Abbott Freestyle Libre 3 – here already?

It was only a little over a week ago that Abbott released their Libre Sense, offering up CGM for athletes without a medical approval, with a reasonable amount of umming and aaahing from the diabetes online community, mainly to the tune of “Why would they do that and not give US CGM?”

Well that’s been answered. And how…

Another Monday, not much happening and then Boom! A press release lands, saying that Abbott’s Libre3 has received its CE mark. This would be the Libre3 that no-one knew about (except for maybe a few Automated Insulin Delivery system providers who were integrating it into their platforms).

And as exciting and frustrating as that may be, it’s worth taking a look at.

Welcome to the Libre3

The Libre3 offers the following:

• Full Real Time CGM
• Smallest CGM in the Libre range (probably the smallest available right now);
• Market beating accuracy (more on this later);
• Priced the same as current Libre (so VAT free as a medical device that’s £48 per sensor);
• Readings every minute;
• Probably only a phone app

So let’s look at all of these.

Full time CGM. Yup, finally, Abbott have medical regulatory approval in Europe for a version of the Libre that is a full CGM system. And not only is it a CGM, it’s one that provides data every minute. Abbott upping their game.

The press release states that Libre3 is the size of a penny, and two pennies thick. For reference , that makes it something like the picture below. That’s a pretty small CGM. Plus one for Abbott.

Market beating accuracy is also claimed in the press release. But if you follow the small print to the study they reference, then you find a paper discussing the Libre 2. And talking about a MARD for adults of 9.2% and for children of 9.7%. Now while that’s not to be complained at, I’m guessing that this indicates something about the technology wrapped up in the Libre3. Namely, it’s probably identical in everything other than size to the Libre2.

Because who’d publish a press release with a link to a paper stating how accurate their system was that didn’t provide data pertinent to their newly announced product? Of course, the big difference in the product is that there’s no NFC antennae, and the coil for this is fairly large, so the significant reduction in size with the same technology onboard as the Libre2 other than the antennae may answer that question… But of course only Abbott really knows (for now). Wait for the early tear downs to confirm this!

For some, the lack of a reader may be considered a downside as there will be those who prefer an independent receiver, however we assume that Abbott have done their homework and determined that their isn’t enough demand and have therefore only furnished us with an app.

So then, size, frequency of readings, etc. All good. But what about price? The press release confirms that it will be the same as that of the Libre and Libre2. So that will be £48.29 per sensor in the UK. Or roughly £105 per month. Which undercuts pretty much everyone.

The competition (at the current moment) is £159 per month for the Dexcom G6 and £129 for the Glucomen Day.

Abbott were also very happy to mention their reduction in waste as a result of their updates too, taking clear aim at Glucomen. Of course with the substantial reduction in the size of the sensor, we’d expect a much smaller inserter, with the reduction in plastic that produces.

One of the things that’s clear from the images is that the sensor filament is no longer central in the setup, and the question is whether this will affect the 14-day longevity. We presume not, but we’ll find out when they start shipping.

What about that competition?

As we mentioned late last year, there were supposed to be a number of new systems coming to market during 2020. So far, only one has made it. And they can’t be happy with this announcement.

Of course, Dexcom haven’t been entirely silent during this time, with plenty of marketing relating to the G7, which is described as being of a similar size to the Libre3, and similar accuracy to the current G6. In the image below it is supposed to be “the same size as a nickel”, but that appears to be a slight overstatement of how small it is.

However, in July, they stated that they’d pulled the G7 soft launch slated for the end of 2020 and wouldn’t roll out properly until “the company has capacity to fully transition G6 users to the new technology”. That doesn’t sound all that promising and may not be as early in 2021 as the community had been hoping.

Meanwhile, Abbott’s press release talks about release in Europe over the next few months. Sounds like 2020 to me…

Accessibility…

As we’ve just discussed, the Abbott press release talks about rolling out in Europe in the coming months. The question for many will be,”Where in Europe?”.

There is particular frustration voiced amongst UK social media users that this announcement came just as it was announced that Libre2 would be available on the NHS, with many seeing the real time CGM as a superior product, and also acknowledging that commercial access to the Libre2 was impossible as Abbott never released it commercially in the UK.

From a commercial perspective this may have been a belief that the returns would be low, and the penetration of the Libre as a reimbursed item on the NHS wasn’t 100% coverage, so the UK would just have to wait, as a less prosperous market for the company. Or it could have been linked to the Libre1 agreement with the NHS. Only Abbott really knows the answer to that question.

Given this state of affairs, will there be a commercial release of the Libre3 in the UK alongside the reimbursed release of Libre2 and a European release or will UK users be locked into paying much more for RT-CGM, until Abbott sees fit to release Libre3 (perhaps alongside an NHS release)?

Questions we can only raise, but can’t answer.

At the very least, it appears we have proper competition in the CGM market at last, but it has taken time to arrive. And in this case, the competition seems very effective. If I was one of the newer entrants to the market, I’d be concerned right now as as it stands, Abbott is undercutting them all on price and accuracy with no calibration. Will any of them succeed? Only time will tell….

But overall, let me leave the final word to Adrianna:

Dexcom discreetly spreading the news about g7…. Abbott… hold my beer ?