Beginning today, anyone can use the twiist insulin pump and Eversense 365 CGM in tandem to automate insulin delivery. I spoke with both manufacturers, Sequel Med Tech and Senseonics, about the new integration and got all the details—so here’s what I learned, and what stands out to me.

Eversense 365 is now the first and only implantable CGM to work with an automated insulin delivery (AID) system. The one-year sensor is implanted into a person’s arm during a short, roughly 10-minute procedure, and requires an external transmitter worn on the skin to send glucose readings to twiist. Users can remove the transmitter whenever they want, but readings won’t come through while it’s off and they wont backdate when the transmitter is put back on.

Eversense introduces a few new, and some exciting, intricacies to an AID system. One of the most notable is its on-body vibration alerts, which can be customized directly in the Eversense app. For example, when a user has a low glucose, the sensor will subtly vibrate nine times to alert them to the low. When I reviewed the twiist pump, I found the audible alarms distracting and turned them off entirely. With Eversense 365, users can silence alerts on twiist while still getting discreet vibration alerts from the transmitter. Urgent low alerts, however, are required to remain active on both systems for safety.

Unlike twiist’s other compatible CGM, the Libre 3 Plus, Eversense 365 enables two-way communication from the sensor to both the pump and a phone. This allows users to view insights and adjust settings directly from the Eversense app and have the flexibility to be away from their phone and not lose automation. For those who use Nightscout, it also opens the door to tracking CGM data on third-party devices—something I wasn’t able to get working using Libre 3 Plus.

Eversense 365 does require one calibration per week to maintain accuracy. Users have seven days, plus a 24-hour grace period, to enter a blood glucose reading. If they don’t calibrate in time, the twiist pump will show a “signal loss” message until calibration is completed. I don’t imagine this will be a major issue—Eversense says users can calibrate as often as they want, and each calibration resets the weekly timer.

Personally, I’m eager to see how this integration performs, and I want to try it myself. Users report stronger accuracy, fewer compression lows, and a more stable connection overall. I’m especially intrigued by the idea of eliminating wonky day-one performance I experience with traditional CGMs.

Eversense 365 is currently available in the U.S. and recently received CE Mark approval in Europe, with an initial rollout planned for Germany, Italy, Spain, and Sweden in the coming months. For now, twiist remains U.S.-only, with no official timeline for international availability, but hopefully that changes soon.

Looking ahead, Eversense is developing two next-generation systems. The first, Gemini, would add a battery to the implanted sensor, allowing it to continue tracking glucose for up to eight hours without the external transmitter. Gemini’s target audience would be for people with type 2 diabetes. The second, Freedom, would integrate Bluetooth directly into the sensor implant—eliminating the need for any external transmitter entirely.

It’s an exciting time for implantable diabetes tech. Glucotrack is also working on an implantable sensor that would last up to three years and test directly from the blood. Portal Diabetes is working on an implantable insulin pump that recently received Breakthrough Device Designation from the FDA.

What are your thoughts on Eversense 365—would you use it now that it connects to an AID system? And how do you feel about implantable diabetes tech? Share your thoughts in the comments below.

Disclaimer: Diabetech content is not medical advice—it’s for educational purposes only. Always consult with a physician before making changes to your healthcare.