I’m about to frankly tick off many yet again, but as ever I am going to just ignore the usual sheep of the diabetes community and go off on one of my usual rants from my nerdy ancient diabetic perspective. I’ve made my dislike for a recent Diabetes UK campaign to have Flash meters (well there is only one so it’s not really meters) available on the NHS. So I thought I would pad out my explanation as to why I find the entire campaign frankly wrong and feel if the government support it, it would be effectively just appeasing an online campaign but at the cost of all diabetics in the future.
- Flash “meters”, for which there is only one. The Abbott Libre. The campaign doesn’t realise that if it makes it free it is simply making a single meter the default meter for all diabetics. Why do I say that? Simply as we all will switch to it as we are frankly fed up of finger tests. This action is something which would be shaping the market in such a way that is uncompetitive to all other manufacturers and as such limiting access to newer and better technologies for patients, but more critically it leads to the next point.
- The Libre isn’t an accurate device. The blood glucose meter part of the Libre setup isn’t the most accurate of currently available meters. It’s frankly not even close to it from the annual testing of meter results. Some might scoff at the fact that a 0.3mmol variance is “close enough” but as I’ll come to soon, I am not one of those. This is also just the blood glucose meter part, the sensor using interstitial tissue is calibrated to be accurate with that meter and itself can be up to 15% further inaccuracy.
- While using FGM (Flash Glucose Monitor) has huge benefits for giving the same levels as CGM (Continuous Glucose Monitor) for recognition of patterns in our treatments so we can maintain them more easily, which is by far its best feature, the device does not support (from any certifications I’ve read on) for patients to administer and adjust their insulin levels based solely from the FGM readings. Some will instantly cry that this doesn’t matter and that is why it has the blood glucose part of the scanner. But patients ARE using it for such, which along with the inaccuracies above should represent a major concern.
- I am probably going to upset more with this comment, least alone Abbott, but the Libre is basically a rushed to market “beta” product. Half-finished basically! Am I being harsh here? Yes, I am, but my reasoning is that the lack of alarms as found on a true CGM is a fundamental major flaw. Alarms found on CGM are a huge safety net for us patients, we are going high, we are going low, even when fast asleep we are woken by the devices to tell us to deal with something which if ignored could quite easily mean we don’t wake up from. Some will argue it’s a different device, yet these are features which are coming in the next version of the Libre (which isn’t that far away) which is basically (yes technobabble time) just the current Libre sensor with the wireless system changed to using BlueTooth LE from the current NFC so it talks to a phone, and the phone does the CGM alarms part. Basically, from what Abbott is doing is the same as what many games manufacturers do, they do early access previews people pay for to fund the development process to get the one they intended all along but if they can get you to pay for it instead of them, it’s great for the company isn’t it?!
- The next version of the Libre which this campaign is solely about protecting and making the default diabetes care meter is going to be a CGM. The FGM step which this campaign is so busy trying to sell to the government is nothing but a soon to be end of life product. When it does get replaced soon what happens with this campaign? Simple. Abbott continues to sell it’s out of date product since the government will be funding it for years to come. It’s newer version which people will suddenly (sadly we just have to watch what happens online with any kind of new diabetes technology for this) will suddenly start screaming for the new version. Which isn’t funded and not likely to get funded as explained next.
- Diabetes UK claims that this campaign doesn’t stop it’s “support” for CGM to be funded. Let me simply counter this as YES IT DOES! Why? The NHS is frankly skint and campaigns to get it to fund anything is bad enough, but to fund something that is “close enough” to a CGM so that CGM needn’t be funded properly in the future is very dangerous. We the diabetes community need proper CGM funding for as many patients as possible. Why? It’s more accurate this FGM and the alarms can be lifesaving. Some CGM is also (Dexcom) certified to make insulin adjustments and eat off its results. In a time when the government spends using “austerity” very often do we really need to pour money at one company which itself is moving to CGM on its currently backward technology? And that funding could be used actually to fund CGM of which there are multiple manufacturers providing a competitive and more advanced market of which Abbott themselves will be joining with the Libre II.
- CGM funding is critical. We are now receiving meters which can use CGM to disable or increase our insulin levels to adjust to the behavior of our blood glucose. Full artificial pancreas solutions are very close with many manufacturers very close to release on these products. But they all need one major component to make these new features usable, and that is CGM. Diverting funds away at this point in time is frankly going all out to win a minor ignorable battle so the war can be lost. We need to focus our campaigns and asking for funding for the devices and care we actually need and not the latest shiny FLASHY device that is out today.
- Linked to above, we also have cost. Yes, it is somewhat “cheaper” compared to CGM but for sensor costs for the Libre are more expensive than Dexcom sensors, although being cheaper than Medtronic’s currently. A Libre sensor does last for 20 days which is nice, a Medtronic is designed to last 6 but can quite often last 12+ days while a Dexcom is happy to last a week and will often last anything from 21 to 50+ days. Dexcom has stated the next sensor tech will double life of them. The costs between the systems are pretty similar over a long period of time and that is before the NHS purchasers can (they should anyhow) be able to wrangle any cheaper deals for buying in bulk.
These are the concerns which I find the current campaign is just ignoring and personally why FGM funding should not be provided on the NHS. It damages CGM funding which SHOULD BE FUNDED! The benefits of CGM for patient safety, cost, and a much more competitive market are far more beneficial for all diabetic patients than this current misguided “I want this latest shiny device now” campaign.
In an interesting addition, Dexcom is offering the G5 Transmitter with a sensor for £160, so yes a touch more than a Libre, but the sensor lasts longer, and replacement sensors are cheaper and last longer. It talks all the time to Apple IOS and Android phones and watches, does alarms, and can even open your BG readings real time to parents or family, whoever you want to view it BG readings. Meanwhile, DiabetesUK and the like keep insisting the Libre is the better device?! Like on WHAT planet?!