Happy Saturday, and welcome back to our weekly advice column, Ask D'Mine! hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil is looking at decisions that pump companies make about the glucose meters that will pair with their devices. This can be a tricky one, especially when we get names like Contour and Contour NEXT that sound so much alike but require different strips... Wil has some thoughts here, of course!Ask-DMine_button

{Got your own questions? Email us at [email protected]}

Trish, type 1 from North Carolina, writes: Wil, with the purchase of a Medtronic Paradigm 523, I received the Contour Next meter. Then, when my endocrinologist wrote a Rx for the (wrong) Contour, I purchased another meter so I could use up the 3 months of test strips I'd just gotten. So now I use them both. They are frequently up to 100+ points off from each other, making me wonder which one is right and how these things got on the market, let alone the meter of choice for Medtronic. Yes, I've contacted the company. The rep's English wasn't even her second language, so I'm not sure what was discussed, but I did receive two brand new meters, Contour and Contour Next.  They have the same problem. Which meter do you recommend? By the way, I'm 62 years old and was diagnosed at age 2. I have no diabetic complications except irritation at the companies who prosper from continually marketing NEW products at us that don't deliver as promised, or aren't as good as the product just replaced.

[email protected] D'Mine answers: So if my math is right—and let's not forget that I'm a high school dropout—you're a 50-year Joslin Medalist, and have less than 15 years to go to get your 75-year medal! (Can we party together on that day?) And may I suggest "irritationopathy" as the new scientific name for your sole diabetes complication?

Oh my, where to start on this issue? I guess we'd better go back to the beginning. So Med-T started the whole wireless have-your-meter-talk-to-your-pump thing back with the first Paradigm models over a decade ago. At the time, they selected the BD strip, a choice that horrified many technical folks. The BD strip was a crap strip, especially in lows, and everyone knew it. So why would the powers-that-be choose a crap strip for such an innovative (at the time) idea? Maybe it was the cheapest. Maybe someone on the board of directors of one Decade of Med-T Meterscompany was sleeping with the secretary of the president of the other company. Who knows? At any rate, a few years later, BD pulled out of the teststrip biz altogether and left Med-T holding the bag and scrambling to find a new partner. Med-T ended up with a specially built OneTouch meter. It was big, heavy, bulky, and it didn't even have a back light for night testing. OneTouch also made a very similar product for Animas. But then Animas got bought up by Johnson & Johnson. Oh. Right. And OneTouch is owned by J&J, too.

That put Medtronic in the position of buying gear from a competitor and that simply wouldn't do for a company that puts its "proprietary" label onto as much as it possibly can.

I think they turned to Bayer because Bayer doesn't make pumps. But when Med-T announced the new marriage, I was not happy to get an invitation. In my experience, the Contour was a miserable, outdated, inaccurate strip. It's among my least favorite of the "name brand" strips. In Europe, Med-T started off using an RF version of the same old Contour meter, a technology more than a decade old.

Here in the USA, however, Bayer developed an RF version of their newer and somewhat sexy USB meter. I guess the only thing I liked about the situation was the fact that—finally—we'd have a BGL meter smaller than the damn pump. What's the point in making pumps smaller and smaller if you still have to use a meter that's the size of a 1977 cell phone? It just seems wrong that your meter should be larger than your pump.

I was still worried about the strips, but Med-T and Bayer assured us all we'd have a brand new super-accurate strip called the Contour Next, a name sufficiently similar to its predecessors to cause no end of heartache at pharmacy pick-up windows, as you noted, Trish.

Whew! Well, so much for the background. Hopefully, that also covered the "why" and "how" this thing got to market part of your question. Now for the tough part. Disclaimer: what I'm about to tell you comes from my clinical experience, not my personal experience. So far, I have five patients who have received the new Bayer/Med-T USB NextLink meter. Two have smashed their meters against big rocks, one has thrown the meter into the river, and I'm not sure of the status of the remaining two, as those patients have been committed to mental institutions for evaluation. Something about rage and hysteria, and shouting at their diabetes equipment (advanced cases of "irritationopathy" I suppose.)

It doesn't look good for what's Next.

So, all of my gang that used them universally hated the meter and the results it gave. More alarmingly, I noticed in two of my patients who switched to the Next thing, that the accuracy of their CGMs tanked. I mean it got really, really bad. I have no explanation, but I know it's a real thing because we did a little science experiment. One of my type 1s was so excited to try out the Next that she started using it before she used up her old strips. When I noticed how badly her CGM accuracy degraded, I persuaded her to go back to the OneTBayer Contour NEXT Link meterouch meter for two weeks and lo and behold, the CGM settled down again. We then did a second round of Next strip use, and things went to pot again. For "perfect" science we once again went back to the OneTouch and the CGM settled down yet again, definitely indicating that the Next strips/meter were somehow the cause of the trouble.

It was a small study, but it was good science.

I'm guessing that after this post hits the street, the old Medtronic OneTouch meters are going to shoot up in value on eBay.

Like I said, I can see that there is a problem, but I cannot explain it. That said, I have a theory. CGMs need to be calibrated by an accurate, stable strip and meter system. If you try to calibrate with a meter that has a wide range of strip-to-strip accuracy, you confuse the algorithm of the CGM. A CGM expects a certain number for its next calibration based on its last calibration and the changes it has tracked since. If you give it a number that's 50 points off what it expects each time, it doesn't take the CGM long to get paranoid, and develop a schizophrenic personality. I suspect an inaccurate strip system with very little variably would actually be better than a more accurate system with a greater degree of strip-to-strip variability. Personally, I suspect the Next strip of being highly variable strip-to-strip.

And I've seen something like this before on a different platform. My Dexcom Seven Plus was dead-on the fingersticks when I was using the iBG Star. It was frickin' amazing how close the two systems were to each other. But my insurance refused to cover the strips and after spending about $700 out-of-pocket on iBG Star strips during the appeal process, I finally realized I couldn't afford to keep using the system. I caved, and stared using the Accu-Chek Nano my insurance would pay for. My CGM went crazy. The numbers were all over the map. I finally started testing twice for every calibration stick and averaging the numbers. Still, the CGM was wonky at best. This wasn't just an academic argument for me. I'm fully hypo unaware. I need the CGM to NOT be 50 points off from crap strips. I remember going into a rage about the Nano "23% more accurate" TV commercials and screaming at the sky, "Twenty three percent more accurate that what? Peeing on an ant hill?!"

Anyway, I ended up back with a Presto (its strips are cheaper than iBG Star's, even though they are really the same strip just cut differently) and things settled down. Now I'm using a recalled OneTouch Verio IQ. It keeps my Dexcom G4 humming along with pretty good accuracy. It's not quite as good as the Presto/iBG Star, but now Verios are covered by my insurance, so it's good enough to be the lesser of evils. Don't you just hate these daily choices between health and keeping the lights on and food on the table for the family?

As to which meter I recommend, boy... I guess I'd go with whichever one is closest to your previous meter. The one that has left you with nothing worse from your diabetes than irritationopathy.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


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