Approximately a month ago, Aboott started to make noises about the roll out of an update to the Libre2 software, following various approvals of their product for use as a Real Time CGM (mostly for competition in low cost markets with Dexcom’s ONE).
Essentially, the new update would officially allow both iPhone users and Android users to receive CGM via the LibreLink app (as many third party apps have offered).
Information was shared via senior UK diabetes charity and medical representativea as well as to users and advocates through the community that Abbott has formulated (And hands up, I am part of that community and welcome information through it). Essentially the news was that the roll out would start on the 12th July and would take about 7 days.
And that’s where it all went a bit Pete Tong.
The software roll out to apple phones was flawed. It didn’t work properly.
It deleted all history on your phone, when it worked, and mostly left users with a white screen and no information.
They lost local data, suffered a lot of pain and were forced to go back and try again, from their installed apps menu.
After a number of days, Abbott released a 126.96.36.199 upgrade that solved the problems, but most shouldn’t have been there in the first place. 2.10 to 188.8.131.52 is quite a lot of fixes…
More amusingly, perhaps, Medcity managed to write an article that made a positive out of the support provided over social media that should never have been required.
And what of Android?
The inconsistency of the Android roll out
Apparently, at the same time, the same software was being rolled out to Android users.
Though you could have fooled many of us, as we eagerly awaited rtCGM through the official app. At the time of writing my app remains on its previous version.
We were told that this would be phased, and yet phased seems to be code for “it appears that not everyone will receive the update”. A poll run on the UK Freestyle Libre users Facebook group suggests that more Android users have not received or been offered an update than have received it. In the poll, nearly 61% of users said they’d not seen it. Granted, an internet poll is easily biased, but that number doesn’t look great.
Abbott have not been clear on what they were doing, and leaving a significant number of users without the update also raises questions about what has been released.
Communication from them included the following:
- The Android app roll-out has been phased over a week. Version 2.10 should be in the Google Play Store for all Android users soon (16th July)
- Expect to see [the update] soon (19th July)
- Abbott recently piloted version 2.10 of the FreeStyle LibreLink app for Android (23rd July)
- The next version of the FreeStyle LibreLink app for Android will soon be available for download on the Google Play Store soon. People who have successfully upgraded to 2.10 or use a previous version can continue to use their app, and new users can download available version 2.8.4. (23rd July)
Which looks suspiciously as though there had been a change of plan with regard to the roll out of rtCGM.
And then on 26th July, a notification of a pause in the roll out due to issues reported with the software appeared.
They might be trying to avoid a further fiasco, but we may be beyond that point!
Where does that leave us?
It’s a difficult question to answer.
From what we can see in this case, you either have an updated app to allow rtCGM or you missed the cut. And if you have one, it probably didn’t work in the first instance on either type of phone.
If you missed the cut, it’s not clear when you will get an update (soon, we’re led to believe).
All in all, it has turned out to be a bit of a mess. And the people who have to deal with this are those who were supposed to benefit.
It all supports the view that this rollout was very much a pilot process, and had that been communicated to end users, we may have been a little more understanding. Instead, Abbott have launched a key new feature very badly, in a way that may still encourage users to desert for Dexcom ONE or other sensors.
Either way, many will continue to use third party apps to obtain rtCGM data off the Libre2, while Abbott sorts themselves out.
What could have been done differently?
Let’s not forget that Abbott already have a real-time CGM in the Libre3. One that we know works well. There was no need for them to convert the Libre2 into one.
Unless, commercially, they felt they had no choice.
With growth in Dexcom ONE in some markets eating into market share, has it become imperative to offer an equivalent?
Looking specifically at the UK, the cost level that the the NHS pays for the Libre2 is, we assume, lower than the Libre3. We know the price charged out to ICBs for Libre2. To roll Libre3 out to a larger number of users would entail bringing the pricing in line with the Libre2 system. Which, we assume, affects the bottom line for Abbott.
If we look at the UK data from OpenPrescribing.net up to May, we see that Libre2 issuance seems to have plateaued at around 190,000 per month. In comparison, Dexcom ONE has had a much lower uptake, but it is increasing.
In May, Open Prescribing shows only around 6,600 Dexcom ONE sensors being issued. Even with a projected growth rate on both of those, six months out the Dexcom ONE uptake would be expected to be significantly lower than Libre2, which would still be expected to be between 170,000 and 190,000 per month. In fact, at current growth, Dexcom would appear not to be touching Libre2 numbers for a number of years.
The graph below shows uptake of Dexcom ONE and Libre2 going back to the start of 2022 in the UK, normalising the Dexcom data to take into account that on a monthly basis, Dexcom requires three sensors to every two of Libre2. It also includes trendlines forecast out 6 months.
There’s a very clear difference in numbers, and one that, even at the current Dexcom ONE growth rates, doesn’t seem likely to unseat Abbott just yet.
More widely, replacing Libre2 with Libre3 to provide rtCGM would, perhaps, have forced the introduction of Libre3 in markets where it hasn’t been launched and there would be a variety of costs associated with that, so it was better to go to “enhanced” Libre2.
The question is, have the issues experienced in the UK cost Abbott more in both reputation and user take up, and ultimately, bottom line, than flipping to the Libre3 would have?
If we continue with the hypothesis that the UK was a pilot, then the pilot has done its job. It’s highlighted issues and put a plan in place to resolve them, opening up a much more straightforward roll out for the remaining territories.
From an end user perspective it’s not been a good look, and there are still a large number of disappointed people out there who haven’t yet got rtCGM. When they finally do receive it, will they forget about the trouble?
From Abbot’s perspective, reputationally, perhaps, they may have paid a price. For safeguarding future rollouts? Perhaps it was worth it.