Dexcom G5 Not Iphone Uploading to Clarity

By Adam Dark-brown and Kelly Close

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

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

Well, what seemed incommunicable five years ago is now available. G5 takes the aforementioned accurate G4 continuous glucose sensor, adds Bluetooth to a new on-body transmitter, and introduces a new iPhone/iPod Touch app for viewing the real-time data and getting notifications on the phone. The information can as well be viewed on a CGM receiver alone (east.yard., for those with an Android telephone).

Dexcom's G5 is a landmark device approval 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., people now expect things to work right out of the box with a world-class user experience. Attending spans are fashion shorter. The bar for great devices is far higher.

The G5 has many advantages. It expands patient options for viewing existent-fourth dimension CGM data (phone or receiver or both) and takes advantage of the smartphone's many assets to evangelize a stronger patient experience (more than customizable alarms, meliorate screen, cloud connection). The spider web-based Dexcom Clarity software is an fantabulous upgrade for those trying to digest overwhelming CGM charts and statistics. And importantly, G5 retains the G4 Platinum sensor accurateness and the widely praised receiver pattern.

Just for others, G5 is a symbol of the complicated and tumultuous fourth dimension we live in. Every bit phones and gadgets become more useful and more than addictive, many are pushing dorsum – "spend less time in front of screens and more than time in the globe." If my Dexcom G5 app goes off in the centre of a meeting, will my co-workers think I'm rude to look at my phone? Is information technology okay to accept my phone in the bedroom? If I trust my telephone with my life, what do I do when the bombardment dies in the middle of a hike?

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

This is a long test drive, and then we've created a Summary department beneath for those who want the well-nigh disquisitional takeaways: major highlights; areas for improvement; who might dearest G5; and who might be less impressed. Those interested in a very detailed review should read on to the Deep Dive section.

Summary

G5 Highlights

• Expanded options for viewing real-time CGM data – phone, receiver, or both. Switching between devices is effortless, and you can calibrate on either device and the other will update.

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

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

• Stiff web-based Clarity analysis software with easy upload, better blueprint recognition, and more digestible charts and statistics.

• G5 posts glucose data to Apple Health, allowing other apps similar Glooko, Meal Memory, and One Driblet to use it (very few diabetes devices do this).

• It retains the splendid 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 specific depression and high alert notifications.

• Retains the Dexcom Share feature 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 telephone and pulling the app up. Could benefit from a "Today" widget (like seeing the weather with just i swipe on the lock screen) or smart sentry compatibility (presumably coming soon).

• Non Android uniform, only this is coming in 2016 (and a receiver option is withal available for now).

• The G5 app depletes phone battery slightly faster than if you were non using it. It does piece of work in Plane and Low Power Mode.

• The G5 transmitter range seems shorter than the G4, and the phone app loses signal a bit more oft than the receiver.

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

• The transmitter is slightly larger than the most recent G4 transmitter, and has a labeled bombardment life of three months (down from 6 months with the G4).

• The 3-hour delay to post data to Apple Health could be reduced (this is an FDA result).

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

Dexcom told the states information technology is actively working on these improvements, or is considering them for future products – most are not elementary or they would have been done already!

Who might honey G5?

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

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

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

• CGM users desiring more warning customizability.

• Those who want more than discretion (e.g., bellyaching by questions about the receiver like, "Is that a pager?")

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

• Those who have problem reading the small font on the receiver.

• Those who want automated data upload for assay and design recognition.

• Anyone that loves apps and nerds out on data!

Who might be unimpressed with the additional benefits of G5 vs. G4?

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

• Those who struggle to proceed their phone charged.

• Android users (until 2016).

• Electric current Dexcom users who don't intendance almost getting CGM information on their phone.

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

• Not-CGM users that: desire something smaller on the body than the G4/G5 transmitter; find CGM as well expensive; or want a device that requires no fingerstick calibrations.

Deep Swoop

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 Next for Dexcom?

• Terminal Thoughts

What is G5 and How Does it Work?

Dexcom'due south G5 CGM system has four main components:

1. The aforementioned G4 Platinum CGM sensor inserted under the pare for seven days. It requires two fingerstick meter calibrations per day and has an industry-leading ix% 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 2 devices, allowing you to choose how you want to see your CGM data: receiver lone, G5 telephone app lone, or both.

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

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

Setting upwards G5 took less than 10 minutes, and we did not need to open the paper instruction transmission once. Subsequently downloading the G5 app from the iTunes app shop, we made a Dexcom business relationship and ran through the easy guided setup screens. Instead of having to enter a clunky transmitter series number, the app simply asks yous to take a motion-picture show of the box – very cool. From in that location, the G5 app Bluetooth paired with the G5 transmitter within 5 minutes.

Electric current Dexcom users will be familiar with the rest. After inserting a sensor and snapping the G5 transmitter in, you merely press "Start Sensor" on the app. G5 however needs a two-hr warm-up, and and then it asks for two start-up fingerstick calibrations. You can start a sensor session on either the app or the receiver; the other brandish 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 menu layout includes the essentials and doesn't bog users down with likewise many options.

The G5 app communicates via Bluetooth with the transmitter every five minutes, at which signal information technology updates the CGM value, graph, trend arrow, and sends a notification (if applicable; more than on that below).

The benefit of the phone over the receiver is immediately credible later opening the G5 app. A larger screen area shows the CGM value more than prominently – if the G4 receiver showed the CGM value in size ~12 font, this is size ~36 font on an iPhone v. Information technology'south a big comeback, since real-time CGM should prioritize "What's my current number and tendency" in a higher place all else.

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

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

G5 can deplete your phone battery slightly more apace than if you were non using it at all, so beware if your phone tends to die in the middle of the day. Fortunately, the G5 app volition proceed giving y'all real-time data in Airplane Style and Low Power Mode, both excellent options for extending the iPhone'due south battery life.

The G5 app menu structure is simple and in that location is nothing unnecessary or overwhelming. Too the master home screen (described in a higher place), in that location are three other main screens: enter a meter calibration, enter "Events," and Dexcom Share. A few highlights:

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

• The events screen – assuasive manual entry of carb grams, exercise, insulin, and wellness – demands enough extra steps that it'south difficult to use routinely. This could exist automatic if Dexcom somewhen 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 need to run the Share app.

Interface wise, there is nevertheless some wasted white infinite on the master trend graph screen in the G5 app, though at least yous tin reduce the top-end to 300 mg/dl. Information technology would exist nice if this graph was fully customizable (e.thou., you could drag the alert confined to point how much infinite you lot want the hypoglycemia and hyperglycemia ranges to take upwardly).

In that location is also no way to view statistics or trends inside the G5 app (dissimilar the FreeStyle Libre reader). You must either open the separate Clarity iPhone app to view a static PDF, or log onto the web-based Clarity software (encounter below) for full functionality. Both are easy but it is an extra step. According to Dexcom, making the analysis software separate from the G5 app actually made the regulatory process easier (i.e., 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 directly to the G5 app.

The G5 app runs in the background, meaning you tin can utilize other apps at the aforementioned time or take the phone locked. If the app is fully exited you lot volition not receive CGM data or alerts, though you lot will get an firsthand notification ("App is closed. Y'all will not receive glucose information.")

Unlike the receiver - which requires pushing 1 button to run across the electric current CGM value – the G5 app requires you to unlock your telephone and then bring the G5 app on screen. The glanceability could amend with a "Today" widget that enables a unmarried downwardly swipe on the lock screen to see the CGM value and tendency graph (due east.g., like weather or calendar). We presume Dexcom volition somewhen release an Apple Watch version of G5 likewise. Unlocking the telephone and pulling up the app only takes a couple seconds, but it does add together upwardly, and it is more inconvenient than the receiver.

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

• You can also utilise Siri and say, "Open up G5 app," though you'll withal have to enter your passcode if you have 1. (Hint: Siri hears "Dexcom" as "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 not show the actual CGM value or trend arrow, though a correct swipe and phone unlock will immediately pull upward the Dexcom G5 app with the pop-upward alert.

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

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

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

Of course, y'all can also opt for vibration alerts lone.

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

Customizing audio preferences does accept some piddling on the iPhone. Adam usually keeps his phone on silent or "do non disturb," and so turning the ringer on was non something he was excited to do. But he nevertheless wanted the Dexcom sound alerts, so here was his workaround:

• Turn ringer on.

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

• Get into "Sounds" settings and turn off audio alerts for text messages, agenda, mail, social media, etc. Adam set up these to vibrate or off completely.

This is a good mode to duplicate the receiver'due south audio functions, but to minimize the cacophony from other random phone notifications. Obviously, G5 app notifications can exist turned off or set to vibrate at any fourth dimension.

It can be easier to wake up to alarms at nighttime with G5, since the iPhone sounds are much louder and more than varied than on the receiver. G5 will work on aeroplane mode (though Share won't work), offering a good nighttime selection to minimize notifications and keep the phone in the aforementioned room.

G5 Transmitter

Highlights

• The transmitter pairs with ii devices (telephone and receiver), which tin 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 option information technology up. You can enter a fingerstick calibration on the phone or app, and the other device will update automatically within a few minutes.

Fortunately, you don't have to tell the telephone or receiver which i you are going to use at any given time. The transmitter sends out a new signal every five minutes, meaning each device volition independently choice the signal up 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 experience, we got more of a v-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 oftentimes than the receiver, only it doesn't happen overwhelmingly often. And normally information technology is just one or two data points.

The G5 transmitter is the same size as the original G4 Platinum transmitter. That is smaller than we would have guessed, given the add-on of Bluetooth and the ability to pair with 2 devices. A downside to the new transmitter is a battery life of three months, downwards from six months for the G4 Platinum. The G4 transmitter generally lasted longer than vi months, so maybe G5 volition too.

We'd note that the transmitter sends information in real-fourth dimension and does non salve any glucose history. In other words, information technology cannot backfill missing data when both displays are out of range. For case, if you get out both the receiver and telephone at home and go for a run, the data is completely lost. This is an issue for those express cases when you don't have either the phone or receiver in-range, but really want to get together the glucose data during that time (exercise is the obvious one)

G5 Receiver

Highlights

• White background screen is easier to read.

• Better use of color and notifications actually bear witness the electric current glucose value and tendency arrow instead of a generic low or loftier alarm.

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 groundwork screen is at present white, making it much easier to read (ii) the receiver shows colored banners across the top to indicate a low or loftier (instead of a colored number on a black background); (three) high or depression pop-upwards notifications actually evidence the current glucose value and tendency (LOW – 77 mg/dl > ) instead of simply a generic message (Depression).

The receiver still has outstanding bombardment life (lasting at to the lowest degree a few days on a single charge), and the size is yet MP3-similar (great for a pocket or purse). The alarm settings, profiles, and book are identical to the G4 receiver.

Like the G5 app, there is yet a lot of wasted white space on the main trend graph screen, and you lot cannot become 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), so uploading data and viewing stats takes less than one minute on a computer.

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

Sensor Accuracy and Scale

Highlights

• Retains the fantabulous G4 Platinum accurateness and reliability – an average 9% mistake versus laboratory claret glucose values.

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

Like G4, G5 asks for two calibrations per day. The near important calibrations are the first few. It'southward crucial to wash easily and actually take two individual fingersticks at start-up – meters are less accurate than we all believe!

G5 is still not approved for dosing insulin in the U.s. (information technology is in Europe), but many patients do this in the real globe every bit they gain trust. Adam has built enough confidence in G4 and G5 that he ofttimes just tests ii times per 24-hour interval (one time in the morning and once at night). He tests more than oftentimes on day one 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 (spider web-based analysis software)

Highlights

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

• Makes CGM data more approachable, only allows for customization in the right places.

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

• "Best Glucose Day" written report.

Adam is addicted to Dexcom Clarity, the new web-based analysis software (free) that launched with G5 and as well works with the G4 receiver. If you lot're running the G5 app, CGM automatically posts to Clarity with a four-hour delay. Otherwise, you can download the PC and Mac compatible uploader, which sits in the background on your calculator, auto-detects the receiver within seconds, and uploads the data in ~20 seconds.

The web version of Clarity revolves around only 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 engagement range, though it defaults to two weeks and can't display more than 30 days of data at a time.

The "Overview" screen is a terrific one-page snapshot of central data – within 60 seconds you can respond, "Where am I having trouble?" This page shows an estimated A1c, average blood glucose, hypoglycemia gamble (low, medium, high), fourth dimension-in-range, calibrations per 24-hour interval, and any identified patterns.

"Patterns" gives a deeper dive on the times of mean solar day when glucose was consistently in a higher place or below target, and Clarity shows the days of CGM traces that make up a particular design. The software besides identifies your "best glucose twenty-four hours," a overnice focus on the underappreciated positive side of diabetes. This screen likewise gives "possible considerations" based on the pattern, but they are too generic to be actionable.

The "Data" page shows a single CGM graph with error confined to signal times of day with lots of variability. The use of color and the error bars makes it articulate what times of twenty-four hours are a problem. You lot can besides thumb through daily CGM traces, and Clarity volition add together "event" markers entered into G5, such every bit logged grams of carbs, exercise, and insulin doses. It's currently not easy enough for Adam to regularly add events, but maybe future app integrations will amend this experience.

"Compare" shows two periods of time side-by-side each other. This is useful to run into the impact a detail alter has had on your diabetes – east.g., eating lower carb for a week, exercising more than oft over ii weeks.

Dexcom does have a Clarity iPhone app, though information technology only allows viewing a PDF of the by 2 weeks of information, which will be absent unless you've uploaded the receiver or are using the G5 app. It would be nice if more Clarity functionality was bachelor in the iPhone app, though information technology is not a tremendous hassle to open the website. The Clarity app seems ideal as an on-the-go option for appointments with a provider.

Apple Health

The G5 app automatically posts information to Apple Wellness, allowing other diabetes apps like Glooko, Meal Retention, and One Drop to admission information technology (probably mySugr likewise 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 exercise, for deeper CGM analysis, for social networking, or annihilation else. That is the promise of Apple Health.

The one downside is G5 posts data to Apple Health with a iii-hour delay, meaning other apps cannot offer real-time benefits. This filibuster stems from how the FDA defines historical ("retrospective") data; perhaps it will subtract in the hereafter.

What Does it Cost?

The best respond is to talk to Dexcom, since insurance varies by company and plan. Most The states private insurance companies (east.g., United, Aetna, Humana, Anthem, Cigna) comprehend CGM, though requirements, co-insurance, and deductibles vary widely. Medicare does not cover personal CGM, only this will hopefully modify. Many European countries are now paying for CGM, but once more, it varies beyond the board.

If you don't accept insurance, CGM is expensive, probably running a few 1000 dollars per year.

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

We hope CGM gets less expensive over time, particularly if more patients can pay a pharmacy co-pay for sensors (similar to picking upward a drug).

Our G5 Wishlist

App

• Make it easier and faster to run across real-time CGM values and trends on the telephone: (i) add a Today widget; (ii) add smart watch compatibility; (iii) prove 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 picture of a meal instead of but manually logging the carbs in Events.

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

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

• Reduce the 3-hour time-delay to post data to Apple Health (this is an FDA issue).

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

Transmitter

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

• Increase betoken range.

• Reduce transmitter size and extend the battery life beyond three months.

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

Organisation

• Make 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 us it is actively working on these improvements, or is considering them for future products – most are not simple or they would have been done already!

What Is Adjacent for Dexcom?

• Android G5 – 2016

• FDA approving 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 twenty-four hours, with fewer expected over time)

• Smaller transmitters and a new receiver – In development

• Google/Dexcom disposable sensor – 2017-2018+

Final Thoughts

We're excited that the G5 has arrived – earlier than expected – and nosotros're obvious fans, unsurprising since we both started wearing CGM many years ago. Information technology's great to see how fast Dexcom is moving, a company with ambitious goals and strong leadership. Nosotros tin't wait to encounter what's adjacent!

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

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