How Often Should I Upload Dexcom G5 Receiver Data

Past Adam Brown and Kelly Close

Twitter summary: Dexcom G5 CGM: expands options for viewing information (app, receiver, both), customizable alarms, meliorate data analysis, maintains leading accuracy

5 years ago, the concept of Dexcom's G5 system seemed utterly impossible. Sending continuous glucose monitoring (CGM) information from a sensor on the body straight to a phone – no receiver required? The FDA would never approve information technology!

Well, what seemed impossible five years agone is at present available. G5 takes the aforementioned accurate G4 continuous glucose sensor, adds Bluetooth to a new on-trunk transmitter, and introduces a new iPhone/iPod Touch app for viewing the existent-time information and getting notifications on the phone. The information can also be viewed on a CGM receiver alone (e.m., for those with an Android phone).

Dexcom'due south G5 is a landmark device approving for the FDA, and a sign of how tremendously far CGM and connectivity have come since Steve Jobs introduced the iPhone in 2007 (we were using the first-gen Dexcom STS!). But expectations have also risen markedly in that time. In much of the U.s.a., people now look things to work right out of the box with a world-course user experience. Attending spans are way shorter. The bar for not bad devices is far college.

The G5 has many advantages. It expands patient options for viewing existent-time CGM data (phone or receiver or both) and takes advantage of the smartphone'due south many assets to deliver a stronger patient experience (more customizable alarms, amend screen, cloud connexion). The web-based Dexcom Clarity software is an first-class upgrade for those trying to digest overwhelming CGM charts and statistics. And chiefly, G5 retains the G4 Platinum sensor accuracy and the widely praised receiver design.

Just for others, G5 is a symbol of the complicated and tumultuous time we alive in. As phones and gadgets become more useful and more addictive, many are pushing back – "spend less time in front of screens and more than fourth dimension in the world." If my Dexcom G5 app goes off in the middle of a meeting, will my co-workers remember I'm rude to wait at my phone? Is it okay to have my phone in the bedroom? If I trust my phone with my life, what do I exercise when the battery dies in the centre of a hike?

The G5 is an ambitious and strong foray into an incredibly challenging area: merging a high-take a chance medical device with cutting-edge consumer electronics. Dexcom deserves tremendous credit for getting it approved and launched quickly.

This is a long test drive, then nosotros've created a Summary section below for those who want the well-nigh critical takeaways: major highlights; areas for comeback; who might love G5; and who might exist less impressed. Those interested in a very detailed review should read on to the Deep Swoop section.

Summary

G5 Highlights

• Expanded options for viewing real-time CGM information – telephone, receiver, or both. Switching between devices is effortless, and y'all can calibrate on either device and the other volition update.

• More customizable alarms on the G5 app – 22 different sounds, more book options than the receiver.

• Improved visual design – a more prominent CGM value in the app, assuming colors, the font is easier to read.

• Strong web-based Clarity assay software with like shooting fish in a barrel upload, better blueprint recognition, and more digestible charts and statistics.

• G5 posts glucose information to Apple tree Health, assuasive other apps similar Glooko, Meal Memory, and Ane Drib to use it (very few diabetes devices do this).

• Information technology retains the excellent accurateness and reliability of the G4 Platinum with Software 505 (9% error vs. laboratory blood glucose values).

• Keeps the widely praised G4 receiver design, updated with a brighter screen and more than specific low and high alert notifications.

• Retains the Dexcom Share characteristic for remote monitoring.

• Fast setup passed our no-instruction-manual test.

G5 - Areas for Improvement

• Low glanceability when using G5 app alone – seeing the current CGM value requires unlocking the phone and pulling the app up. Could do good from a "Today" widget (like seeing the weather with just one swipe on the lock screen) or smart watch compatibility (presumably coming soon).

• Not Android uniform, but this is coming in 2016 (and a receiver option is notwithstanding available for now).

• The G5 app depletes phone bombardment slightly faster than if you were not using information technology. Information technology does piece of work in Aeroplane and Low Power Mode.

• The G5 transmitter range seems shorter than the G4, and the telephone app loses point a bit more oftentimes than the receiver.

• There are no statistics or pattern recognition within the G5 app, and the separate Clarity iPhone app only allows viewing a static PDF (full functionality on the web).

• The transmitter is slightly larger than the most recent G4 transmitter, and has a labeled bombardment life of iii months (down from half dozen months with the G4).

• The three-hour delay to post data to Apple Health could be reduced (this is an FDA effect).

• Toll, especially for those without insurance or high deductibles.

Dexcom told united states it is actively working on these improvements, or is considering them for future products – most are non simple or they would accept been washed already!

Who might dear G5?

• Dexcom users who prefer not to behave the receiver, or those resisting CGM because they don't want to behave another device.

• Heavy sleepers that don't wake upward to CGM alarms.

• Very active users who don't like carrying the receiver during practise.

• CGM users desiring more alarm customizability.

• Those who desire more discretion (e.thousand., annoyed by questions about the receiver like, "Is that a pager?")

• Parents, caregivers, and loved ones that want to remotely monitor CGM data.

• Those who have trouble reading the small-scale font on the receiver.

• Those who desire automated data upload for analysis and design recognition.

• Anyone that loves apps and nerds out on data!

Who might exist unimpressed with the boosted benefits of G5 vs. G4?

• Those trying to spend less time on their phone or who find smartphones stressful.

• Those who struggle to go on their phone charged.

• Android users (until 2016).

• Current Dexcom users who don't intendance near getting CGM information on their phone.

• Current Animas Vibe and t:slim G4 users that are happy with the G4-integrated pumps.

• Non-CGM users that: want something smaller on the body than the G4/G5 transmitter; find CGM too expensive; or want a device that requires no fingerstick calibrations.

Deep Dive

Table of Contents:

• What is G5 and How Does it Work?

• The G5 iPhone App

• G5 Daily App Interaction, Alarms, and Customization

• G5 Transmitter

• G5 Receiver

• Sensor Accuracy and Calibration

• Dexcom Clarity (web-based analysis software)

• Apple Health

• What Does it Cost?

• Our G5 Wishlist

• What is Adjacent for Dexcom?

• Concluding Thoughts

What is G5 and How Does information technology Piece of work?

Dexcom's G5 CGM system has four master components:

1. The same G4 Platinum CGM sensor inserted under the pare for seven days. Information technology requires two fingerstick meter calibrations per twenty-four hour period and has an manufacture-leading nine% error vs. lab-measured glucose values.

2. A new transmitter equipped with Bluetooth that sends a glucose value every five minutes. The transmitter pairs with two devices, allowing you to choose how you lot desire to see your CGM information: receiver alone, G5 phone app lone, or both.

3. A new G5 iPhone/iPod Touch app that (i) displays the existent-fourth dimension CGM information and trend; (two) alarms the user with sounds and notifications; and (iii) sends the data to caregivers (Share), the new web-based Dexcom Clarity analysis software, and Apple tree Health. The app functions on the telephone as a fully standalone receiver. It is a free download on the App Store.

4. A slightly updated G4 receiver that can display the CGM data alongside or independent of the G5 app (east.thou., if you don't have your telephone with you, for Android users). You must buy the receiver when you get G5, just y'all don't accept to apply it. Those who ain the G4 Share receiver tin can update the software to work with G5.

Setting up G5 took less than ten minutes, and we did not demand to open the paper instruction manual once. After downloading the G5 app from the iTunes app store, we fabricated a Dexcom account and ran through the easy guided setup screens. Instead of having to enter a clunky transmitter serial number, the app just asks you to take a flick of the box – very cool. From in that location, the G5 app Bluetooth paired with the G5 transmitter within v minutes.

Current Dexcom users will exist familiar with the remainder. Subsequently inserting a sensor and snapping the G5 transmitter in, y'all merely press "Start Sensor" on the app. G5 still needs a two-hr warm-up, and then information technology asks for ii beginning-up fingerstick calibrations. Yous tin start a sensor session on either the app or the receiver; the other display will update within a few minutes.

The G5 iPhone App

Highlights

• Current CGM value shown front-and-center in larger font.

• Excellent use of color.

• The make clean bill of fare layout includes the essentials and doesn't bog users down with as well many options.

The G5 app communicates via Bluetooth with the transmitter every v minutes, at which signal it updates the CGM value, graph, trend pointer, and sends a notification (if applicable; more on that beneath).

The do good of the telephone over the receiver is immediately credible subsequently opening the G5 app. A larger screen surface area shows the CGM value more prominently – if the G4 receiver showed the CGM value in size ~12 font, this is size ~36 font on an iPhone five. Information technology'southward a large comeback, since real-time CGM should prioritize "What'due south my current number and trend" in a higher place all else.

Colour is much meliorate used in the G5 app, and Dexcom has redesigned the manner the CGM value and trend arrows appear – a red balloon denotes a depression, a yellow airship denotes a high, and a muted gray ways in-range. The arrows wrap around the balloons, a design choice that makes the trend less apparent than with G4 (where the pointer appeared separately to the right of the CGM value; see picture). We like that G5 changes the graph background colour dynamically, providing a bolder visual reminder that blood glucose is low or high.

The telephone app was a chip less reliable than the receiver connectivity-wise. In our tests, the G5 app had more than "signal lost" alerts and isolated dropped data points throughout the day. That said, the G5 app connectivity is definitely reliable enough to utilise as the sole receiver. And perhaps our feel stemmed from lots of Bluetooth interference here in San Francisco.

G5 tin deplete your phone battery slightly more speedily than if you were not using it at all, then beware if your telephone tends to dice in the heart of the twenty-four hours. Fortunately, the G5 app will go along giving you real-time data in Airplane Manner and Low Ability Mode, both excellent options for extending the iPhone's bombardment life.

The G5 app menu structure is uncomplicated and there is zero unnecessary or overwhelming. Also the main dwelling screen (described above), there are three other main screens: enter a meter calibration, enter "Events," and Dexcom Share. A few highlights:

• Fingerstick calibrations tin now exist entered using a keypad, saving fourth dimension over the previous scroll interface on the receiver.

• The events screen – allowing manual entry of carb grams, exercise, insulin, and health – demands enough extra steps that it's hard to employ routinely. This could be automated if Dexcom eventually integrates with other apps and devices.

• G5 preserves remote monitoring with Dexcom Share, allowing parents and caregivers to receive notifications on Apple or Android devices (via Dexcom Follow). G5 users now won't demand to run the Share app.

Interface wise, in that location is still some wasted white infinite on the main trend graph screen in the G5 app, though at to the lowest degree you lot can reduce the top-end to 300 mg/dl. It would be dainty if this graph was fully customizable (e.m., you lot could drag the warning bars to indicate how much space yous want the hypoglycemia and hyperglycemia ranges to accept up).

There is also no way to view statistics or trends within the G5 app (unlike the FreeStyle Libre reader). Y'all must either open up the separate Clarity iPhone app to view a static PDF, or log onto the web-based Clarity software (see below) for full functionality. Both are easy merely it is an actress footstep. Co-ordinate to Dexcom, making the analysis software separate from the G5 app actually made the regulatory process easier (i.due east., Clarity is lower risk). That should hopefully result in faster improvements to the software.

G5 Daily App Interaction, Alarms, and Customization

Highlights

• Alarms are much more customizable and can be louder than receiver.

• Notifications appear on the lock screen, one swipe and phone unlock to become direct to the G5 app.

The G5 app runs in the groundwork, pregnant you can utilize other apps at the same time or take the phone locked. If the app is fully exited yous volition non receive CGM data or alerts, though you volition get an immediate notification ("App is closed. You will non receive glucose information.")

Unlike the receiver - which requires pushing ane push to see the current CGM value – the G5 app requires you to unlock your phone and then bring the G5 app on screen. The glanceability could improve with a "Today" widget that enables a single down swipe on the lock screen to see the CGM value and trend graph (due east.g., similar weather or calendar). We assume Dexcom will somewhen release an Apple Sentinel version of G5 as well. Unlocking the phone and pulling upward the app only takes a couple seconds, but it does add together up, and it is more inconvenient than the receiver.

• A workaround is to disable your phone's passcode, but that has its own drawbacks.

• You lot can also use Siri and say, "Open G5 app," though you'll still take to enter your passcode if you have one. (Hint: Siri hears "Dexcom" equally "Decks COM," so stick with "G5 app").

When glucose goes above or below range, a notification conveniently appears on the iPhone lock screen – for example, "Low glucose alert." The notification does non show the actual CGM value or trend arrow, though a right swipe and telephone unlock volition immediately pull upwardly the Dexcom G5 app with the pop-upwardly alert.

Notifications can exist accompanied with a sound like on the receiver, assuming:

• The phone ringer is on and loud plenty to hear.

• The telephone is not on vibrate (silent) or "do non disturb."

Of course, you can also opt for vibration alerts alone.

Like any other iPhone app, the notification settings and sounds are customizable, which has pros and cons. On the plus side, the iPhone can exist louder than the receiver alarms, and up to 22 different sounds tin exist selected for the high and low alerts (including the original G4 receiver sounds). Adam initially selected "Sonar Horn" for his low alert, but when his colleagues jumped out of their chairs and thought it was a burn drill, he opted for the aforementioned depression alert equally on the receiver. Choose your sounds advisedly!

Customizing audio preferences does take some niggling on the iPhone. Adam usually keeps his phone on silent or "do not disturb," then turning the ringer on was not something he was excited to do. Simply he even so wanted the Dexcom audio alerts, so here was his workaround:

• Turn ringer on.

• Go into "Notifications" settings and turn off audio alerts for every app except Dexcom.

• Go into "Sounds" settings and plough off audio alerts for text letters, calendar, mail, social media, etc. Adam set these to vibrate or off completely.

This is a practiced style to duplicate the receiver's audio functions, but to minimize the cacophony from other random phone notifications. Obviously, G5 app notifications tin be turned off or ready to vibrate at whatsoever time.

It can be easier to wake up to alarms at night with G5, since the iPhone sounds are much louder and more varied than on the receiver. G5 volition work on plane mode (though Share won't work), offering a skilful night pick to minimize notifications and continue the phone in the same room.

G5 Transmitter

Highlights

• The transmitter pairs with two devices (phone and receiver), which can be used independently, together, and seamlessly swapped.

The transmitter is really the hub of G5: it broadcasts the sensor signal via Bluetooth and allows both the phone and receiver to independently pick it up. You lot can enter a fingerstick calibration on the phone or app, and the other device volition update automatically within a few minutes.

Fortunately, you don't have to tell the telephone or receiver which one you are going to use at whatsoever given fourth dimension. The transmitter sends out a new bespeak every v minutes, meaning each device volition independently option the signal upwards if it is in range. This allows switching between displays effortlessly.

On the downside, the G5 transmitter range seems shorter than on the G4. While G4 had a 20+ foot range in our feel, we got more of a 5-10 foot range with G5. G5 cannot transmit through multiple floors of a house, while G4 generally could. The G5 phone app drops the betoken more than often than the receiver, simply information technology doesn't happen overwhelmingly oftentimes. And usually it is only i or 2 data points.

The G5 transmitter is the aforementioned size equally the original G4 Platinum transmitter. That is smaller than we would have guessed, given the addition of Bluetooth and the power to pair with two devices. A downside to the new transmitter is a battery life of 3 months, down from six months for the G4 Platinum. The G4 transmitter more often than not lasted longer than six months, so mayhap G5 will too.

We'd note that the transmitter sends data in existent-time and does not save any glucose history. In other words, it cannot backfill missing data when both displays are out of range. For instance, if you get out both the receiver and phone at abode and get for a run, the data is completely lost. This is an upshot for those limited cases when you don't have either the telephone or receiver in-range, but really want to gather the glucose data during that time (exercise is the obvious 1)

G5 Receiver

Highlights

• White groundwork screen is easier to read.

• Better use of color and notifications really testify the current glucose value and trend arrow instead of a generic depression or high alert.

For those familiar with the G4 receiver, the new G5 receiver won't feel much different. Dexcom has primarily made some user interface tweaks: (i) the background screen is now white, making information technology much easier to read (ii) the receiver shows colored banners across the top to indicate a depression or high (instead of a colored number on a black background); (iii) high or low pop-upwardly notifications really show the electric current glucose value and trend (Depression – 77 mg/dl > ) instead of just a generic message (Depression).

The receiver still has outstanding bombardment life (lasting at to the lowest degree a few days on a unmarried charge), and the size is all the same MP3-like (great for a pocket or pocketbook). The alarm settings, profiles, and volume are identical to the G4 receiver.

Like the G5 app, in that location is still a lot of wasted white space on the main tendency graph screen, and you cannot get statistics or pattern recognition on the receiver itself. On a positive note, Dexcom Clarity automatically detects a plugged in receiver (via a Mac or PC software tool), then uploading information and viewing stats takes less than one minute on a calculator.

Those using the G4 Receiver with Share tin can update the software to make their current receiver talk to the G5 transmitter.

Sensor Accuracy and Scale

Highlights

• Retains the excellent G4 Platinum accurateness and reliability – an boilerplate nine% error versus laboratory claret glucose values.

G5 uses the same G4 Platinum sensor and includes the updated Software 505 algorithm. This gives G5 an boilerplate 9% error vs. laboratory blood glucose values – for context, if your claret sugar is 100 mg/dl on boilerplate, that ways G5 will be off from your real blood glucose value by ~9 mg/dl on average. This is the best accuracy of whatever CGM available (on boilerplate), though everyone experiences different results. Dexcom believes this accurateness approaches glucose meters; nosotros would agree in our experience.

Like G4, G5 asks for two calibrations per 24-hour interval. The nigh of import calibrations are the first few. It'south crucial to wash hands and actually take 2 individual fingersticks at starting time-upwardly – meters are less accurate than we all believe!

G5 is still not approved for dosing insulin in the United states of america (it is in Europe), but many patients do this in the existent earth as they gain trust. Adam has built plenty conviction in G4 and G5 that he ofttimes simply tests 2 times per mean solar day (one time in the morn and once at night). He tests more than often on day 1 of a sensor (when accuracy is the worst), if he doesn't believe the CGM value, or if he is about to take a large correction dose of insulin.

Dexcom Clarity (web-based analysis software)

Highlights

• Outstanding pattern recognition, disquisitional statistics, and colorful graphs to identify trouble times.

• Makes CGM information more than approachable, but allows for customization in the right places.

• Data running through G5 app posts automatically to Clarity; the uploader is PC and Mac compatible and automatically detects receiver.

• "Best Glucose Day" written report.

Adam is fond to Dexcom Clarity, the new web-based assay software (complimentary) that launched with G5 and also works with the G4 receiver. If you're running the G5 app, CGM automatically posts to Clarity with a four-60 minutes delay. Otherwise, you tin can download the PC and Mac compatible uploader, which sits in the background on your reckoner, car-detects the receiver within seconds, and uploads the data in ~20 seconds.

The spider web version of Clarity revolves around just four screens and is focused on identifying problem areas (When am I going low or loftier?) and keeping things approachable. Every screen allows for customizing the date range, though information technology defaults to ii weeks and tin can't display more than xxx days of information at a time.

The "Overview" screen is a terrific one-page snapshot of central information – within 60 seconds you tin can answer, "Where am I having trouble?" This page shows an estimated A1c, average claret glucose, hypoglycemia chance (depression, medium, high), time-in-range, calibrations per day, and any identified patterns.

"Patterns" gives a deeper swoop on the times of day when glucose was consistently above or below target, and Clarity shows the days of CGM traces that brand up a detail blueprint. The software likewise identifies your "all-time glucose day," a nice focus on the underappreciated positive side of diabetes. This screen also gives "possible considerations" based on the blueprint, but they are too generic to exist actionable.

The "Data" page shows a single CGM graph with error bars to signal times of day with lots of variability. The utilise of colour and the error bars makes it clear what times of day are a problem. You tin likewise pollex through daily CGM traces, and Clarity will add "event" markers entered into G5, such every bit logged grams of carbs, exercise, and insulin doses. It's currently not easy plenty for Adam to regularly add together events, but peradventure future app integrations will improve this feel.

"Compare" shows 2 periods of time side-by-side each other. This is useful to see the impact a item alter has had on your diabetes – east.chiliad., eating lower carb for a week, exercising more than often over two weeks.

Dexcom does take a Clarity iPhone app, though information technology only allows viewing a PDF of the past ii weeks of data, which will be absent unless you've uploaded the receiver or are using the G5 app. It would be squeamish if more Clarity functionality was available in the iPhone app, though it is not a tremendous hassle to open the website. The Clarity app seems ideal as an on-the-become option for appointments with a provider.

Apple Health

The G5 app automatically posts data to Apple Health, allowing other diabetes apps similar Glooko, Meal Retentiveness, and 1 Drib to admission it (probably mySugr besides in the future). This is the idea of a diabetes "ecosystem of apps" targeted to specific needs and patient preferences. Imagine apps for meals, for do, for deeper CGM analysis, for social networking, or anything else. That is the promise of Apple Health.

The i downside is G5 posts data to Apple tree Health with a three-60 minutes delay, meaning other apps cannot offer real-fourth dimension benefits. This delay stems from how the FDA defines historical ("retrospective") information; perhaps information technology will subtract in the futurity.

What Does it Price?

The best answer is to talk to Dexcom, since insurance varies by visitor and plan. About United states of america private insurance companies (e.thou., United, Aetna, Humana, Anthem, Cigna) comprehend CGM, though requirements, co-insurance, and deductibles vary widely. Medicare does non cover personal CGM, but this will hopefully alter. Many European countries are now paying for CGM, just once again, it varies across the board.

If you don't have insurance, CGM is expensive, probably running a few k dollars per twelvemonth.

The G5 pricing model is similar to G4: an upfront price to get the starter kit, which includes the receiver, a transmitter, and four sensors. The G5 app is free. Ongoing costs include transmitters (up to iv per year, though might be less in practice) and seven-day sensors. Dexcom has non disclosed what each component costs.

We hope CGM gets less expensive over fourth dimension, particularly if more patients tin pay a chemist's co-pay for sensors (similar to picking up a drug).

Our G5 Wishlist

App

• Get in easier and faster to run into real-time CGM values and trends on the phone: (i) add together a Today widget; (2) add together smart watch compatibility; (three) show actual CGM values and trends on the lock screen notifications.

• Android compatibility (reportedly coming in 2016).

• Add statistics within the G5 app, or build out the Clarity iPhone app with more functionality.

• Enable users to take a pic of a meal instead of only manually logging the carbs in Events.

• Improve Events logging by integrating with other apps and devices (Fitbit, Strava, LoseIt!, myfitnesspal).

• Permit customization of the tendency graph to preclude wasted white infinite. Can the scale be modified to devote larger areas of the screen to hypoglycemia and in-range?

• Reduce the three-hour fourth dimension-filibuster to post information to Apple tree Health (this is an FDA upshot).

• Add an insulin-dosing calculator that uses the CGM value, tendency arrow, and planned carb intake.

Transmitter

• Improve the signal reliability between the transmitter and the G5 phone app.

• Increase signal range.

• Reduce transmitter size and extend the bombardment life across 3 months.

• Enable some information back-filling – could the transmitter store the last 30 minutes of data?

Organisation

• Brand it less expensive.

• Obtain FDA approval to dose insulin without a confirmatory fingerstick (the G5 already has this approval in Europe).

• Factory calibration (no fingersticks).

Dexcom told the states it is actively working on these improvements, or is because them for future products – near are not uncomplicated or they would have been done already!

What Is Next for Dexcom?

• Android G5 – 2016

• FDA approval for insulin dosing off CGM – 2016

• G5 pump integrations (Tandem, Insulet, Animas, and Bigfoot Biomedical) – late 2016 at the very earliest

• G6 – 2017 (one calibration per mean solar day, with fewer expected over fourth dimension)

• Smaller transmitters and a new receiver – In development

• Google/Dexcom disposable sensor – 2017-2018+

Terminal Thoughts

Nosotros're excited that the G5 has arrived – earlier than expected – and we're obvious fans, unsurprising since we both started wearing CGM many years ago. It'due south great to run into how fast Dexcom is moving, a company with ambitious goals and strong leadership. We tin't wait to come across what'due south side by side!

wellshinagesphe.blogspot.com

Source: https://diatribe.org/dexcom-g5-mobile-cgm-your-phone-receiver-optional

Share this post