Diabetes tech or not diabetes tech? “Libre Sense” is the question…

Whilst that’s a very poor nod to Shakespeare, Libre Sense is the question here. And that’s because they announced the launch of a “Glucose Sport Biosensor” yesterday, and is designated “not for medical use”. Abbott is working with Supersapiens, who are the first company to have a non-exclusive agreement in place to distribute the technology and make it available in the health and fitness market.

So who are Supersapiens, and what is Abbott doing here?

Who are Supersapiens?

Or perhaps that should be “What is Supersapiens?” The website shows it to be a company with an app that’s used with the aforementioned sensor to monitor glucose levels and optimise athletic performance through better understanding of fuelling.

The founders of Supersapiens include Phil Southerland, who you may recognise as the founder of Team Novo Nordisk. But hang on a second, there are also two other members of the Team Novo Nordisk executive team involved in Supersapiens – Chris Belli and Fitzalan Crowe. What’s also interesting is that Team Novo Nordisk riders already use the Libre2 sensor and have published a number of items of research into glycaemic management in professional cyclists with type 1 diabetes.

Essentially, what we seem to have here is the exec team from Team Novo Nordisk monetising the research that they have undertaken into glycaemic management for exercise in T1, in partnership with Abbott, to sell Libre to those without Diabetes.

Taking a step back and looking further into the Supersapiens team, there are some significant sports related coaches and general managers involved, including the General Manager of the Yankees and David Brailsford of the Ineos Cycling team. This would suggest that they buy into the incremental performance gains that better understanding of body fuelling miight bring to performance athletes.

So then… Abbott?

As we mentioned in the previous section, Abbott Libre 2 sensors are used by Team Novo Nordisk, and the US FDA approval of the Libre 2 sensor is as an iCGM (integrated CGM), intended to work with automated insulin delivery systems. As such, it would be expected to produce a continuous stream of data every x minutes.

Similarly, we know that the European Libre2 does this because:

1. It has real time alerting and;
2. We’ve patched its app and allowed it to send realtime data to DIY AID apps.

Abbott’s press release states that this is based on the Freestyle Libre CGM system and is being tested by two teams at the Tour de France. One wonders whether it is really any different at all from the Libre2 and whether it could be viewed as Abbott releasing the LibreX₁ real-time CGM into a different market (as predicted on this website in 2017) area in order to both widen their available market and to better test the product in the real world, ahead of a CE mark for medical use. If you believe what Abbott diabetes care senior VP Jared Watkin said:

“Now with Libre Sense we’re bringing that same proven technology to empower athletes to help them reach their athletic performance goals”

There’s probably no discernable difference between Libre2 and Libre Sense, other than the software on the phone. Not even in accuracy.

And let’s not forget, if there’s no medical link-up, what you test for accuracy is somewhat different…

So what does the website say about “Libre Sense”?

According to this image from the website, the sensor technology is “breakthrough” and “highly accurate, stable and consistent”.

Let’s look at each of those separately. If, as we believe, the sensor is basically the Libre2 with different branding, I’m not sure that a ten year-old plus technology can be described as “Breakthrough”… Even less so as we’ve been using it in Libre since 2014 and it originated in the Navigator. Come on Supersapiens, that feels a little like false advertising.

How about the statement about it being highly accurate? Well, as it’s a non-medical system, they don’t have to publish anything public, so the little superscript 5 states that the data is held on file at Abbott. Way to go. Who wants to bet that it’s about as accurate as the Abbott Freestyle Libre2? And would you consider that to be “highly accurate”?

Moving on to some of the other claims about the Libre Sense Biosensor, we see that the claim about the technology is repeated. They’re working hard to present the idea that glucose sensing is something novel, and while this is true for athletic training, we know that there’s 15-20 years of CGM doing exactly the same thing.

And what about this statement relating to “More than 2 million users”? Apart from a lack of attention to detail in the typesetting, if the claim is that Abbott sensor technology has that many users, as we know, it must be Libre technology.

It does look as though the marketing is distancing the “Libre Sense” sensor from the Freestyle Libre/Libre2 sensor, and I wonder whether this is due to the non-medical approval and an attempt to make it look as though they are attempting not to encourage people with diabetes using it as CGM. It’s very clearly saying that this is not a medical device, over and over again.

What do we know about the app?

Well, from the image above, it looks very pretty. Prettier than LibreLink. Digging through the website, as the app isn’t available yet, there’s not much info. It appears to be targeted at driving your fuelling strategy for exercise and performance, and the insight generation is targeted around this (rather than glucose levels). This should perhaps come as no surprise.

As someone mentioned on Twitter, one of the big things in health and exercise apps is the integration between systems, and presentation of an API.

There’s little in this to suggest what is available in that respect, however, given what Abbott knows about the WeAreNotWaiting community, I wouldn’t be surprised to see the Supersapiens app delaying any broadcast data in a similar manner as Dexcom does to Apple Health.

What does it cost?

It perhaps comes as no surprise to learn that this is a “premium product”.

Supersapiens has the product available to pre-order and in doing that, it comes in three packages.

A two sensor pack for €160, a six sensor pack for €420 and a subscription model at €130 per 28 days, which can be cancelled at any time. When I took all of these to the payment page, these prices were VAT inclusive.

If we start by supposing that in Europe, this is a way for Abbott to get their RT-CGM product into the hands of people with diabetes in a “public guinea pig” phase, similar to what they did with Libre1, then this pricing model is quite interesting. If this is the case, the subscription model prices the Libre Sense at almost exactly the same price (VAT inclusive) as the Libre 1 or 2. Which is some 25% cheaper than Dexcom’s G6. And you can do that for the starter set up because the subscription can be cancelled at any time. It looks suspiciously like a way of getting their CGM into the hands of people who may very well use it as a medical device, with minimal fallback on either Abbott or Supersapiens (because “It’s not a medical device”).

In the two sensor pack, €80 for one sensor is around £72. In comparison, the Freestyle Libre1 in the UK costs you £57.95 including VAT. So you’re paying approximately £15 (25%) more for the Supersapiens/Abbott Libre Sense product. I’m not sure why anyone would do this given that you can cancel the subscription at any time.

What’s also of note is that the 6-sensor pack is described as the “training pack”. Body Transformation plans often operate on a 12-week plan basis, or the equivalent of this, so this pack appears to be squarely aimed at personal trainers and their clients. Again the subscription comes into play. With €420 for this pack and a three month subscription at €390, I’m not sure why you’d buy it.

Can we answer the initial question?

Is it Diabetes tech or isn’t it Diabetes tech? It looks like Libre, smells like Libre and functions like Libre. It’s not sold as Freestyle Libre because, as we’re told multiple times, “It’s not for medical use”.

I think that we’ll see reasonable take up of the product in health and fitness circles as people look for incremental gains, and I can see it being used to optimise professional athlete fuelling.

My guess is that there will be a market for this product amongst people with Type 1 wanting CGM at a lower price than either Dexcom or Glucomen can offer. Is it diabetes tech? The marketing says “No”, but I’d not be at all surprised to see it used that way.

Notes

1. X for next gen real time Libre