Freestyle Libre 3

[Bruce Stephens]

If you can get a libre 2 prescription from your consultant, I would assume that changing your prescription later to the Libre 3 would be a logical progression

That was my assumption, but it seems it won't (in the UK) be so straightforward. I'm still not quite sure why.

(The reasoning given is that the cost will be different, that Libre 3 is priced to be competitive with other CGMs, but Abbott has (as far as I know) always said it'll be the same price. So that feels unconvincing to me though I haven't seen the UK pricing. I wonder if it's some semi-political choice connected with the need for a smartphone: if you offer it to everyone then only those with a suitable smartphone (or able to buy one) will be able to use it, so that'll skew in the obvious ways. If it's in a different category maybe it's easier to get away with that.)

 

[BadaBing]

I recall there was some grumbling from Abbott a couple of years ago, but the EU laws are on our side. Similar protection in the US.

"Perhaps surprisingly, this seems to be covered by the European Software Directive in article 6 which was implemented in member states years back, which allows for decompilation of the code by a licensed user in order to enable interoperability with another application (xDrip in this case)."

To make better software

"Legal issues aside, there is a larger point here. As the success of open source software over the last twenty years has shown, one of the richest stores of new ideas for a product is its user community. Companies that embrace that group are able to draw on what is effectively a global research and development effort. Abbott is not just wrong to bully people looking to derive greater benefit from its products by extending them in interesting ways, it is extremely stupid. It is throwing away the enthusiasm and creativity of the very people it should be supporting and working with as closely as it can."

Abbott Laboratories Sends Heavy-Handed Copyright Threat To Shut Down Diabetes Community Tool For Accessing Blood-Sugar Data

One of the most important recent developments in the world of diabetes has been the arrival of relatively low-cost continuous blood glucose monitors. These allow people with diabetes to take freque…

www.techdirt.com

I hear you. I really do hear you!

I will not rehearse the various defences to an intellectual property claim here as this is not the appropriate place to do so.

What I would say is that the law in this area in England is in a state of flux, particularly following the UK leaving the European Union on 31 January 2020.

English courts have never been bound to follow decisions made by US courts. At best they are only persuasive.

There are certainly perfectly good arguments that could be made on - either side - to persuade a judge.

Thankfully, 98% of the time it never gets that far.

I prefer to take the easy route and get a Libre 3, if possible.

 

[BadaBing]

Hi again @BadaBing,
I think the Libre is well worth a trial, if you haven't already taken advantage, 1 free sensor

Sampling | Diabetes Care | Abbott

Claim your 15 day free sensor if you have diabetes and have not tried the FreeStyle Libre 2 plus sensor before

sample.freestyle.abbott

If you can get a libre 2 prescription from your consultant, I would assume that changing your prescription later to the Libre 3 would be a logical progression

Thanks Benny G

I already use the Libre.

I would just prefer the Libre 3 - if possible - and without having to attach something else to it or download something else to make it be a cgm and not have to scan the sensor at least once every 8 hours (which one is required to do if one gets it on the NHS).

 

[BadaBing]

That was my assumption, but it seems it won't (in the UK) be so straightforward. I'm still not quite sure why.

(The reasoning given is that the cost will be different, that Libre 3 is priced to be competitive with other CGMs, but Abbott has (as far as I know) always said it'll be the same price. So that feels unconvincing to me though I haven't seen the UK pricing. I wonder if it's some semi-political choice connected with the need for a smartphone: if you offer it to everyone then only those with a suitable smartphone (or able to buy one) will be able to use it, so that'll skew in the obvious ways. If it's in a different category maybe it's easier to get away with that.)

You may be onto something here Bruce. Perhaps the Libre 3 has been priced in England to be competitive with other CGMs.

Of course over the last two or so years we were told that the Libre 3 price (if one bought it privately) would be the same as the Libre 1 and Libre 2. That appears to be the case for users in Germany.

Logically and commercially, at some stage Abbott are going to want to make the Libre 3 more widely available to UK diabetics (unless the NHS is paying them way over-the-odds per unit for the small(???) cohort who will get the product on the NHS).

If Abbott does sell eventually the Libre 3 privately, it doesn't make sense not to keep the price point the same as, or close to, the Libre 1 and Libre 2. Especially when Dexcom's upcoming G7 (which I understand will be available to buy privately) is being touted as closer in price to the Libre 1 and Libre 2.

Anyway, I guess I'll know more when I meet with my consultant later this year. In the meantime, if anyone else meets with their consultant and has "the conversation" it would be interesting to know.

 

[Bruce Stephens]

Especially when Dexcom's upcoming G7 (which I understand will be available to buy privately) is being touted as closer in price to the Libre 1 and Libre 2.

And there's already one or two that are similar to Libre 2 price, so maybe there'll be enough convergence in price that the survivors will end up all being available to anyone who wants one.

 

[Benny G]

I hear you. I really do hear you!

I will not rehearse the various defences to an intellectual property claim here as this is not the appropriate place to do so.

What I would say is that the law in this area in England is in a state of flux, particularly following the UK leaving the European Union on 31 January 2020.

English courts have never been bound to follow decisions made by US courts. At best they are only persuasive.

There are certainly perfectly good arguments that could be made on - either side - to persuade a judge.

Thankfully, 98% of the time it never gets that far.

I prefer to take the easy route and get a Libre 3, if possible.

That was my assumption, but it seems it won't (in the UK) be so straightforward. I'm still not quite sure why.

(The reasoning given is that the cost will be different, that Libre 3 is priced to be competitive with other CGMs, but Abbott has (as far as I know) always said it'll be the same price. So that feels unconvincing to me though I haven't seen the UK pricing. I wonder if it's some semi-political choice connected with the need for a smartphone: if you offer it to everyone then only those with a suitable smartphone (or able to buy one) will be able to use it, so that'll skew in the obvious ways. If it's in a different category maybe it's easier to get away with that.)

Thank you for the correction Bruce. It will be interesting to see how the CGM market progresses, it's very niche, but there are huge amounts of money to be made, so fingers crossed the politics can be put aside.

 

[Bruce Stephens]

so fingers crossed the politics can be put aside.

I'm guessing at the reasons for treating Libre 3 differently to Libre 2. It might be something else entirely. (Maybe it's as dumb as Abbott offering less of a good offer to the NHS for the Libre 3, for example.)

 

[BadaBing]

The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding

Sorry Lucy123, I didn't reply to you.

The NICE guidelines are - unfortunately - simply guidance and not law. The guidance uses words such as "should offer" rather than "must offer." So neither hospital trusts nor ccgs are compelled to do what the guidance says (although it is considered to be following best practice if they do so).

There is a first instance High Court decision (involving IVF treatment) where the judge decided it was wrong for a ccg to refuse to offer a lady IVF treatment as recommended by NICE guidelines in effect at the time.

Interestingly the ccg decided not to appeal the decision to the Court of Appeal or UK Supreme Court.

That judgement has made ccgs/hospital trusts conscious of the fact that they can be sued successfully in the courts by patients if they fail to adopt NICE guidelines for reasons which are considered "unreasonable" or "irrational" by Her Majesty's judges.

That said, there is rarely such a thing in litigation as a "sure thing/100% winnable" case, which is why 98% of cases are resolved out of court.

And the NHS has more money to spend on lawyers and litigation than most patients.

 

[Lily123]

Sorry Lucy123, I didn't reply to you.

The NICE guidelines are - unfortunately - simply guidance and not law. The guidance uses words such as "should offer" rather than "must offer." So neither hospital trusts nor ccgs are compelled to do what the guidance says (although it is considered to be following best practice if they do so).

There is a first instance High Court decision (involving IVF treatment) where the judge decided it was wrong for a ccg to refuse to offer a lady IVF treatment as recommended by NICE guidelines in effect at the time.

Interestingly the ccg decided not to appeal the decision to the Court of Appeal or UK Supreme Court.

That judgement has made ccgs/hospital trusts conscious of the fact that they can be sued successfully in the courts by patients if they fail to adopt NICE guidelines for reasons which are considered "unreasonable" or "irrational" by Her Majesty's judges.

That said, there is rarely such a thing in litigation as a "sure thing/100% winnable" case, which is why 98% of cases are resolved out of court.

And the NHS has more money to spend on lawyers and litigation than most patients.

I should have phrased my answer better and that many CCGs would want to inforce the NICE guidelines as mandatory rather than optional

 

[trophywench]

I should have phrased my answer better and that many CCGs would want to inforce the NICE guidelines as mandatory rather than optional

Nah @Lily123 - CCGs pick and choose which ones they treat as Gospel and which they ignore. If it will save them money - they follow it PDQ. Otherwise depends which side of the bed they got out of .....

 

[Lily123]

Nah @Lily123 - CCGs pick and choose which ones they treat as Gospel and which they ignore. If it will save them money - they follow it PDQ. Otherwise depends which side of the bed they got out of .....

I’m definitely too hopeful for CCGs…..

 

[BadaBing]

I’m definitely too hopeful for CCGs…..

Yes, but to be fair, ccgs and hospital trusts only do what the HM Department of Health - and in reality HM Treasury - direct them to do.

 

[helli]

Yes, but to be fair, ccgs and hospital trusts only do what the HM Department of Health - and in reality HM Treasury - direct them to do.

My understanding is they are in charge of their own budget within certain guidelines. The fact healthcare is a postcode lottery is proof to me that each CCG has some control over where they spend the money the Treasury gives them.

 

[Paulbreen]

Wow, there seems to be quite a fuss with the Libre3, as a user of this device i can point out a few things regarding the L3 compared to the L1 & L2,
Size about 50% of the L1 &L2
Packaging 50%, maybe a little more less
Scanning no longer required, L3 transmits to your phone every 5 minutes, phone takes care of informing you of possible alarms.
It's not much different to the other 2 but the last point about no scanning is its most positive point and improvement.
For those who dont have access to a smart phone or dont want a smart phone then its no good for you as it only works with an app.
At the moment its not compatible with any pumps so it's not much use as an integrated CGM.

 

[rebrascora]

I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does
It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!

 

[BadaBing]

Wow, there seems to be quite a fuss with the Libre3, as a user of this device i can point out a few things regarding the L3 compared to the L1 & L2,
Size about 50% of the L1 &L2
Packaging 50%, maybe a little more less
Scanning no longer required, L3 transmits to your phone every 5 minutes, phone takes care of informing you of possible alarms.
It's not much different to the other 2 but the last point about no scanning is its most positive point and improvement.
For those who dont have access to a smart phone or dont want a smart phone then its no good for you as it only works with an app.
At the moment its not compatible with any pumps so it's not much use as an integrated CGM.

Thanks Paul

I understand you are based in Germany. Is that right?

The information you have given is very helpful indeed.

As I said when I started this thread, I want to get a sense of just how much of a gatekeeper function hospital trusts in England are going to operate in terms of allowing diabetics living in England to access real time cgms now the NICE eligibility criteria have been updated.

 

[Robin]

I guess this is proof that I am becoming an old fogey!

You and me both, then. I find the reader much more manegeable especially on a horse! My phone won’t do facial recognition when i’ve got a riding hat on, I can’t take gloves off to do a fingerprint, or both hands off the reins to type in a code, so apart from the phone being too big and cumbersome (I’d end up dropping it in a puddle) even just looking at it is a non starter. I can fish the reader out of my breast pocket and swipe with one gloved hand.

 

[BadaBing]

I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does
It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!

Hello rebrascora

Thanks. It's a big deal for me is all I'll say. It is also inappropriate and/or inconvenient to do so during certain moments of the day from a work perspective.

I have found some civilians (non-diabetics) remain uncomfortable about what the rest of us have to do to try and stay healthy.

 

[helli]

I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does
It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!

It sounds to me it‘s about your (or my) lifestyle.
I work at a desk with my mobile as my only phone. It is far far easier and far less intrusive to glance at my phone lockscreen whilst I am on a video call (or in a face to face meeting) than to scan my arm.
i don’t want to be “the woman with diabetes” which having to scan identifies me as. As I use my phone and CGM/Libre, I could be glancing at an email or a text or a WhatsApp message which are all things that are completely normal in my business.
My pump is also controlled via my phone so everything is in one place. I can have a lunch meeting without anyone knowing I am checking my levels or dosing my insulin. They probably think I am responding to an urgent email.

When not at work, I use my phone to listen to podcasts or navigate whilst walking as well as checking the news and keeping in contact with friends and family. My phone lives in my leggings’ or jeans pocket. Not at the bottom of my bag. I try to avoid taking a bag out with me.

 

[BadaBing]

There is an international conference taking place in Barcelona this weekend about diabetes and technology. Some of the attendees at that conference have tweeted slides of presentations given about the Libre 3. One of the slides I have seen tweeted suggests that the MARD of the Libre 3 is now 7.8%.

I always understood the MARD of the Libre 3 was going to be the same as the Libre 2 (9.2%).

I have no idea whether the claim of a 7.8% MARD is real, but if it is that is yet another reason I would prefer the Libre 3. It's about using the latest tools available to try and stay as healthy as possible for as long as possible.