Freestyle Libre V3

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icowden

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Type 1
Hi all,

I am currently fighting Surrey Heartlands CCG to get them to remove their fingers from their posteriors and allow upgrades to the LIbre V3 in accordance with NICE Guidelines.

Has anyone managed to get old of a V3 yet, and if so, how do you think it compares? We have just purchased a Dexcom G7 to try as my daughter finds the Libre V2 painful to put on. I'm curious as to whether the V3 is better?
 
workaway32 said:
I'm not sure the Libre 3 is part of NICE guidelines is it? I thought it was the Libre 2 or the Dexcom One. I have managed to approved for the Dexcom one but do not have it yet. After reading this: https://diabetes.gifts/dexcom-one-vs-libre-2/ I was persuaded to give the Dexcom One a try.
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Libre 3 is a CGM just as Libre 2 is. It has been approved by the NHS and is available on prescription. It costs no more than the Libre 2 but has better clinical outcomes.

I had missed that Libre 2 is CGM as I don't tend to view it as such as it requires manual use all of the time (you have to keep manually scanning).

I just don't get the delay given that it costs no more than Libre 2, but is smaller, hopefully less painful to apply and has better clinical outcomes.

10 days on the Dexcom G7 has shown us just how useful this tech is in controlling my daughters levels. She also likes that it is smaller (she is 14 so appearance matters) and doesn't hurt as much to put on. We used to have good results using the Libre v1 and the Miao Miao, but she didn't like how bulky it was (anyone want a Miao Miao?).

What is most frustrating is that in other CCGs the Libre V3 has been approved.
 
icowden said:
Libre 3 is a CGM just as Libre 2 is. It has been approved by the NHS and is available on prescription. It costs no more than the Libre 2 but has better clinical outcomes.

I had missed that Libre 2 is CGM as I don't tend to view it as such as it requires manual use all of the time (you have to keep manually scanning).

I just don't get the delay given that it costs no more than Libre 2, but is smaller, hopefully less painful to apply and has better clinical outcomes.

10 days on the Dexcom G7 has shown us just how useful this tech is in controlling my daughters levels. She also likes that it is smaller (she is 14 so appearance matters) and doesn't hurt as much to put on. We used to have good results using the Libre v1 and the Miao Miao, but she didn't like how bulky it was (anyone want a Miao Miao?).

What is most frustrating is that in other CCGs the Libre V3 has been approved.
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I asked re libre 3 and it didn't seem to be an option in my area, unlike dexcom 6. Libre seems more accurate even that dexcom
 
Tdm said:
I asked re libre 3 and it didn't seem to be an option in my area, unlike dexcom 6. Libre seems more accurate even that dexcom
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That is, the libre 3 is more accurate than dexcom 6
 
Certainly our experience with Dexcom G7 vs LIbre 2 is that the Dexcom tends to swing more wildly at the top end. The libre tends to be within 2 mmol of a finger prick, whereas the Dexcom has been as far out as 5 or 6 above.
 
Not sure that's right, at least in general. There's a graphic on this thread https://forum.diabetes.org.uk/boards/threads/cgm-availablity.101836/ where Partha Kar - one of the NHS diabetes leads - tweeted a summary of what was available (back in August) and Libre 3 wasn't on the list then.

This site - https://www.abbott.co.uk/media-cent...mallest-and-thinnest-sensor-in-the-world.html - does say "The FreeStyle Libre 3 system is available via the NHS Supply Chain Framework for people with more complex diabetes management needs who require a real-time CGM device. For example, those with impaired hypoglycaemia awareness." Are you thinking your daughter could qualify under that guideline?
 
icowden said:
Libre 3 is a CGM just as Libre 2 is. It has been approved by the NHS and is available on prescription. It costs no more than the Libre 2 but has better clinical outcomes.

I had missed that Libre 2 is CGM as I don't tend to view it as such as it requires manual use all of the time (you have to keep manually scanning).

I just don't get the delay given that it costs no more than Libre 2, but is smaller, hopefully less painful to apply and has better clinical outcomes.

10 days on the Dexcom G7 has shown us just how useful this tech is in controlling my daughters levels. She also likes that it is smaller (she is 14 so appearance matters) and doesn't hurt as much to put on. We used to have good results using the Libre v1 and the Miao Miao, but she didn't like how bulky it was (anyone want a Miao Miao?).

What is most frustrating is that in other CCGs the Libre V3 has been approved.
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If the G7 is going well, is it worth changing the fight to get a Dexcom One? Its basically the same as the G7 but should be generally available on the NHS.
 
workaway32 said:
If the G7 is going well, is it worth changing the fight to get a Dexcom One? Its basically the same as the G7 but should be generally available on the NHS.
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Not really. I don't understand why the Dexcom One should be approved and not the G7. Again, they are the same cost. The difference is that the G7 is smaller and better, with improved clinical outcomes. There is no point moving to an inferior product.

The LIbre 2 is good, but the Libre 3 is better. We should be using the newest tech not having to wait for years whilst some group sits around picking their noses. If there is no additional cost, it is a no brainer. Why would you not get the latest product?
 
Rob Oldfield said:
This site - https://www.abbott.co.uk/media-cent...mallest-and-thinnest-sensor-in-the-world.html - does say "The FreeStyle Libre 3 system is available via the NHS Supply Chain Framework for people with more complex diabetes management needs who require a real-time CGM device. For example, those with impaired hypoglycaemia awareness." Are you thinking your daughter could qualify under that guideline?
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Yes. But mostly I am thinking that this is a better, smaller device with improved clinical items and which costs no more than the Libre 2. Given that this is the case, why is it *not* available as an upgrade?
 
icowden said:
Not really. I don't understand why the Dexcom One should be approved and not the G7. Again, they are the same cost. The difference is that the G7 is smaller and better, with improved clinical outcomes. There is no point moving to an inferior product.

The LIbre 2 is good, but the Libre 3 is better. We should be using the newest tech not having to wait for years whilst some group sits around picking their noses. If there is no additional cost, it is a no brainer. Why would you not get the latest product?
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Where are you getting your information they are the same cost? The G7 is not the same cost as the dexcom one; it was manufactured to be cheaper by not integrating with pumps. Not sure on Libre 3, I can’t find any price information so please do share
 
workaway32 said:
Not sure on Libre 3, I can’t find any price information so please do share
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Abbott repeatedly announced (before it was released) it would be the same price as Libre 2, and it's the same price in a few countries where it is sold (that we know about). I do wonder if the NHS has a particularly good deal on the Libre 2 which they failed to get with Libre 3, but my guess is that having Libre 3 in the hospital-only group is an awkward combination of things and is more accident than anything.
 
I think we can be 99.99% certain the NHS is paying Abbott more for the Libre 3 than the Libre 2. That's why the Libre 3 has been lumped in with insulin pumps in England.

It also seems fairly clear the NHS always intended to roll out the Libre 3 and Dexcom G7 as component parts of hybrid closed loops/automated insulin delivery systems/artificial pancreas systems, which the NHS intends to announce in February/March/April 2023 after NICE decrees hybrid closed loops are beneficial in keeping T1s' glucose in range, lead to less hypos and reduce the risk of long term complications.

Of course The integrated care systems/integrated care boards (former CCGs) will do everything they can to stymie any roll out of hybrid closed loops to save money.

The insulin pump manufacturers and Libre 3 and Dexcom G7 manufacturers now need to jump through the medical device regulatory hoops in each country to prove that their products will work together and, most importantly, are safe to use as a hybrid closed loop, etc.

But I agree, the Libre 3 ought to be available on prescription and to buy, just as it is in Germany and other EU countries.
 
icowden said:
Yes. But mostly I am thinking that this is a better, smaller device with improved clinical items and which costs no more than the Libre 2. Given that this is the case, why is it *not* available as an upgrade?
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I have read elsewhere that the Libre 3 is less expensive to make than the Libre 2. And yes, the Libre 3 is a miniaturised version of the Libre 2.

However, both the NHS and Abbott have made it crystal clear in press announcements issued earlier this year that the Libre 3 is  not an upgrade for the Libre 2. Indeed, Abbott have said at the moment in the UK the Libre 3 will only be available for more "complex" [Abbott's word] forms of diabetes.

It is obvious the NHS intend to provide the Libre 3 as part of an automated insulin delivery system (aka hybrid closed loop or artificial pancreas) to those T1s who the NHS decide are eligible (which I suspect will be a vanishingly small number of T1s).

That is why at the moment the Libre 3 is not widely available in England, and cannot be prescribed routinely by a GP.
 
BadaBing said:
It is obvious the NHS intend to provide the Libre 3 as part of an automated insulin delivery system (aka hybrid closed loop or artificial pancreas) to those T1s who the NHS decide are eligible (which I suspect will be a vanishingly small number of T1s).
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I think I'm more optimistic than that. My guess is it'll (initially) roughly match the criteria for pumps. Maybe it'll exclude a small number of people who qualify for a pump but I'd guess not. So I'm imagining that anyone who's offered a pump is offered it in the context of a closed loop (though I guess that might not be practical immediately, so might be phased in as staff get experience to support such usage).
 
Bruce Stephens said:
I think I'm more optimistic than that. My guess is it'll (initially) roughly match the criteria for pumps. Maybe it'll exclude a small number of people who qualify for a pump but I'd guess not. So I'm imagining that anyone who's offered a pump is offered it in the context of a closed loop (though I guess that might not be practical immediately, so might be phased in as staff get experience to support such usage).
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I hope you're right. According to something I read elsewhere apparently it is more expensive for Abbott to make the Libre 2 than it is the Libre 3. If true, it makes commercial sense for Abbott to move people over to the Libre 3, like they have in Germany.

I just hope the high/low glucose alarms work more often on the Libre 3 than they do on the Libre 2. Am having issues at the moment not receiving high/low Libre 2 alarms on Librelink app and now my Libre 2 Reader. And I'm conscious the Libre 3 is essentially a miniaturised version of the Libre 2.
 
BadaBing said:
According to something I read elsewhere apparently it is more expensive for Abbott to make the Libre 2 than it is the Libre 3. If true, it makes commercial sense for Abbott to move people over to the Libre 3, like they have in Germany.
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It's possible there's some special deal in the UK where the NHS pays a little more in exchange for having support for its use in looping which might also partly explain why they're not selling it direct to consumers.

(I must admit I prefer an explanation more towards the accidental: the NHS wanted to limit use of Libre 3 because it's a bit more complex to support, but then Dexcom came up with Dexcom ONE and there were also these other two CGMs at a similar cost, so Libre 3 is in the wrong place but it's too late to move it.)
BadaBing said:
Am having issues at the moment not receiving high/low Libre 2 alarms on Librelink app and now my Libre 2 Reader.
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If you're using an Android phone I can recommend trying Juggluco. (Can run alongside LibreLink. Just turn off the alarms in that and set them in Juggluco.)
 
Bruce Stephens said:
If you're using an Android phone I can recommend trying Juggluco. (Can run alongside LibreLink. Just turn off the alarms in that and set them in Juggluco.)
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Because of my job I don't use third party apps that haven't been scrutinised, authorised and licensed by official government medical device regulators, such as the MHRA, nor authorised officially by any of the manufacturers of the various cgms or flashgms.

Abbott need to make their Librelink software and Libre 2 Reader do what the MHRA has granted them a licence to make available their Librelink software and Libre 2 Reader to UK patients to do - provide high and/or low glucose alarms when the Librelink app or Libre 2 Reader are used normally in accordance with the user instructions.

At the moment it looks like my issues with my Libre 2 Reader were caused by putting on 4 successive faulty Libre 2 sensors.

Just read elsewhere someone recount that they failed to receive an alarm from Librelink on their phone and woke up to paramedics treating them for severe hypoglycaemia!

Is the NHS doing anything to encourage Abbott to fix the issues? Including significantly increased numbers of faulty Libre 2 sensors compared to Libre 1?
 
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I suspect the NHS don't know as people report to Abbott, you could report your self to the MHRA yourself by reporting via the Yellow Card eprting.
 
grovesy said:
I suspect the NHS don't know as people report to Abbott, you could report your self to the MHRA yourself by reporting via the Yellow Card eprting.
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I'm happy to be corrected if I'm wrong, but I don't believe I can report my difficulties to the MHRA under the MHRA's Yellow Card Scheme because my understanding is I have not - so far - had an "adverse effect," such as severe hypoglycaemia that needed the assistance of someone else to treat it. My understanding is that the MHRA only seem to be interested in serious, catastrophic (or near catastrophic) events.

I have reported verbally and in writing to my diabetes clinicians the difficulties I have had with Freestyle Librelink with no high/low glucose alarms on my mobile over the last two months.

I hope others have done so too.

Of course, I have no idea whether my clinicians will report my concerns to NHS England, nor whether NHS England will actually do anything.
 
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