What’s in a name?

The “Medtronic Minimed 530G with Enlite” has got to be the longest, most convoluted name for an insulin pump. Within the first moments* of the Medtronic Diabetes Advocates Forum**, I sent out this tweet:

"Medtronic Minimed 530G w/Enlite" flows off the tongue with same awkwardness as "Los Angeles Angels of Anaheim". SoCal thing? #medtronicdaf

— Scott E (@Scott_InTheD) January 10, 2014

* “First moments” = by the time I realized that it was not inappropriate to open up a laptop and tap away on the keys while someone was speaking

** A peculiar name for the forum given that Bayer was also a host – in absentia. But a wordy name like “Medtronic Diabetes Advocates Forum presented by Bayer Diabetes Care”, although not unprecedented, would have been downright laughable.

Why did they call it that? Because “Medtronic Minimed 530G with Enlite and Bayer Contour NextLink Glucose Meter” would have been too cumbersome.

Back to the 530G’s proper name. This product – this whole contraption of varying components – isn’t just a pump. Nor is it a pump-plus-CGM-plus-meter. It’s a system.  A finely tuned system that was designed and packaged as such for a myriad of benefits – more than I could have imagined.

First, to the obvious: performance. This machine is going to stop the flow of insulin based on the data it receives. That data had better be correct, right? The FDA (and our health) want to be sure of that. The Enlite CGM sensor is part of the system that feeds that data to the pump and that has been proven (to the satisfaction of someone important) that it us up to the task ***. They wouldn’t hire a Sofsensor or a Glucowatch to do the job.

*** Yet, I can – and do – give myself doses of insulin on a whim, based on my own unjustifiable gut feel. Inevitably, the FDA is going to force me to issue a recall on myself.

But the CGM is only as accurate as the meter used to calibrate it. We all know how important meter and test-strip accuracy is, right? RIGHT? Think about it – take the allowable margin of error of a meter, add it to the margin of error for the sensor, then factor in the mathematics that turns it into an estimated blood glucose reading, and you’ve got yourself a guess, at best.

It’s a system, where each piece has to be good enough so that when put together, the whole system is good enough. Pump+CGM+Meter.

We all know that the next-step is for the pump to do more than just Threshold-Suspend. (The next step for Medtronic, by the way, is Predictive Suspend, where the pump will stop the flow of basal before the hypo occurs, rather than after. You can go to clinicaltrials.gov and see if you’re eligible to test it out – if you’re in Europe.)

* * *

As this explanation and future-speculation was being discussed, I asked the question (paraphrased): what if I’m not comfortable/trusting enough to have the pump automatically correct a high? When that feature is available, will I be forced to purchase it when I get a new pump?

The unconvincing response was “no”, but a well-timed question followed from a self-proclaimed Perfect Diabetic seated in the row behind me: (paraphrased) “What if I want your pump but decide that I prefer someone else’s CGM? My insurance isn’t going to pay for two Continuous Glucose Monitors.”

As we already know, you can’t buy a 530G without Enlite. That’s why it’s called the “(blah blah) 530G with Enlite”. But the longer answer (which was actually clarified in a session later that day) is that Medtronic tried for – and achieved – a new type of billing code for this “system” that I discussed earlier. It’s one product and has one code. It is, as far as insurance companies know and care, not a Continuous Glucose Monitoring System. So if you want to buy a Dexcom right after you get this pump – or if you want to get this pump right after you’ve purchased a Dexcom – you should be able to do it, and insurance won’t be any the wiser.

My thoughts: I know insurance companies are generally stupid and impractical, but…. really? Also, let’s not forget the out-of-pocket costs which would likely be higher than that of a pump alone.  But still, it’s comforting to know that they thought of this. In fact, they do a ton of work to influence insurance policies, much of which is way too confusing for me to write about.

* * *

So, back to the name. During our lunch break, I found myself seated with two of Medtronic Diabetes’ marketing executives. “So, what do you think of the name?” I was asked.

I tried to tread delicately, but eventually demonstrated how I was totally and completely baffled by Medtronic’s naming conventions. I didn’t (and still don’t) understand the “Paradigm” (or the paradigm, sans quotes). I thought the name described the proprietary connector used in place of a Luer; but I was wrong. I couldn’t figure out why the Revel was a Paradigm, as was the unnamed 522/722, but the 530G was not.

What I got, at first, was the meaning behind the name 530G (the 5 signifies the generation, the 3 represents something I forgot, nobody’s sure what the zero means, and the G …Gesundheit). I went further to talk about how confusing the CGM lingo was (I currently have a Sofsensor, a MiniLink, possibly a RealTime and/or Guardian, and a Revel. Dexcom, I noted, has a “transmitter” and “receiver” – easy peasy.

Then, something peculiar and unexpected happened. They asked me how I thought products should be named. My answer … well … it didn’t come as easily as I thought.  Should it simply be a name, like “Minimed” (a name recently resuscitated because of its positive reputation)? Well, no, I said. When Omnipod came out with their newer, smaller Omnipod they named it, quite unceremoniously, the Omnipod, with nothing to differentiate it from the old one.

But be simple, I said. Though, breaking my own rule, I said the infusion sets should retain their names, because “the straight one”, “the angled one”, and “the metal one” leave no room for the new one – which may also be straight or angled or metal. I also suggested that they pick an identifier and stick with it. For awhile, it seemed like their “gimmick” was dropping letters: Sof(t)-sensor. (In)Serter. But then came the Revel, complete with all five letters.

It’s just confusing to remember and to say, like the Medtronic Minimed 530G with Enlite. (But then again, most people don’t obsessively blog about their pumps and rarely have reason to mention them by name).

Back to my point.  They ASKED me. And engaged me. They valued my input and didn’t get defensive. That’s quite reassuring. (Also reassuring: this same openness to ideas extended beyond things as petty as names, but that’s another post for another time).

Maybe, if we’re lucky, the next version of the system will be simply the “Minimed 6” – a simply named package which includes components refered to as “the pump”, “the sensor”, “the transmitter”, and “the meter”.

* * *

And now, “the disclosure”: Medtronic Diabetes and Bayer HealthCare invited me to the forum, all expenses paid, and asked nothing in return. They set no guidelines for what I could or couldn’t write in my blog and didn’t compensate me for writing about them. All thoughts are my entirely my own. They did, however, give me a shiny blue water bottle which is sitting on the desk in my cubicle at work.

AND, “the disclaimer”: Everything written above is entirely from my own recollection of the event. It can, and most likely does, contain errors of fact, which are simply due to inattentiveness, forgetfulness, or simple brain farts. I do not wish to misrepresent the truth, and will promptly correct errors when brought to my attention.