Abbott’s FreeStyle Libre Pro – Positive Feedback from Patients and Providers
By Ava Runge
Ease, comfort, and actionable patterns, but some challenges with insurance coverage
Approved and launched in the USA last fall, Abbott’s FreeStyle Libre Pro is a blinded (non-real-time) professional continuous glucose monitoring (CGM) system. It enables healthcare providers to place a small round sensor on the upper back of the arm of a person with diabetes, and following two weeks of wear, use a reader device in the office to download 14 days of glucose data. While wearing the sensor at home, users do not need to enter any fingerstick data or carry around a receiver – the Libre Pro collects all glucose data automatically, measured once every 15 minutes. After the sensor’s data is downloaded in the office, healthcare providers receive a visual report (called an “Ambulatory Glucose Profile”) that shows trends and patterns in glucose levels, time-in-range, average glucose, high and low blood sugars, and glucose variability from the two weeks of sensor wear.
To learn about real world experiences with the Libre Pro, diaTribe collected feedback from a number of people with diabetes and their healthcare providers, including two highly-regarded endocrinologists, Dr. Peters and Dr. Bohannon. Read on below for their impressions on wearing and using the FreeStyle Libre Pro.
[Note: The FreeStyle Libre “consumer” version that allows the user to view glucose values in real-time was submitted to the FDA in late summer 2016. A US launch might be coming in the second half of 2017.]
What are the best features of Libre Pro?
Very easy to use. Above all else, everyone who used Libre Pro emphasized its simplicity. It was easy to apply the sensor in the office, comfortable to wear, and straightforward to download – “as far as professional CGMs go, this is by far the easiest to apply and download,” reported Dr. Bohannon enthusiastically. She said it was particularly helpful that users of the Libre Pro did not have to carry around a reader device or record fingersticks; they could simply go about their lives as usual between appointments – it is great to see less hassle and greater simplicity.
Comfortable and (almost) painless sensor. Most people who used the Libre Pro reported little-to-no pain on insertion, and shared that the sensor was comfortable for the duration of its wear.
Highly valuable, comprehensive glucose data and insights. Users noted that viewing the Libre Pro data was fascinating and helpful, particularly for those who had never seen continuous glucose data before. The automatically generated reports also help healthcare providers quickly identify glucose patterns (e.g., continually going high after breakfast or low at night), making it possible to adjust therapy on an individual basis to improve diabetes management – “I love data that fills in the gaps between fingersticks,” said Dr. Peters. The reports were a source of reassurance for others, who were glad to learn that their blood glucose stayed in range throughout most of the day and night. With a glucose value automatically collected every 15 minutes (96 times per day, including at night), the Libre Pro provides a lot more information than a few fingersticks per day.
Are there any drawbacks?
A few users noted that the sensor adhesive does not last the full 14 days as intended. Dr. Bohannon said that the sensors fell off during the first week for around 20% of her patients who tried them. This is a common challenge for on-body diabetes devices, and hopefully can be improved in future models. In the meantime, many have found that adhesives such as Skin Tac can help keep sensors in place. diaTribe senior editor Adam Brown of Adam’s Corner uses Durapore tape and finds it very helpful for securing his CGM.
While everyone diaTribe spoke with found the Libre Pro to be accurate, some noticed “false lows” recorded on the device that did not seem to match blood glucose meter readings. Dr. Bohannon suggested that this could be due to compression: pressure near a CGM sensor (e.g., while lying in bed sleeping) can restrict blood flow to the area and can record lows erroneously. (In tests of the Libre Pro, the sensor reports values within 20% or 20 mg/dl of the “true” lab value 84% of the time. Read the user manual here.) A member of the diaTribe Advisory Board also found that the Libre Pro tended to over-report hypoglycemia patterns, especially for those running on the borderline of 70-80 mg/dl. Indeed, the official FDA summary data notes on page 2 that Libre Pro can inaccurately overreport hypoglycemia. The FDA emphasizes that Libre Pro interpretation must only be based on trends over time (i.e., what the full 14 days of wear show). Since the device can overreport hypoglycemia, this is especially important to watch for those with glucose values often running in the range of 70-80 mg/dl.
Dr. Bohannon noted that she found it very easy to download glucose data from the Libre Pro, although it was complicated to enter into the electronic medical record (EMR) system. She added that this is a challenge with most diabetes devices – not specific to the Libre Pro – since EMRs vary widely and data reports have not yet been standardized to one-size-fits-all.
Does insurance cover the Libre Pro?
diaTribe had been very optimistic earlier that this would be 100% covered by insurance – now it seems the answer is really “it depends!” In the USA, professional CGM devices such as the Libre Pro have billing codes, meaning that they may be covered under certain insurance plans (call a representative from your plan to find out if this is covered for you). Drs. Peters and Bohannon, however, noticed that many insurance companies do not pay for each 14-day Libre Pro sensor, meaning that doctors and patients end up having to absorb the cost (different healthcare providers seem to navigate this scenario differently). To prevent surprise expenses, it is recommended that people with diabetes call their insurance companies to ask about coverage before using the Libre Pro. On the plus side, Libre Pro is much cheaper than most professional CGMs: each disposable, individually-worn 14-day sensor costs $60 (one used per person), and each office only needs to purchase one $65 reader device.
The bottom line:
Overall, the patients and providers diaTribe spoke to said that the FreeStyle Libre Pro is a simple, comfortable, and low-hassle device. It helps uncover glucose patterns not captured by fingersticks alone, and helps inform treatment plans accordingly (e.g., medication doses, food choices, etc). The cost to people with diabetes and their healthcare providers is minimal when Libre Pro is covered by insurance, though unfortunately some insurance plans have not yet decided to cover it.
How can I try the Libre Pro?
If you are interested in trying the Libre Pro, talk to your healthcare provider to see whether their office is currently offering the device. Your healthcare provider can get more information here. If your insurance covers the Libre Pro, then there should only be a small co-pay fee to wear each 14-day sensor.
[Photo credit: Abbott]