Abbott’s #FreestyleLibre – disrupting and democratising Diabetes care in Europe

Abbott’s Freestyle Libre – disrupting and democratising Diabetes care in Europe
Abbott’s Freestyle Libre – disrupting and democratising Diabetes care in Europe

A little over two years ago, the Abbott Freestyle Libre launched, to much fanfare and significant consumer trialling and direct patient marketing (anyone see a theme there with how another new entrant into Diabetes care is marketing themselves?). Since that point it has changed how people view their diabetes and their relationship with healthcare professionals in a dramatic and far reaching way.

The Libre was blogged about, widely reviewed, with given away product and Abbott managed to generate much excitement, indeed, this topic in the forum has generated 4172 comments, up to now and started on the release of the product.

The UK based Facebook group focused on the Libre has more than 7,500 members and there are multiple Libre groups across social media. Abbott’s results also include commentary about how the Libre has lifted their Medical Device group’s sales and annual results. From their Q3 2016 results:

Worldwide Diabetes Care sales increased 11.5 percent on a reported basis in the third quarter, including an unfavorable 1.0 percent effect of foreign exchange, and increased 12.5 percent on an operational basis. International sales growth was driven by continued consumer uptake of FreeStyle Libre, Abbott’s revolutionary continuous glucose monitoring system that eliminates the need for finger-sticks.

From pretty much every perspective you look at it, the Libre has been a success, not only for Abbott, but for people with Diabetes of all types. Speaking to the Abbott Customer Care line, the helpful representative told me they had “Hundreds of thousands of registered Libre customers”, which isn’t to say they are all active but gives some idea of the uptake. But why?

Very simply, Price and Data.

First up, low price = disruption in the product market place…

For the early adopters amongst us, it was a way in to Continuous Data that many of us felt we could afford. I’ve written before how the price of CGM had put me off, but all of a sudden, at a price of £100, I could get up and running with something giving me continuous data. Two years ago, the equivalent set up costs on Dexcom were around £1000.

The resultant uptake in Europe outstripped Abbott’s estimate of demand to such an extent that they were forced to stop supply to new customers around 6 weeks after launch while they ramped up a new manufacturing facility. This supply restriction lasted six to nine months.

18 months after the launch by Abbott, and with their supply in full swing, Dexcom moved their sales in-house and massively reduced prices of their products, making it possible to get set up on Dexcom for around £250. The #wearenotwaiting crowd rejoiced, and Abbott went on to launch their Android App making it possible to start using continuous data for the price of a single sensor. £50. That’s now all you need to spend to get 14 days of data, really useful data, accessible in Diasend and we’ll move on to that shortly.

Demographic information out of Scotland shows that, as you’d expect, uptake has been amongst members of the population with higher and middle incomes, as they are the ones that can, or have made the sacrifices to, afford it.

There is no denying that it has changed the way that people purchase continuous data systems, and has brought a fundamental adjustment to the non-prescription diabetes device market, especially in the UK.

Similarly, the data presentation has caused other providers to change theirs. Diasend, for example started to include an AGP graph after Libre users started uploading data and wondering where it was!

Second up, Data = Democracy

Why did I put price first? Well without the product at the price, data would be irrelevant. By disrupting the pricing model of incumbent CGM providers, Abbott has been able to get access to many thousands of users that weren’t using anything like this before.

The data that it provides has proved to be a revelation to most. You only have to take a look at the many facebook groups where users discuss overnight hypos, the time it really takes for insulin to act, carb spikes, exercise reactions, etc, to realise how enabling it has proven to be. For the first time, many not hugely engaged T1s and a fair few T2s have started to look at what they do on a day to day basis in a way they haven’t had the opportunity to before. In a survey that I am currently running, just under 50% of the responses have come from Libre users. If that’s anything to go by, it has doubled the market for continuous data consumers.

And it shows.

I’ve mentioned previously about attending clinics where the registrar I’d been speaking to hadn’t a clue about AGP graphs and how to interpret them, and how the data I’d received enabled me to demonstrate very clear dawn phenomenon, or how it showed me how long insulin really took to act and just what my post prandial spikes really looked like rather than guesses based on what I had been told be HCPs. And I’m not the only one.

Now, these graphs are providing significantly more people access to data that they never had before.

But the question then becomes, how is this democratising diabetes care?

For the first time, by combining data with social media, people are able to find out much more about themselves. Partha Kar often talks about patients being experts in their diabetes and healthcare professionals being specialists.

Previously, the amount of expertise varied, and many weren’t that engaged, but now, more people than ever are engaged and know far more about themselves. And they are helped to be experts by their peers, reviewing data that is easily accessed, and more importantly, easily shared.

This means that HCPs are being presented with patients that know far more about how all the inputs they have everyday affect them, and are looking for help with dealing with them. They are providing immediate and often compelling evidence that clearly shows why a pump would make sense, or perhaps a change of insulin, or even a low carb diet.

The key here is the transfer of power. Now that we know about ourselves in such detail, we have pulled a lot of power away from HCPs. We are able to ask questions that we weren’t able to before, and more importantly, provide easy, full, hard-to-fake evidence to back up what we’re asking and why.

As these systems become adopted by insurance companies and national healthcare schemes, this will only happen more frequently, hopefully enabling some of those that really aren’t engaged to get involved.

Why is this a good thing? It’s a good thing because, whilst it transfers power into the hands of those who need to act, it also should free up time for HCPs to deal with those who really need help. It also enables HCPs to learn from the data that they are seeing more and more frequently about what T1D really looks like and from non-Diabetic users, that 3.8mmol/l is a normal glucose reading.

Essentially, as the use of products like this filters into everyday life for more and more people, what they learn about themselves enables them to better understand and manage what they do. But that’s not all. They also provide a much more complete picture of what is and isn’t normal and provide insights into how it should all be handled.

And it doesn’t stop there…

The Freestyle Libre and WeAreNotWaiting

As I’ve written about previously, multiple attempts have been made to allow the Libre sensor to be used as CGM, with a number of homebrew effots created. The LimiTTer, Glimp on an Android Phone which now supports a CGM mode, a version for the Sony Smartwatch 3, plus others. The Libre sensor has been adopted as part of this ecosystem, and remains something that people are interested in hacking.

Finally, there’s also the benefits that Abbott have gleaned from the device…

Abbott’s Data Uploads…

Early in its life, a number of people identified that the Libre software updated an anonymised version of all the data you downloaded onto your PC or Mac up to Abbott servers in the states. It’s written in the small print, as part of the license that you allow this. With “hundreds of thousands of customers” using the product throughout Europe, that’s a lot of glucose data. But it’s also a lot of Insulin, Carb ratio and ISF data as well.

In fact, it’s a lot of data that you might want if you were going to build yourself something like a better bolus calculator or insulin prediction algorithm. It’s certainly a vast amount of data that can be mined to generate very interesting statistics. So how will Abbott use it? Well that’s something we don’t yet know. But it creates some interesting options.

I suspect the answer is, “Watch this space”….


  1. Very informative article!! All looks good except a news is missing about a company Ambrosia Systems based in Silicon Valley. They are making an ultra small device to send data from FreeStyle Libre Sensor to mobile app, no need to scan the sensor with the Reader or the Android phone. Every 5 minutes mobile app will receive data from the sensor wirelessly. No need to charge the device, good for full 2 weeks like FSL sensor. Device will stick on top of the sensor. Ultra small device you will even not notice it. Interesting stuff … Wait for global launch in January 2017 🙂

    • Interesting. There is something similar being created in Europe. BluReader I think it’s called. The key piece is to ensure that it’s not a medical device and therefore not subject to FDA or EMA approval requirements, which a commercial product has to be very careful about. They have to take care about liability. Unfortunately, contains no information a to what they will be producing.

      They’re also going to have to price it right – one of the reasons for the success of the Libre has been the price, so any transmission device needs to effectively cost less than £60 a month if you are comparing it to the Dexcom G5, and much less if comparing to Dexcom G4.

      Exciting times though!

      • You are absolutely right, Ambrosia has to price it right. I heard from couple of prominent VC at Sequoia Capital and Google Ventures guy who started Ambrosia Systems with his friend earlier worked at Abbott Diabetes, and also working on artificial pancreas.

      • Accessories to a medical device carry the same classification as the medical device it connects to. There is some clarification on this with regard to Class 2 and Class 1 devices in the States and allows for a new Class called Medical Device Data Systems (MDDS) but it is merely for transport from one place to another without change in the data or the device. In the case of Class 3 devices (again US only) MDDS is not an option. FDA states that a person will not be prosecuted (at least for now) if it is a homegrown device/system for personal use (ie Nightscout, DIY, etc…) However, language from FDA has become increasingly threatening with regard to commercialization of these homegrown efforts including shared code repositories. Murky territory but it’s clear to me that Ambrosia will have a big challenge if they expect to manufacture and distribute the device as stated. Since my first meeting with Ben West in 2013 or so I have tried to raise the safety consciousness around do it yourself med devices. It’s easy now for the non-savvy to get in over their head. Not worried about engineers who grow their own but to the uninformed results can be dangerous. Disclosure: I am a medical device company CEO and inventor.

        • Thanks for that clarification Kevin. A helpful insight that reflects some of my thinking in relation to calls for help to build certain “home-build” projects.

  2. As per my understanding FreeStyle Libre is not yet launched in States. Currently Europe has more than quarter million user, i.e. Abbott is selling about half million devices per month, big enough market for them. Also, as per online news, FreeStyle Libre would be available in States in mid to 2017, Ambrosia can do FDA filing if they want to enter US market.

  3. Vergüenza y frustración por el servicio proporcionado por Abbott.
    Pedí cuatro paquetes de Freestyle Libre en noviembre,NOVIEMBRE!!!Estamos en febrero y todavía no los he recibido.
    Pésimo servicio para el producto que vende,teniendo en cuenta la inversión económica que tienes que hacer.
    Nunca más

    Shame for Abbott’s behaviour. I ordered 4 Freestyle Libre productos un november,NOVEMBER! Currently is february and I haven’t received them yet.
    Poor client servicie regarding the product they sell,taking into account the investment you have to make.
    Never again

  4. Their customer service is not so good, I have been trying to get a refund from them for several months. The device was not impressive to my husband, he found it gave him readings higher than they really were e.g. a freestyle reading of 9 would be 6 with pin prick test, he says its dangerous and told them so, they did not reply. They did agree to a refund but we have so far not received it and they acknowledge receipt of the returned device.

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