The highly anticipated Animas Vibe Insulin Pump with integrated CGM has finally been FDA approved in the United States and the first orders will ship out later this month.
I was given the opportunity to do a free two-week trial of the Vibe on behalf of ASweetLife.org. Having never used an Animas pump before (but nearly all of their competitors), I was particularly excited to see what they’re all about and to get my hands on the first Dexcom G4-integrated pump system.
We’ll start with the obvious: integration. We’ve been waiting stateside for an integrated competitor to Medtronic for a long time and it’s refreshing to finally see a Dexcom-compatible pump on the market. Choice in the market is a positive thing. The implementation is done fairly well overall. It really is incredibly convenient to have your CGM close at hand without wearing an additional device, and Dexcom is well regarded for its accuracy and longer wear as a CGM system.
A traditional Dexcom G4 Platinum system contains a receiver with five graph screens (1-, 3-, 6-, 12-, and 24-hours on the x-axis) in yellow, white, and red on the y-axis (for high, in range, and low glucose values). Vibe includes all five of these graphs with an altered color scheme, employing red for high, green for in range, and blue for low. The colors are clear and bright and carried into the coloring of the trend arrows as well, though if you have difficulty distinguishing between red and green, you might have some frustration.
Added specifically for the Animas Vibe is a 6th screen called the “Trend Arrow Screen” with the current glucose value, colored trend arrow (with the same RGB color scheme), current time, and Insulin on Board (IOB).
User should note that this is one of two appearances of IOB. Though it does not yet appear on the home screen (as it does on Tandem, Insulet, Asante) or primary status screen (as it does on Medtronic), Animas offers two locations for IOB: It is available on the 2nd of its 7 pump status screens (the Bolus Status screen) and now you can access this crucial data on the Trend Arrow screen rather quickly via the CGM shortcut button on the upper right side panel of the pump.
To access any of the 6 CGM screens from a blank screen, you can press this CGM shortcut button and the last CGM screen that you viewed will appear. You can then scroll between the six screens, though the response time between pressing the button and the next graph appearing is sometimes slow at 2-3 seconds after the button press for each new graph to draw.
Unfortunately, there is no quick way to get from the CGM screen to your other primary pump screens – home, status, or main menu, so if you want to then bolus after viewing your trend, for instance, there are additional scrolling and selection steps involved.
Animas also has beautiful craftsmanship going for it, with a sort of 3-tubed compartmentalized construction that makes it extremely watertight, the tunnels housing the AA battery (lithium or alkaline), the brains, and the reservoir cartridge separately.
3. Looks and Dimensions
It’s a reasonable weight for a pump, similar in weight and size to Medtronic’s pumps. It’s short and compact without being heavy with a well-thought out design.
It’s also very pretty – available in 5 colors (silver, an apple green, a rosy pink, a medium blue, and black) – and the screen is large for the size of the pump body. It feels genuinely good in the hand and solidly made.
Alarms are pleasant and customizable, though they are not as customizable as they are on the Animas Ping. Vibe does not allow you to download tunes to use as alarms as Ping does, but you can set most of the various alert volumes to Off, Vibrate, Low, Medium, or High. I personally find the High volume to be far too quiet for a CGM alert and found that I missed the Attentive and Hypo Repeat alert settings available to me on a traditional Dexcom G4 receiver.
5. Insulin Calculation
There are some fundamentally intelligent things about the way Animas calculates insulin, such as correcting to the midline of your target BG range rather than to the extremities of the range as Medtronic does.
Animas also allows for the smallest basal delivery increment on the market (0.025 U/hr) and the fastest bolus delivery (which more closely mimics how we receive insulin via injection).
A poster presented at last year’s ADA Scientific Sessions based on an Austrian study titled Absorption Kinetics of Insulin Following Subcutaneous Bolus Administration with Different Bolus Durations (not sponsored by Animas) suggested that a faster subcutaneous bolus speed results in a faster onset and peak of insulin performance, resulting in a reduced postprandial blood glucose value. This study pointed to Animas as having the edge.
If you find that their bolus delivery duration is too fast for your liking, however, there are variable delivery rates for boluses. At the faster rate, I felt no different than if I were injecting a bolus across a range of infusion set locations during my trial, including more tender spots like the upper arm.
6. “Jump to Bolus” Feature
An oft-heard frustration of Animas Ping users has been that the suggested bolus value did not prefill when calculated on the Ping. With the release of Vibe, Animas addresses this frustration by allowing you to “jump to bolus” by pressing the up arrow and jumping instantly to your suggested bolus value.
7. Infusion Set Options
Animas pumps allow for any standard luer lock infusion set rather than proprietary sets like Medtronic and Asante require. Animas offers a variety of infusion set styles, but your options are not limited to their offerings. A full set change took me, on average, 5-6 minutes.
8. Animas pump’s food library
Animas pump’s food library, unlike the food library on the Omnipod PDM, is actually able to add selected carb count values to your bolus calculator, much like what users of the Smiths Cozmo pump enjoyed, though Animas doesn’t allow you to customize the food library to add new or reorder items.
In this video, I take you through the various CGM screens of Vibe, program and deliver a bolus, and compare the Vibe’s CGM to the Dexcom G4 Platinum receiver with updated software. You’ll hear how loud the alerts are and walk through some of the menus with me.
Animas has had a color screen longer than anyone else in the pump market, but they’ve also made no updates to it. The color screens on the market today are higher resolution and more modern in look and feel than what we’re seeing again from Animas. The Insulet Omnipod PDM has been in color since 2009, Tandem since their launch in 2012, and Asante since this last November’s MySnap release. What we see in the pipeline mock-ups of Medtronic’s 640G and Accu-Chek’s Insight (at least its meter remote) prove that color and user-friendly font is where all of the pump companies are headed.
Animas’ color screen has a slow refresh rate and uses a system font reminiscent of a DOS command prompt. The screen utilizes nearly every available line of its nine lines of text, but often to the extent of filling the screen with visual clutter.
There is also no way to turn the screen off for dark theaters. You must wait for it to timeout (which is user-defined: 15, 30, 45, or 60 seconds).
2. Botton Speed
Button presses for some features – switching between CGM graphs, as mentioned above and resuming from a suspend – are exceptionally slow in responding, taking seconds to act. Resuming from a suspend takes as long as 15 seconds before the screen changes with no indication that the pump is performing an action after the button press. Animas’ scroll speed, however, is still almost too fast. For this admittedly novice Animas user, I found it impossible to stop on a dime on the Animas Vibe. You end up five feet shy of it in either direction rather and then must button press your way to the final value.
Speaking of button presses, the Vibe, like its predecessor, has no back button. If you find yourself in a menu and want to go back to the previous screen, in most instances, you must circle all the way back through. There is a back arrow on some screens, such as the Status screen, but I found that I was frequently frustrated at scrolling through their menu structure.
3. Remote Bolus Option
Having never used an Animas Ping, I can’t speak to feeling the loss of an integrated meter/remote. I am accustomed to operating a pump directly on the device rather than via remote, but for those who prefer more discreet pump wear beneath clothing, you may miss having the remote bolus option available on the Animas Ping with its paired One Touch meter. The Vibe does have a dedicated audio bolus button on the top of the unit that could be used for discreet bolusing, but if the One Touch Ping remote is a must-have Animas pump feature for you and you’re due for a new pump, you’ll be pleased to know that Animas Ping will continue to be available as a pumping system, particularly since Vibe is not yet approved for the under 18 set.
4. No Low Glucose Suspend
Worth noting for clarification, the Animas Vibe pump does not act on the data it receives from the Dexcom CGM the way that Medtronic’s 530G system reacts to data from Medtronic’s Enlite CGM. This pump will not suspend basal delivery in response to a low blood sugar. Your CGM value is never ported into your bolus calculators, though you can tell Vibe to use your bolus calculator blood glucose value (obtained via fingerstick) to calibrate the CGM after the bolus delivery is complete.
1. Outdated Dexcom Software
The Animas Vibe runs the original Dexcom G4 Platinum algorithm and not the new and improved 505 software update (available to download for your non-pediatric adult Dexcom G4 receiver here). Pitting Vibe’s CGM against my updated Dexcom receiver (shown here displayed on a remote monitor), it was clearly behind this rising blood sugar.
Other times, the values ran comparably, but the trend arrow turned earlier on the updated software, which is similar to the results I saw running updated receivers against non-updated.
2. Suspending Your Pump will Suspend Your CGM
If you have been directed by your health care provider to suspend a pump during a low blood sugar (such as with significant IOB or if you want to cancel an extended bolus and your basal simultaneously), then it’s crucial that you understand that suspending the pump functions on Vibe will suspend your CGM visibility as well.
In instances where your health care team recommends suspension, Animas recommends that you would instead use Temp Basal OFF and cancel all extended boluses manually. Suspend is a lot faster to program than Temp Basal off (8 button presses vs 20+ button presses) and is further up in priority than the Basal menu, so it was the first option I went for when I chose this method of handling a dropping BG with IOB (at the advice of my CDE). Worth noting, competitor Medtronic does not suspend CGM visibility with a Pump Suspend.
3. Extra Button Press
When you receive an alert on a traditional Dexcom G4 receiver, acknowledging the alert takes you straight to the graph and the data you need to view to make a therapeutic decision. On the Vibe, that’s several screens in. You receive an alert that your blood sugar is dropping or rising rapidly or below 55. This alert screen does not give you any other information, so you press OK to Confirm.
What would you like to see next when you acknowledge the alarm? On a traditional G4 receiver, you’d be taken immediately to your graph where you would see the number, trend arrow, and graph. On the Vibe? You acknowledge the alert and are taken to a CGM menu where your first option is to calibrate BG.
You still don’t even know what your BG or trend is. You must scroll down to select Trend Graph, press OK again, and then you may see your number, arrow, and/or graph.
This is clunky and, frankly, frustrating. Three button presses to get to the data I need when it would take one on a traditional receiver. This extra button press barrier between my CGM data and me is unnecessary and I found myself continually frustrated.
4. Contextual Memory
My last concern with the Vibe as a pump and Animas’s general platform is that the pump has no contextual memory as most of its competitors do. If you’re mid-cartridge change and the Vibe times out, you have to go back into the main menu again and back into the priming menu. If your cannula prime is always 0.50 units, you’re going to have to re-enter it every time. If you suspend the pump, it doesn’t automatically prompt you to resume upon waking the screen. It just doesn’t remember what I was doing and take me back there the way many other pumps I’ve used would do.
I was in the middle of programming a combo bolus earlier this week and received an alert from my CGM that my blood glucose is high. Confirming the alert canceled out everything I had entered and sent me back to the CGM menu. Scroll down to Main Menu. Select. Scroll back to Bolus menu. Scroll back to ezCarb. Back to entering the carbs, the BG, the duration, the split…
Seasoned Ping users may be able to move through an Animas menu with agility, but having used pumps that don’t require me to keep hopping down that bunny trail, I can’t get over how unnecessarily complicated their menu structure is. Why is the Basal menu lower in priority than History and Suspend/Resume? When I input a wrong carb or BG value (likely due to scroll speed), why is it difficult to back up and re-enter that number? Why can’t the Review Total screen (for the Food Library) appear as an option only in the context of having actually used the Food Library? Why must I scroll down through five options on the CGM screen to reach the main menu to get to the bolus screen where I have to scroll through additional bolus options when after viewing my trend graph, I will so often go straight to programming a bolus?
If you love your Animas Ping and your Dexcom, you will be satisfied with finally having access to this integrated system. There will still be the option to carry a separate Dexcom receiver (for the price of a spare receiver) to provide you with additional CGM coverage that could alleviate some of the grievances you might share about the algorithm update availability or the low volume alert tones on the pump. (A spare receiver would also allow you to take advantage of Dexcom Share (Dexcom’s remote receiver dock) or other remote monitors like Nightscout.)
While I believe that Animas has miles to go to deliver on a user interface that respects human factors, their pumps are reliable, proven, and universally respected. Vibe didn’t live up to four years of hype for me personally, but it’s a crucial step in the right direction and will serve as a strong competitor to Medtronic in the integrated pump market here in the U.S. as it has abroad.
Melissa Lee writes the blog Sweetly Voiced.