Menarini’s Glucomen Day CGM. The newest game in town…

I took it on myself to purchase the starter kit of this new CGM to see whether it was as good as the reps on the stall at ATTD in February thought it was. It came at a cost of £199 which included what’s in the above picture.

The kit consists of:

• Two rechargeable transmitters, each of which lasts 14 days;
• One reusable insertion device;
• Two sensors;
• A Glucomen Day meter.

The transmitters take four hours to charge each, but then last for the life of each sensor. Whether they go beyond that remains to be seen, as does finding out whether the sensors can be re-started. That’s something that we’ll have to wait and see. 

This is the first of the CGM systems that I talked about in this article to become available to buy in the UK (and we’re more than six months on from then), however, I think it’s fair to say that CoVID-19 has had a part to play in delaying releases. At the time of the article, it was touted as the Agamatrixx Waveform Cascade, so there’s been a bit of a marketing tie up here with Menarini. At the time of that article, the claimed MARD was 11%, however, customer services reps on calls have claimed 9.9% recently, while the manual says 11.4%. We’ll see how that works out.

Additionally, this system boasts of being the first invasive CGM that doesn’t require an inserter needle, and uses the structural properties of the sensor itself for insertion, which obviously has benefits when disposing of insertion materials.

Pricing

Menarini offer a couple of ongoing pricing models for their kit:

• A monthly subscription model at £139 per month. This includes:

 

 

 

 

 

 

 

 

 

 

• A pay as you go (PAYG) model, with each item bought off the list. In this model, the sensors can be bought in twos or tens. When you buy two it costs £76.50 per sensor and for packs of ten, £75 per sensor.

If you want to understand this pricing, you really need to compare it on a monthly basis to what Dexcom offers. Dexcom’s G6 and the Glucomen Day CGM pricing models are shown below:

Item	Dexcom – Number	Dexcom – cost per item	Glucomen – number	Glucomen – cost per item
Individual Sensor (min pack size)	1	£51.25	Min pack size – 2 sensors	£76.50 per sensor
Monthly sensor pack	Contains 3 sensors	£153.75	2 sensor pack	£152.99
Transmitters	1 per transmitter pack	£200	1 reusable transmitter per pack	£52.99
Monthly Subscription: – Contains all transmitters and sensors required	Full year’s supply of sensors and transmitters	£159 per month Saves £788.25 annually over PAYG cost	Full year’s supply of sensors and transmitters	£139 per month Saves £366.88 annually over PAYG cost
Starter pack (1 months use)	1 transmitter and 3 sensors	£159	Full resuable transmitter and inserter pack (including two transmitters) and 2 sensors	£199

There are other items that can be purchased, but I think these are the key options.

If you look at the PAYG pricing, we can see that on a monthly basis, the Glucomen Day CGM sensors cost more or less the same as the Dexcom G6 sensors. This suggests to me that either Menarini/Waveform considers that its sensor technology is either as good as Dexcom’s or the cost of manufacture is very similar. If it’s the former, then I’d have to question why the declared MARD is 11.4%.

The real “savings” come from having rechargeable transmitters that (according the the inference from the website) last for five years. In theory, this means that over the five year period, you are saving some £3,800 by not having to buy and dispose of transmitters. What this doesn’t say is that if we look back over the last five year period, on the Dexcom front we’ve gone from the Dexcom G4 to the Dexcom G6, so is it realistic to expect someone to use the same system for the next five years to realise those savings?

So let’s get started at setting it up, charging a transmitter and getting the system going…

Getting Plugged In

Firstly, attaching the transmitter to the sensor kit. The sensor applicator looks enormous,but the sensor is only a tiny part, and while all the bits an pieces in the box and the instructions make this look a little scary, it’s surprisingly simple. First you attach the transmitter to the sensor:

Then you attach the insertion device to the sensor and transmitter array:

 

Again, all fairly straightforward. Once you’ve done this, you put the inserter on yourself (currently only the abdomen is approved) and then hit the top button to insert and the end button to release the sensor, then pull the inserter away. Getting the inserter to disengage took two attempts but didn’t seem to cause any issues. Having said that, after completing the insertion, the amount of rubbish to dispose of is quite a lot lower than the Dexcom (even though there’s a plastic component missing in the GlucoMen picture) and contain no sharps, which is more important…

Due to the shape of the whole thing together, it does feel quite large. As can be seen in the pictures below, there’s an elevated ridge that feels like it is going to catch on clothing. It’s not as large as an Ominpod, but compared to the Libre, Medtrum and Dexcom sensors I’ve worn, it feels like more of a lump.

In terms of size, it is 35mm by 24mm and at its deepest point, 11mm deep (and 9mm across the rest of the transmitter body), compared to the Dexcom which is 38mm long, 18mm wide and 9mm deep once attached. While that doesn’t seem much bigger, somehow, maybe because of the shape, it feels it. I’ll see how I get on with it over the next couple of weeks, however, I’ve mentioned previously that it feels like it will get caught on something and ripped out.

Once you’ve got the sensor attached, you open the app and wait for it to detect the sensor. No need to tell it you’ve started a new one.

It then runs for 45 minutes before asking for the first calibration, which the system uses to calibrate itself for the next 10 minutes before giving you a glucose reading. It’s worth noting that while Glucomen supply a meter and strips with the device, you don’t need to use this to calibrate the CGM. In this case I am manually calibrating from an Ascensia Contour Next One meter. While we’re talking about calibration, it’s worth highlighting that this is a once-daily calibration CGM. If you read through the documentation, if you go past the calibration time that it requires, it changes the colour of the glucose dots to tell you they are estimated values rather than fully calibrated. 

And that’s all there is to it really. It’s easier to set up than I expected given the plethora of parts that arrived and some of the pictures in the getting started guide. I think some people will need to be shown how to do it, but it isn’t as complex as it looks.

An overview of the app

I’ve broken the app up into three parts. The home page, the alerts and the info page.

The home screen

The home screen contains a lot of information, and most of it is clickable. This makes also makes it useful. as I mention in the video, the background on the homescreen varies dependent on glucose levels, with Orange for high, Red for low and blue when in range. 

Alerts

One of the questions that has been raised is how flexible are the alerts. As you can see in the video, there are all the expected alerts, including very low, low, high, rising or falling “quickly” and also predicted high or low. It’s worth noting that the very low can’t be disabled, however, you can elect to not enable critical alerts in the phone notification settings, which means that the very low alert won’t fire if you have “Do not disturb” set. I tested this overnight last night, and thanks to spending the night sleeping on the sensor, the glucose level spent most of the night at 2.2mmol/l and the Very Low alert didn’t fire as “Do not disturb” was enabled.

The Info screen

The info screen contains some useful data, including full guides for inserting and removing sensors, the complete user guide as well as links to a technical chat assistant and a medical help phone number. When I tried ringing the number included I got a “This service is closed” message and it hung up, so I;m not sure that this is particularly useful.

Accuracy and other things

During this first 24 hours I’ve seen some quite significant deviation of the Glucomen Day from bloods and the Dexcom (though neither CGM has been perfect). I’ve also heard from early adopters in Europe that they had issues with the longevity of the sensors, One of whom said that it failed after six hours and another who couldn’t get more than six days out of any of the sensors they tried. As this test progresses, if I do see early failures, they’ll obviously get recorded and noted down when it comes to the final review looking at the overall accuracy and use of the system.

After less than a day of use, I’m not going to comment on the accuracy or otherwise of this set-up as that’s not really fair on any system, however, it would be good to see whether it is suffering from similar issues to other CGMs during the first couple of days post-insertion, and if it settles down after that.

Keep watching as the trial progresses.