The good news is that our technology options for diabetes management are expanding every day. But the bad (?) news is that now you have to decide which ones work best for you. We take a deep dive into the new Freestyle Libre flash glucose monitoring system to help you make up your mind.
Should You Use a Freestyle Libre system?
With the Freestyle Libre system approved for use in the United States, many stateside PWD are looking at Libre as new tool to improve their diabetes management. But what exactly is the Freestyle Libre system, and how will you know if it’s a good fit for you? We talked with a few seasoned Libre users to get a feel for their experiences with the flash glucose monitor.
How does the Freestyle Libre work?
The Freestyle Libre is a flash glucose monitoring system that includes a sensor worn on the back of the upper arm and a handheld reader. The sensor uses a thin filament that’s inserted underneath the skin to measure glucose levels every minute. The handheld reader is used to scan the sensor, replacing routine finger sticks. Recently approved for use in the United States, the Libre has been available internationally for several months.
Key differences between the US version and the international version are that the US version has a 10 day sensor life, a 12 hour queuing up period for the reader, and requires a prescription, while the international version has a 14 day sensor life, a 1 hour warm-up after insertion, and does not require a prescription. Also, the Libre sensors cannot be “re-started,” meaning that it has a hard-stop after 10 or 14 days (depending on which system you’re using), while the Dexcom and Medtronic CGM sensors can be re-started after expiration.
So what do people actually using the Freestyle Libre think?
Scully Brown, a Canadian PWD diagnosed with type 1 diabetes at the age of 22, has used both the Libre flash glucose monitoring system and both available CGM models (Dexcom and Medtronic). “[The Libre] is super easy to insert, super low profile, and [produced] no adhesive problems for me. Happy that it’s meant to be worn for a full two weeks. It’s very easy to use.”
Another fellow Canadian agreed: “Insertion is easy-peasy and not intimidating for those new to medical devices, and there’s no need for calibration although of course I do still check my blood sometimes to compare numbers,” said Michelle Sorensen, who was diagnosed with type 1 diabetes in 1999 and is also a health care professional. “Cost is a huge pro, too. For someone like me paying out of pocket, the start up in Canadian dollars is $50 for the meter and then $89 per two week sensor. Because of this, plans that wouldn’t cover the CGM are covering this flash technology.”
But there are drawbacks, as with any device. “I’m not a fan of carrying around the reader/meter, and you can’t re-start it,” shared Scully. “And only a couple insurance companies are providing coverage, but that’s better than none.”
Michelle added, “I have heard some people say they don’t want to remember to test, they want alarms to remind them when to worry about diabetes. I see that point of view as being true for a number of people. But for me, it’s not a problem because, for better or worse, I rarely forget about my glucose or diabetes for long so it’s not a problem to grab the meter and quickly flash it across the sensor.”
Is the Freestyle Libre a continuous glucose monitor?
This is a tricky question. According to the Freestyle Libre website (US version), the Libre is a “continuous glucose monitoring (CGM) device indicated for replacing blood glucose testing and detecting trends and tracking patterns aiding in the detection of episodes of hyperglycemia and hypoglycemia, facilitating both acute and long-term therapy adjustments in persons (age 18 and older) with diabetes.” But the Canadian version of their website states, “The FreeStyle Libre flash glucose monitoring system is indicated for measuring interstitial fluid glucose levels in adults aged 18 years and older who have at least 2 years of experience in self-managing their diabetes.” No mention of being a continuous glucose monitor.
Classification matters in terms of insurance coverage, with the Libre covered by insurers outside of the US but coverage within the States still being under review.
The Libre is classified as a ‘flash glucouse monitoring system,’ which differs from the continuous glucose monitoring system,” shared PWD Alanna Shockley, a Canadian with type 1 diabetes who received 100% coverage for her Freestyle Libre system. “Health Canada states that the CGM provides constant monitoring with no extra involvement from the user, where the Libre is user directed monitoring showing a brief history of trends. Since it is not continuous it isn’t classified by this particular insurance company as a CGM and falls under the blood glucose monitoring requirements.”
“It’s not a simple matter of classification. It’s really important to understand that the Freestyle Libre system is not a continuous glucose monitor,” said Michael Park, another Canadian PWD. “Rather, it’s an interstitial fluid glucose monitor that automatically records numbers every minute, as well as every time you check in. I understand that many people are addicted to the constant monitoring from the CGM devices, but we need to remember that the vast majority of diabetics don’t have access to that technology, nor the resources to control their sugars at that level of minutia. Acknowledging that this is a step up from a glucose meter, it really is an incredible step! Comparing 96 test results per day to the recommended four glucose checks by insurance companies, this really is an amazing system.”
In the US, we’re hopeful that full reimbursement for Libre will be approved, seeing as how the Libre System is marketed as a replacement therapy for finger sticks for making treatment decisions. Only time will tell.
But what about alarms?
“I do miss night alarms for peace of mind when my levels are unstable or unpredictable. But the years with my Dexcom helped me gain better control of nights so I am safer now. If I set my alarm for middle of the night, it’s easy to grab my Libre and flash it over my arm and read the meter, which lights up,” shared Michelle.
Scully agreed, stating that the alarms are what keeps her preferring Dexcom. “It does not alarm or alert [independently] when BG isn’t in range. This is a number one issue for myself, as a person with type 1 diabetes.”
But not everyone found the lack of alarms that alarming. “Being able to get that amount of information from a device that doesn’t yell at me is a truly loving and helpful innovation in diabetes management,” said Michael Park.
How do I decide which to use?
There are a lot of points to consider, but for most, insurance coverage is the deciding factor. Outside the US, Libre is fully or partially covered by most insurance companies, while traditional CGMs may not receive coverage at all, leaving patients paying costs out of their pocket.
But once cost/payment is secured, people with diabetes have several points to consider. Do you feel that you need a CGM that alarms when you go above or below thresholds? Does ease of insertion and wearability matter most? Are you okay with carrying another device or do you need your devices pared down to the minimum number? Are you negotiating adhesive allergies?
To make a final decision, try and get your hands on these devices. See which one looks most easily integrated into your lifestyle. Consult with the companies to see if you can wear a sample product to test wearability or skin reaction. And check in with people who have worn one, or both, systems. Real life experience and feedback from peers might be exactly the information you need, along with your health care provider’s advice, to make an informed decision.