I just saw this report about the Freestyle Libre system. If you’re not familiar, the Libre system is a round sensor worn on the back of the upper arm for up to 14 days, which measures glucose every minute in interstitial fluid through a small filament that is inserted just under the skin (just like a CGM). The difference between a CGM and the Libre system is that the user has to scan a reader over the sensor to get a glucose reading (with no additional pricks).
The study was conducted and published by the makers of the device. But here’s some more on what they did:
The real-world data findings were presented today at the Advanced Technologies and Treatment for Diabetes (ATTD) congress in Paris. The data show a strong link between real-world use of FreeStyle Libre system and glucose control. The full data set was generated from 50,831 readers, which were used to scan 279,446 sensors. This constituted 409.4 million glucose measurements, 86.4 million monitoring hours and 63.8 million scans – representing more than 50,000 FreeStyle Libre users across the Europe region.
I think that the results aren’t really surprising. And maybe this is one of those studies that just has to be done to prove what most people would assume to be true.
Key findings of the real-world data of the FreeStyle Libre system: More scanning: Users checked their glucose levels an average of 16.3 scans per day
Across the spectrum of scan rates seen in the population, the following trends were observed as scan rates increased: Improved HbA1c: Average glucose level decreased as scan rate increased with estimated HbA1c decreasing from 8.0 to 6.7 percent Reduction in hypoglycemia: Time spent below glucose levels of 70, 55 and 45 mg/dL decreased by 15 percent, 40 percent and 49 percent Reduction in hyperglycemia: Time above 180 mg/dL decreased from 10.5 to 5.9 hours per day Increased time in range: Time in glucose range (70-180 mg/dL) increased from 12.0 to 16.8 hours per day
So the published report (which you can see on the Abbott website) says that people check their glucose with traditional self-monitoring methods (finger pricks) less than three times per day on average. And Freestyle Libre users check their glucose more than 16 times per day on average.
My assumption is that CGM technology and the FreeStyle Libre system (which isn’t quite CGM but certainly gives a user more data than finger pricks) is good for people managing diabetes. And therefore should be available and used by every single person diagnosed with diabetes. But when I assume stuff, I’m usually forgetting someone else’s perspective. So…are there reasons that don’t include financial burden or insurance/coverage/access that make you believe that CGM/Libre technology wouldn’t be helpful? What are the reasons other than coverage/access that have stopped you from using this technology?
PS: The FreeStyle Libre system is under review by the FDA in the US.
I have always been a person wth diabetes who checked blood sugar more often than my peers. I’ve often wondered about this. I think the main reason might be that knowing the number implies a responsibility to do something about it. This is where a good foundation of diabetes education could equip more people to know how to respond well to an out-of-range blood glucose number.
For me it just seems natural to want to do something with an out of range blood glucose. I can take a corrective insulin dose, go for a walk, or eat something if I’m low.
I believe a large percentage of people do not want to change how they live, especially how they eat. They want to do the minimum for their diabetes treatment and then get on with living their “real life.” They have not fully accepted the fact of their diabetes. This may be because they don’t think there’s anything they can do about it. They feel they are either doomed to progress to a worse outcome or they may be lucky and not be burdened with complications. Either way, they think that their choices will not make a material difference.
I know that medical professionals struggle with trying to motivate their diabetes patients to take action to promote better health. I sense this in my regular appointments when I show up, a fully engaged patient, with a boatload of data and most of it is good. I sense that the doctors are pleased with my attitude and it contrasts markedly with many of the clinician’s other patients.
You are right. The “reader” (which is what they are calling what I think would be similar to the “receiver” on the Dexcom) only displays a BG when it’s waved over the device. Unlike a CGM it is not constantly sending your BGs to a screen for you to see. It’s sort of like a half-step between finger pricks and CGM.
There is no alarm but I believe people have hacked together a system that will upload data to NightScout and allow it to issue alarms, which seems like it would be critical for us parents.
I know a lot of families in Europe that have been using it for a while now and are very happy with it. We have family in Chile and Spain and have been tempted to get one, but there is something that doesn’t convince me still.
I have been using the Libre in Canada (shipped here by a German friend) for nearly two years now. My A1C (and more importantly the variability of glucose levels) is down, my hypoglycemic events are down, and I am not bleeding five times a day to feed the insatiable blood-sucking metres. Rather, I am testing up to 40 times a day with no more than a wave of the reader over my arm. The Libre costs (50 Euros) more than the bloodstrips (which are covered by insurance here and the Libre is not) but a lot less than a CGM. The sensor works for 14 days; the reader goes for weeks on a charge (USB charging once or twice a month) and is readable in daylight (never had a pump or metre that was).
Your question was whether the technology is right for everyone. The answer is NO.
The reader only reads the sensor when you pass it over the sensor. You have to be aware of your glucose changes and want to be involved in managing your glucose levels. Personally I find this preferable to relying on equipment, technology and algorithms which never quite fit my needs. The high demand for the Libre in Europe speaks well for it - no insurance coverage there either. When I show it to others with diabetes, the major question they ask is “where can I get one?”
I am now on my 43th Libre Sensor. Before the Libre I have used the Navigator with 3 sensors. Some of you might already know that I do MDI. Most of my injections and carbs are documented in my Glucosurfer project. From time to time I will upload the Libre data to my project too. This way Libre and conventional data will be combined to get the full picture. For the Libre this data processing is also important because the Libre Reader will just remember the last 3 months. As a result you can get an overview of a whole year in retrospective. One day is the small vertical stripe from top to bottom. The blood glucose is expressed in colors (low = blue, healthy = green, yellow = 140 to 199, red = above 200):
The most benefitial analysis to me is the Ambulatory Glucose Profile of the last 30 days. Here mayor problems in “Carbs per Insulin”, Carb counting and Basal coverage can be identified more easily. It is a nice graph to bring with you for every Endo session:
One huge relief with the Libre is the absence of any alarms. This might sound strange but this gives me much more responsibility - in a good way. Better outsmart and fix the problem than being forced to react is my motto here. I can imagine that people with anxiety might be driven mad by the Dexcom. And - even better - you have the choice because companies like ambrosiasys.com have developed a little addon called BlueCon that will translate the Libre data to bluetooth, making the Libre in combination with your iPhone a full fletched CGMS. All that for a much lower price (half of the Dexcom prices if I recall that correcly).
Look again at the one year in retrospective: I kept my A1c at 6% (as before the Libre) and I made all my dosage decisions based on the Libre! This is not recommended but after using the Libre for some months in 2015 I made this step of faith. For me being 30 years in this business it might have been easier. I know that meters show big differences from the real blood glucose and I know the Libre will do that too. But coming from times where I made dosage decisions based on stripes with color scales this is all quite golden to me.
Still the Libre and any other Monitoring devices are pretty useless if people are not willing or have not the necessary skills to be in control of their diabetes. These devices will give you all the numbers but you have the responsibility to learn something from the data, to make adjustments and to verify the effectiveness of these adjustments. This constant willingness to adjust is key and prerequesite to any success / improvement / trend reversal. No Endo will do that for you.
You’re so right about this. I realize that those of us that participate here and other places online in diabetes forums are a small subset of all people with diabetes. The single largest factor of diabetes success is the person with diabetes. Their knowledge, motivation, and persistence count for much more than any technology.
I like the colorful one-year snapshot of your BGs!
Terry-
I agree the big problem is the PWD who do what is needed to manage their diabetes are a rare breed especially in the eyes of the medical professionals. I think it is very rare for them to see people engaged and willing to do whatever it takes to live a happy healthy live. Which is why some of us have such a hard time with some doctors because they want to put is into those “standard” groups. And those of us who continue to do whatever we can, we have to now fight the battle during office visits when our goals don’t match the standards.
And while I think everyone should have the options to use this “new” technology, I think many don’t want the constant reminder that things are not going well. This disease is one that beat you up if you take every number as a failure. And while I know you don’t, they are a number to help you fix, correct analyze what is happening. But many can’t get beyond that number that screams “what did you do wrong this time?” Such a mental game we play with our diabetes.
You’re right, @Sally7. I think it’s easy to slip into the mindset that whatever piece of personal health data you look at, it’s easy to see it as a judgment on your personal value. I have diabetes. I recognize that that cold reality means I will not always be in a good blood glucose range, no matter how hard I try.
The important thing is to not let it wear you down so that you lose hope and stop trying. My philosophy is to look at out-of-range BG numbers like signposts that point to a direction to take. When I see good numbers, however, I take all the credit!
As far as doctors go, they like my results but I suspect they don’t fully understand my tactics and would likely disagree with many of them. I don’t mind that. I live with the results of every diabetes decision I make. I don’t necessarily put a lot of weight in any medical professional’s opinion of my tactics. I do listen but I don’t always concur.
Should all PWD use a Libre or CGM? Let’s go back 40 years when the first home blood glucose meter was introduced and ask: Should all PWD use a blood glucose meter?
Some questions answer themselves, and the intransigence of the insurance industry remains the same.
My wife and my 5 year old daughter are using it over one year now, and it’s much easier living. Also using sony smartwatch 3 as an cgm overnight for alarms, and I’m finally sleeping. ambrosiasys.com looks like there are tring to sell idea, not the product itself.
