the Guardian.

"Realize the difference between the sensor and the finger sticks and that they'll be different at the same time. It's a sensor value and it'll be different. The sensor takes a reading every 10 seconds and then every 5 minutes gives you an average."

"So that's why the Guardian says you're 150 but your glucose meter says 120?" I asked.

"Yes," Kendall said. He explained how values and trends are different. "If you have stable blood sugars - early morning or fasting - it'll be pretty close and accurate. If it's an hour after a meal, your blood sugars are going up and there's a lot of variability and it can be off."

"It's not an end all be all. There's still a lot of work and we don't want to set false expectations. There's still a lot people need to learn. The Guardian is there to sense trends - falling low or going high rather than finding an exact value. Why am I not coming down? Or an alarm goes off and [you say] gosh, I don't even feel low, but you're falling. It keeps you above that dangerous level."

"I love the idea of having an alarm go off at 80 or 200," I said, "before I even go low or high. You just avoid them completely."

Kendall nodded, "It'll benefit everybody. But it'll be about teaching people."

Kendall gave a wonderful analogy that I think really helps emphasize the Guardian's important qualities. Rather than making adjustments based off the Guardian's instant blood glucose readings (which you aren't supposed to do), he says, "It's like the difference between showing a movie clip and a photograph. It will help connect all the dots together."

If you have any more questions about the Guardian, I can try to send them to Kendall and perhaps he can find out more specifics. It seemed the Minimed is really try to be safe and not giving people new technology without the proper training. Personally, I would not want to be handed something that could potentially kill me without having a very strong support team to help me work out the bugs. Hopefully the trial will help convince insurance companies to pay for the Guardian as soon as possible so that we will all be on it.

Kendall also mentioned that within 12-18 months, a newly developed "sensor augmented" pump would be released, which is a Guardian/Paradigm pump combo. One piece of technology, but the sensor and the pump set inside of you.

Medtronic Minimed's website has more information on this and other new technology.

You can also visit Printcraft's blog on the Guardian RT.


At December 17, 2005 12:18 AM , Blogger Wil said...

Very nice article, Allison!

At December 17, 2005 6:41 AM , Blogger Sandra Miller said...

Excellent post, Allison!

In reading Kendall's response to your query about my situation (thanks, by the way, for bringing that up!), I'm wondering why I was contacted by a Medtronics rep in the first place.
The rep's explanation was the "unique situation" we have in our area.... hmmmm... I'm not sure if that means support is available here (we live in a University town, and take Joseph to what I've been told is a very proactive, cutting edge pediatric diabetes clinic). I'd love to get more info on exactly why our situation is so very unique...

Because you are right, I wouldn't even consider a new technology for my son if the training and support were not in place.

At December 17, 2005 9:32 AM , Blogger Ellen said...

Nice reporting Allison.

"At this point, I thought of Sandra Miller and mentioned to Kendall that there was a mother I knew who wanted to put her son it. He simply shook his head."

Sandra, if Wil has a hard time finding enough places on his body for the sensor and pump, where will you put it on your son's little body?

My now 18 year old son, who's been pumping over 10 years, would not be willing to change 2 sites every few days. There's also the danger of the child saying, "I don't have to check my bg, I can just use the Guardian."

At December 17, 2005 1:07 PM , Blogger Sandra Miller said...


The concern about having to insert a second site every two to three days is one the biggest obstacles for us.

Right now, we rotate between his right and left abs and hips-- there's really no fat anywhere else. Two set changes, plus the possibility of losing sites down the road... I just don't know if there's anyway around this issue with the current version of the Guardian...

At December 18, 2005 2:01 AM , Blogger skytor said...

Nice post Allison!
I heard rumors that the next Minimed pump will have the sensor built in, and that the infusion set contains the sensor and the insulin-delivery tube. Can anyone confirm? If so, it would definately be good news for your kid sandra and for other kids out there (including 35 year old's like myself:)


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