# Freestyle Libre 3



## BadaBing (Apr 21, 2022)

Hello

Has anyone in the UK had a meeting with their diabetes consultant yet to discuss whether they should have the Libre 3?

If yes, how did the meeting go?

Was it difficult or easy to persuade your consultant that you should have the Libre 3?

If your consultant said you couldn't have the Libre 3 what reason(s) did they give?

Are you using the Libre 3 right now? If so, what are your first impressions of it?

Do you miss having to scan your sensor once every 8 hours?

How are you coping with the extra data the Libre 3 sensor gives you? Is it overwhelming?

Have any of your Libre 3 sensors failed? If yes what happened?


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## Robin (Apr 21, 2022)

BadaBing said:


> Hello
> 
> Has anyone in the UK had a meeting with their diabetes consultant yet to discuss whether they should have the Libre 3?
> 
> ...


I'm not sure anyone in the U.K. is using it yet, has it been approved yet? One of our forum members who lives in Germany has been using it, and there has been some helpful discussion here.


			https://forum.diabetes.org.uk/boards/threads/libre-3-experience.99551/


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## helli (Apr 21, 2022)

Why are you focusing on Libre 3?
Do you have a requirement for a CGM?
i struggle to see why the case for a Libre 3 would be different to any other CGM and leave it to your CCG to determine which they are willing to fund.


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## trophywench (Apr 21, 2022)

My understanding is the same as @Robin.

With our CCG I hardly expect em to offer such a thing to anyone they aren't forced to.  They were several years behind the rest of the country letting any of us have a pump.  Yes I know what the new Guidelines say.  So what?  Are NICE paying them more cash to do it?


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## BadaBing (Apr 21, 2022)

Hello

Thank you all very much for your replies.

Later this year I will meet with my consultant for the first time (the pandemic is still playing havoc with appointments).

I want to get a sense of just how challenging it is going to be to obtain this device or a.n. other CGM proper in England now the new NICE guidelines and criteria are applicable.

I want to understand just how much of a gatekeeper the NHS in England is going to be.

My understanding (but please correct me if I am wrong) is that if a patient is eligible for a Libre 3 it will be funded out of hospital trust budgets and not CCG budgets. That is why (for the moment at least) the Libre 3 won't be available on prescription. 

In my neck of the woods I see my hospital diabetic consultant and they have to greenlight a CGM.


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## Lily123 (Apr 21, 2022)

BadaBing said:


> Hello
> 
> Thank you all very much for your replies.
> 
> ...


The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding


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## everydayupsanddowns (Apr 24, 2022)

I think Nick from the big Libre facebook groupas trialled it in the UK, and it is currently on the tariff to be available in the same way as Dexcom etc (which is to say, currently quite hard to get).

BUT

As @Lily123 says new Nice guidance has been published which should (if implemented) make access to CGM, both rtCGM and isCGM far more widespread. Hopefully!

See:


			https://forum.diabetes.org.uk/boards/threads/updated-nice-guidance-aims-to-improve-cgm-access-for-both-t1-and-t2.99321/


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## rebrascora (Apr 24, 2022)

I am curious about your comment....


BadaBing said:


> Do you miss having to scan your sensor once every 8 hours?


and


BadaBing said:


> How are you coping with the extra data the Libre 3 sensor gives you? Is it overwhelming?


Do you only scan your current Libre 3 times a day?
I average 30 scans a day and that gives me the data I need to "Sugar Surf" and average 90% TIR. I absolutely love Libre for this reason. 

What extra data does the Libre 3 give? Personally I am more than happy with the Libre 1 and have no interest in upgrading although I am led to believe that it may eventually be phased out, which will be a real shame as I think it is more reliable than the Mark II version.


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## Lucyr (Apr 24, 2022)

What do you mean by the libre 3 giving extra data? Isn’t it the same amount of data you get?

I’m using (self funded) libre 2 with the Shuggah app which means it just works as a cgm, didn’t need to add anything else to the sensor just downloaded from the App Store. It doesn’t give me extra data though, it’s the same amount of data I just don’t have to spend 5 minutes trying to get my phone positioned perfectly to scan the sensor before I see the bgs


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## Bruce Stephens (Apr 24, 2022)

Lucyr said:


> What do you mean by the libre 3 giving extra data? Isn’t it the same amount of data you get?


It should give much more information. The graphs (the main 24 hour ones, anyway) are produced from 15 minute readings (so 4 an hour), whereas with Libre 3 you get a reading every minute. (Libre 1 and 2 produce a bit more than that which provides the information needed for the arrows, and maybe in Libre 3 once it gets to Libreview maybe the per-minute data is squashed a bit.)

(I'm not sure how useful the extra data is, but I think people have found it useful.)


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## BadaBing (Apr 25, 2022)

Lucyr said:


> What do you mean by the libre 3 giving extra data? Isn’t it the same amount of data you get?
> 
> I’m using (self funded) libre 2 with the Shuggah app which means it just works as a cgm, didn’t need to add anything else to the sensor just downloaded from the App Store. It doesn’t give me extra data though, it’s the same amount of data I just don’t have to spend 5 minutes trying to get my phone positioned perfectly to scan the sensor before I see the bgs


Hello Lucyr

Bruce has explained brilliantly the difference between the Libre 1 and 2 and Libre 3 (the Libre 3 sends data to your mobile phone every minute, whereas the Libre 1 and 2 send data to a smartphone or other receiving device every 15 minutes).

I don't want to use a third party device or third party software to turn the Libre 1 or Libre 2 into a cgm proper. 

The Libre 3 means it is no longer necessary to use third party devices and software any more as the Libre 3 is a cgm proper.


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## helli (Apr 25, 2022)

Bruce Stephens said:


> It should give much more information. The graphs (the main 24 hour ones, anyway) are produced from 15 minute readings (so 4 an hour), whereas with Libre 3 you get a reading every minute. (Libre 1 and 2 produce a bit more than that which provides the information needed for the arrows, and maybe in Libre 3 once it gets to Libreview maybe the per-minute data is squashed a bit.)
> 
> (I'm not sure how useful the extra data is, but I think people have found it useful.)


I am surprised by this as I have xDrip configured to collect data from my Libre 2 (and previously Libre 1) every 5 minutes. It may accept more frequent updates but this is good enough for me.


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## BadaBing (Apr 25, 2022)

helli said:


> I am surprised by this as I have xDrip configured to collect data from my Libre 2 (and previously Libre 1) every 5 minutes. It may accept more frequent updates but this is good enough for me.


That's the benefit of the Libre 3 helli. It gets rid of the need to use third party software or devices to receive data from the libre sensor quicker.


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## helli (Apr 25, 2022)

BadaBing said:


> That's the benefit of the Libre 3 helli. It gets rid of the need to use third party software or devices to receive data from the libre sensor quicker.


I think you misunderstand my comment. 
If xDrip can get data every 5 minutes, Libre 2 produces data this often, not just every 15 minutes. 
The OOP2 approach I use, takes the data from the Bluetooth alarm feed so Libre 2 is transmitting it more often than every 15 minutes.
Third party tools do not make up data. 

However, bear in mind that no applications are perfect for everyone's needs. That is why third party apps exist. Many people rave about Dexcom but xDrip was initially written for Dexcom because the native tool was not good enough. 
I maybe cynical, but I do not expect Libre 3 to do away with the need for third party apps for everyone. 

(I also don't have a problem with third party tools if they are the best tools for the job.)


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## Bruce Stephens (Apr 25, 2022)

helli said:


> I am surprised by this as I have xDrip configured to collect data from my Libre 2 (and previously Libre 1) every 5 minutes. It may accept more frequent updates but this is good enough for me.


I suspect Libre 2 is providing basically the same information as Libre 3 (and it's mostly the software that's different). What I mean is that when you scan Libre 1 or Libre 2 you get 4 readings an hour for the last 8 hours (plus a few extra readings from the last period), but I think that's about the memory in the sensors. With xDrip I can believe you can get more frequent readings (I'm sure they're there, but normally just get overwritten).

(I'm basing that partly on the sports version sold under a different name which is advertised as producing a reading every minute, using a sensor that looks very like the Libre 2 sensor.)


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## BadaBing (Apr 25, 2022)

helli said:


> I think you misunderstand my comment.
> If xDrip can get data every 5 minutes, Libre 2 produces data this often, not just every 15 minutes.
> The OOP2 approach I use, takes the data from the Bluetooth alarm feed so Libre 2 is transmitting it more often than every 15 minutes.
> Third party tools do not make up data.
> ...


I understand. However, I come at this from a very different perspective.

I am a lawyer by training. I am well aware the manufacturer of the libre considers the use of third party software or devices to get at the data the sensor produces may infringe the manufacturer's intellectual property rights in their medical device. 

I don't know whether or not the manufacturer's assertions have been tested via court litigation, but I know the manufacturer takes proactive steps to enforce its IP rights. 

I have seen on other forums users of the Libre 1 and 2 who have contacted the manufacturer about a technical issue who have gotten short shrift when it became apparent to the manufacturer's customer service people that third party devices/software were being used with the Libre.

For obvious reasons, I would prefer to have the Libre 3 which avoids the issue entirely.


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## Benny G (Apr 25, 2022)

Dexcom - Dex rip - xeD rip - xDrip
Dexcom users made xDrip to improve their user experience.

@BadaBing
*For obvious reasons, I would prefer to have the Libre 3 which avoids the issue entirely.*

For obvious reasons, I would prefer Libre 3 to be supported by 'better software' which would avoid the issue entirely.

Libre 1 used with 3rd party blucon or miaomiao, or Libre 2 used with 3rd party apps already supply full CGM and better software for sensor users.

5 years ago when I first started using the Libre 1, I rang Abbott's support number and asked if I could buy the CGM upgrade. They said 'No.' So I bought a 3rd party Blucon, and did it myself. 
Here we are 5 years later and finally the official CGM upgrade is available as Libre 3.

I like technology. I like to listen to music on my Samsung phone, and I'm quite happy to use '3rd party' Sony buds.
I use Libre 1 with 3rd party Blucon for CGM on my smartphone and watch.

I like Libre, the 3rd party apps just raise it to another level.


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## BadaBing (Apr 25, 2022)

Benny G said:


> Dexcom - Dex rip - xeD rip - xDrip
> Dexcom users made xDrip to improve their user experience.
> 
> @BadaBing
> ...


I hear and understand what you say Benny G.

From what I have read, Dexcom appear to be entirely comfortable with third party devices and/or software being used with their glucose monitoring products. 

Abbott are not comfortable, and as I have said, they do assert and enforce their intellectual property rights in their medical devices,  as they are entitled to do.

Personally, I cannot take the risk. And there is no need to do so if the Libre 3 is now available (assuming one meets the NICE eligibility criteria).


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## Benny G (Apr 25, 2022)

BadaBing said:


> I hear and understand what you say Benny G.
> From what I have read, Dexcom appear to be entirely comfortable with third party devices and/or software being used with their glucose monitoring products.
> Abbott are not comfortable, and as I have said, they do assert and enforce their intellectual property rights in their medical devices,  as they are entitled to do.
> Personally, I cannot take the risk.


I recall there was some grumbling from Abbott a couple of years ago, but the EU laws are on our side. Similar protection in the US.

"Perhaps surprisingly, this seems to be covered by the European Software Directive in article 6 which was implemented in member states years back, which allows for decompilation of the code by a licensed user in order to enable interoperability with another application (xDrip in this case)."

To make better software

"Legal issues aside, there is a larger point here. As the success of open source software over the last twenty years has shown, one of the richest stores of new ideas for a product is its user community. Companies that embrace that group are able to draw on what is effectively a global research and development effort. Abbott is not just wrong to bully people looking to derive greater benefit from its products by extending them in interesting ways, it is extremely stupid. It is throwing away the enthusiasm and creativity of the very people it should be supporting and working with as closely as it can."










						Abbott Laboratories Sends Heavy-Handed Copyright Threat To Shut Down Diabetes Community Tool For Accessing Blood-Sugar Data
					

One of the most important recent developments in the world of diabetes has been the arrival of relatively low-cost continuous blood glucose monitors. These allow people with diabetes to take freque…




					www.techdirt.com


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## Benny G (Apr 25, 2022)

Hi again @BadaBing,
I think the Libre is well worth a trial, if you haven't already taken advantage, 1 free sensor 









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					sample.freestyle.abbott
				




If you can get a libre 2 prescription from your consultant, I would assume that changing your prescription later to the Libre 3 would be a logical progression


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## Bruce Stephens (Apr 25, 2022)

Benny G said:


> If you can get a libre 2 prescription from your consultant, I would assume that changing your prescription later to the Libre 3 would be a logical progression


That was my assumption, but it seems it won't (in the UK) be so straightforward. I'm still not quite sure why.

(The reasoning given is that the cost will be different, that Libre 3 is priced to be competitive with other CGMs, but Abbott has (as far as I know) always said it'll be the same price. So that feels unconvincing to me though I haven't seen the UK pricing. I wonder if it's some semi-political choice connected with the need for a smartphone: if you offer it to everyone then only those with a suitable smartphone (or able to buy one) will be able to use it, so that'll skew in the obvious ways. If it's in a different category maybe it's easier to get away with that.)


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## BadaBing (Apr 25, 2022)

Benny G said:


> I recall there was some grumbling from Abbott a couple of years ago, but the EU laws are on our side. Similar protection in the US.
> 
> "Perhaps surprisingly, this seems to be covered by the European Software Directive in article 6 which was implemented in member states years back, which allows for decompilation of the code by a licensed user in order to enable interoperability with another application (xDrip in this case)."
> 
> ...


I hear you. I really do hear you!

I will not rehearse the various defences to an intellectual property claim here as this is not the appropriate place to do so.

What I would say is that the law in this area in England is in a state of flux, particularly following the UK leaving the European Union on 31 January 2020.

English courts have never been bound to follow decisions made by US courts. At best they are only persuasive.

There are certainly perfectly good arguments that could be made on - either side - to persuade a judge.

Thankfully, 98% of the time it never gets that far.

I prefer to take the easy route and get a Libre 3, if possible.


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## BadaBing (Apr 25, 2022)

Benny G said:


> Hi again @BadaBing,
> I think the Libre is well worth a trial, if you haven't already taken advantage, 1 free sensor
> 
> 
> ...


Thanks Benny G

I already use the Libre.

I would just prefer the Libre 3 - if possible - and without having to attach something else to it or download something else to make it be a cgm and not have to scan the sensor at least once every 8 hours (which one is required to do if one gets it on the NHS).


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## BadaBing (Apr 25, 2022)

Bruce Stephens said:


> That was my assumption, but it seems it won't (in the UK) be so straightforward. I'm still not quite sure why.
> 
> (The reasoning given is that the cost will be different, that Libre 3 is priced to be competitive with other CGMs, but Abbott has (as far as I know) always said it'll be the same price. So that feels unconvincing to me though I haven't seen the UK pricing. I wonder if it's some semi-political choice connected with the need for a smartphone: if you offer it to everyone then only those with a suitable smartphone (or able to buy one) will be able to use it, so that'll skew in the obvious ways. If it's in a different category maybe it's easier to get away with that.)


You may be onto something here Bruce. Perhaps the Libre 3 has been priced in England to be competitive with other CGMs.

Of course over the last two or so years we were told that the Libre 3 price (if one bought it privately) would be the same as the Libre 1 and Libre 2. That appears to be the case for users in Germany.

Logically and commercially, at some stage Abbott are going to want to make the Libre 3 more widely available to UK diabetics (unless the NHS is paying them way over-the-odds per unit for the small(???) cohort who will get the product on the NHS). 

If Abbott does sell eventually the Libre 3 privately, it doesn't make sense not to keep the price point the same as, or close to, the Libre 1 and Libre 2. Especially when Dexcom's upcoming G7 (which I understand will be available to buy privately) is being touted as closer in price to the Libre 1 and Libre 2.

Anyway, I guess I'll know more when I meet with  my consultant later this year. In the meantime, if anyone else meets with their consultant and has "the conversation" it would be interesting to know.


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## Bruce Stephens (Apr 25, 2022)

BadaBing said:


> Especially when Dexcom's upcoming G7 (which I understand will be available to buy privately) is being touted as closer in price to the Libre 1 and Libre 2.


And there's already one or two that are similar to Libre 2 price, so maybe there'll be enough convergence in price that the survivors will end up all being available to anyone who wants one.


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## Benny G (Apr 25, 2022)

BadaBing said:


> I hear you. I really do hear you!
> 
> I will not rehearse the various defences to an intellectual property claim here as this is not the appropriate place to do so.
> 
> ...





Bruce Stephens said:


> That was my assumption, but it seems it won't (in the UK) be so straightforward. I'm still not quite sure why.
> 
> (The reasoning given is that the cost will be different, that Libre 3 is priced to be competitive with other CGMs, but Abbott has (as far as I know) always said it'll be the same price. So that feels unconvincing to me though I haven't seen the UK pricing. I wonder if it's some semi-political choice connected with the need for a smartphone: if you offer it to everyone then only those with a suitable smartphone (or able to buy one) will be able to use it, so that'll skew in the obvious ways. If it's in a different category maybe it's easier to get away with that.)


Thank you for the correction Bruce. It will be interesting to see how the CGM market progresses, it's very niche, but there are huge amounts of money to be made, so fingers crossed the politics can be put aside.


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## Bruce Stephens (Apr 25, 2022)

Benny G said:


> so fingers crossed the politics can be put aside.


I'm guessing at the reasons for treating Libre 3 differently to Libre 2. It might be something else entirely. (Maybe it's as dumb as Abbott offering less of a good offer to the NHS for the Libre 3, for example.)


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## BadaBing (Apr 30, 2022)

Lily123 said:


> The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding



Sorry Lucy123, I didn't reply to you.

The NICE guidelines are - unfortunately - simply guidance and not law. The guidance uses words such as "should offer" rather than "must offer." So neither hospital trusts nor ccgs are compelled to do what the guidance says (although it is considered to be following best practice if they do so).

There is a first instance High Court decision (involving IVF treatment) where the judge decided it was wrong for a ccg to refuse to offer a lady IVF treatment as recommended by NICE guidelines in effect at the time.

Interestingly the ccg decided not to appeal the decision to the Court of Appeal or UK Supreme Court.

That judgement has made ccgs/hospital trusts conscious of the fact that they can be sued successfully in the courts by patients if they fail to adopt NICE guidelines for reasons which are considered "unreasonable" or "irrational" by Her Majesty's judges.

That said, there is rarely such a thing in litigation as a "sure thing/100% winnable" case, which is why 98% of cases are resolved out of court. 

And the NHS has more money to spend on lawyers and litigation than most patients.


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## Lily123 (Apr 30, 2022)

BadaBing said:


> Sorry Lucy123, I didn't reply to you.
> 
> The NICE guidelines are - unfortunately - simply guidance and not law. The guidance uses words such as "should offer" rather than "must offer." So neither hospital trusts nor ccgs are compelled to do what the guidance says (although it is considered to be following best practice if they do so).
> 
> ...


I should have phrased my answer better and that many CCGs would want to inforce the NICE guidelines as mandatory rather than optional


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## trophywench (Apr 30, 2022)

Lily123 said:


> I should have phrased my answer better and that many CCGs would want to inforce the NICE guidelines as mandatory rather than optional


Nah @Lily123 - CCGs pick and choose which ones they treat as Gospel and which they ignore.  If it will save them money - they follow it PDQ.  Otherwise depends which side of the bed they got out of .....


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## Lily123 (Apr 30, 2022)

trophywench said:


> Nah @Lily123 - CCGs pick and choose which ones they treat as Gospel and which they ignore.  If it will save them money - they follow it PDQ.  Otherwise depends which side of the bed they got out of .....


I’m definitely too hopeful for CCGs…..


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## BadaBing (Apr 30, 2022)

Lily123 said:


> I’m definitely too hopeful for CCGs…..


Yes, but to be fair, ccgs and hospital trusts only do what the HM Department of Health - and in reality HM Treasury - direct them to do.


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## helli (Apr 30, 2022)

BadaBing said:


> Yes, but to be fair, ccgs and hospital trusts only do what the HM Department of Health - and in reality HM Treasury - direct them to do.


My understanding is they are in charge of their own budget within certain guidelines. The fact healthcare is a postcode lottery is proof to me that each CCG has some control over where they spend the money the Treasury gives them.


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## Paulbreen (Apr 30, 2022)

Wow, there seems to be quite a fuss with the Libre3, as a user of this device i can point out a few things regarding the L3 compared to the L1 & L2, 
Size about 50% of the L1 &L2
Packaging 50%, maybe a little more less
*Scanning no longer required, L3 transmits to your phone every 5 minutes, phone takes care of informing you of possible alarms.*
It's not much different to the other 2 but the last point about no scanning is its most positive point and improvement.
For those who dont have access to a smart phone or dont want a smart phone then its no good for you as it only works with an app.
At the moment its not compatible with any pumps so it's not much use as an integrated CGM.


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## rebrascora (Apr 30, 2022)

I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does 
It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!


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## BadaBing (Apr 30, 2022)

Paulbreen said:


> Wow, there seems to be quite a fuss with the Libre3, as a user of this device i can point out a few things regarding the L3 compared to the L1 & L2,
> Size about 50% of the L1 &L2
> Packaging 50%, maybe a little more less
> *Scanning no longer required, L3 transmits to your phone every 5 minutes, phone takes care of informing you of possible alarms.*
> ...


Thanks Paul

I understand you are based in Germany. Is that right?

The information you have given is very helpful indeed. 

As I said when I started this thread, I want to get a sense of just how much of a gatekeeper function hospital trusts in England are going to operate in terms of allowing diabetics living in England to access real time cgms now the NICE eligibility criteria have been updated.


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## Robin (Apr 30, 2022)

rebrascora said:


> I guess this is proof that I am becoming an old fogey!


You and me both, then. I find the reader much more manegeable especially on a horse! My phone won’t do facial recognition when i’ve got a riding hat on, I can’t take gloves off to do a fingerprint, or both hands off the reins to type in a code, so apart from the phone being too big and cumbersome (I’d end up dropping it in a puddle) even just looking at it is a non starter. I can fish the reader out of my breast pocket and swipe with one gloved hand.


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## BadaBing (Apr 30, 2022)

rebrascora said:


> I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does
> It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!


Hello rebrascora

Thanks. It's a big deal for me is all I'll say. It is also inappropriate and/or inconvenient to do so during certain moments of the day from a work perspective. 

I have found some civilians (non-diabetics) remain uncomfortable about what the rest of us have to do to try and stay healthy.


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## helli (Apr 30, 2022)

rebrascora said:


> I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does
> It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!


It sounds to me it‘s about your (or my) lifestyle.
I work at a desk with my mobile as my only phone. It is far far easier and far less intrusive to glance at my phone lockscreen whilst I am on a video call (or in a face to face meeting) than to scan my arm.
i don’t want to be “the woman with diabetes” which having to scan identifies me as. As I use my phone and CGM/Libre, I could be glancing at an email or a text or a WhatsApp message which are all things that are completely normal in my business.
My pump is also controlled via my phone so everything is in one place. I can have a lunch meeting without anyone knowing I am checking my levels or dosing my insulin. They probably think I am responding to an urgent email.

When not at work, I use my phone to listen to podcasts or navigate whilst walking as well as checking the news and keeping in contact with friends and family. My phone lives in my leggings’ or jeans pocket. Not at the bottom of my bag. I try to avoid taking a bag out with me.


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## BadaBing (Apr 30, 2022)

There is an international conference taking place in Barcelona this weekend about diabetes and technology. Some of the attendees at that conference have tweeted slides of presentations given about the Libre 3. One of the slides I have seen tweeted suggests that the MARD of the Libre 3 is now 7.8%. 

I always understood the MARD of the Libre 3 was going to be the same as the Libre 2 (9.2%). 

I have no idea whether the claim of a 7.8% MARD is real, but if it is that is yet another reason I would prefer the Libre 3. It's about using the latest tools available to try and stay as healthy as possible for as long as possible.


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## helli (Apr 30, 2022)

I assume MARD is Mean Absolute Relative Difference which measures the accuracy of CGMs.
In my experience with multiple different CGMs, this varies significantly per person.
Dexcom is often quoted as if it is the gold standard of CGMs. For me, Libre with xDrip (I understand this is not an option for you @BadaBing) was far more accurate.
I don’t take too much notice of the “average accuracy”. The ability to calibrate is the most important factor for me and I don’t understand why Libre excludes this capability from their native apps.


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## BadaBing (Apr 30, 2022)

helli said:


> It sounds to me it‘s about your (or my) lifestyle.
> I work at a desk with my mobile as my only phone. It is far far easier and far less intrusive to glance at my phone lockscreen whilst I am on a video call (or in a face to face meeting) than to scan my arm.
> i don’t want to be “the woman with diabetes” which having to scan identifies me as. As I use my phone and CGM/Libre, I could be glancing at an email or a text or a WhatsApp message which are all things that are completely normal in my business.
> My pump is also controlled via my phone so everything is in one place. I can have a lunch meeting without anyone knowing I am checking my levels or dosing my insulin. They probably think I am responding to an urgent email.
> ...


Well said helli! I feel exactly the same. I don't want to be treated differently because I have diabetes.

I believe the Libre 3 would much better protect my right for my medical condition to remain private.


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## BadaBing (Apr 30, 2022)

helli said:


> I assume MARD is Mean Absolute Relative Difference which measures the accuracy of CGMs.
> In my experience with multiple different CGMs,m this varies significantly per person.
> Dexcom is often quoted as if it is the gold standard of CGMs. For me, Libre was far more accurate.
> I don’t take too much notice of the “average accuracy”. The ability to calibrate is the most important factor for me and I don’t understand why Libre excludes this capability.


I don't take much notice of MARDs either day-to-day. But the fact that the claimed MARD is reducing all the time (the Libre 1 MARD is 11 I think) can only be a good thing from a health perspective.

As well as the fact that Dexcom,  Abbott and the others are competing continually to make their product better than their rivals.


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## Paulbreen (Apr 30, 2022)

BadaBing said:


> Thanks Paul
> 
> I understand you are based in Germany. Is that right?
> 
> ...


Yep, I live in Germany, but more than experienced with the NHS, things are aa little different here and when something becomes available the health insurance companies will decide if they will pay for the new treatments, most of the time they do and you dont have to wait too long for said items to get to the people who need them, there are no multiple layers of interference from the government both nationally and locally. 
As a guess 2023 maybe 2024 the Libre3 will come over there, your normally 18 months to 2 years behind what happens here.


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## Paulbreen (Apr 30, 2022)

rebrascora said:


> I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does
> It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!


Hey Barbara, I've never really looked at the phone to see what my BG was doing, I just set the alarms to give me a good enough warning to be ready to do something about it, and I'm with you being a progressive old fogey lol, I'm just a bit of a nerdy one. have a great weekend


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## Jgarrity (Apr 30, 2022)

Lily123 said:


> The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding


Hi I just saw you said that everyone is entitled to at least libre 1 is this true? I have a friend who is in his 30s a scaffolder and has just been diagnosed with type one and I know this would help him massively I have already told him to bring it up with his gp but would love further confirmation to help him out 
Thanks 
James


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## Lily123 (Apr 30, 2022)

Jgarrity said:


> Hi I just saw you said that everyone is entitled to at least libre 1 is this true? I have a friend who is in his 30s a scaffolder and has just been diagnosed with type one and I know this would help him massively I have already told him to bring it up with his gp but would love further confirmation to help him out
> Thanks
> James


It says it is best practice so should be 

NICE guidance

Offer adults with type 1 diabetes a choice of real-time continuous glucose monitoring or intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) based on their individual preferences, needs, characteristics, and the functionality of the devices available.


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## helli (Apr 30, 2022)

Jgarrity said:


> Hi I just saw you said that everyone is entitled to at least libre 1 is this true? I have a friend who is in his 30s a scaffolder and has just been diagnosed with type one and I know this would help him massively I have already told him to bring it up with his gp but would love further confirmation to help him out
> Thanks
> James


As @Lily123 says, thsee are the current NICE guidelines
However, they are only “guidelines” so maybe interpreted differently (or ignored) by each CCG and it is recent guidelines so may take some time to be implemented for everyone with Type 1. They are not an “entitlement”.
That said, before the recent guidelines were published, more than 50% of people with Type 1 in England, had Libre.
Therefore, it is definitely worth your friend asking but he may have a higher chance of getting Libre on prescription if he asks his diabetes team rather than GP. It was only a diabetes consultant who had access to the “Libre fund bucket”.


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## BadaBing (Apr 30, 2022)

Lily123 said:


> The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding


Hello Lily123

With all due respect, I don't agree with your interpretation of the new guidelines.

First, the NICE guidelines are simply guidance, not law. NICE have now recommended that if patients meet the stated criteria then hospital trusts should offer real time cgms or flash cgms having regard to the patients individual characteristics, preferences and wishes. 

I agree that hospital trusts cannot be compelled to do so (although if their reasons for refusing are unreasonable or irrational, those reasons may be subject to challenge in court).

Of course not every T1 (nor every T2s who meet the criteria) who meet the criteria will get a real time cgm. That goes without saying.

But if one thinks about the actual language that has been used in the updated NICE guidelines, it envisages that some patients ought to receive the Libre 3 (or another real time cgm) if they prefer to have one. 

If I am wrong about that, it begs the question: why have the NICE guidelines been updated in such a manner to hold out the reasonable expectation that some within our cohort may receive a real time cgm if in fact and practice it will never be offered?

Of course, I may not be eligible to be offered a Libre 3 (or another real time cgm). But if I understand your reasoning correctly, it means that no one else would either; even if they meet squarely one or more of the new criteria and it is their "preference," "wish"  or because of their "individual characteristics" (words that appear clearly and unambiguously in the updated NICE guidelines) they want to have a real time cgm rather than a flash cgm.


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## Lily123 (Apr 30, 2022)

BadaBing said:


> Hello Lily123
> 
> With all due respect, I don't agree with your interpretation of the new guidelines.
> 
> ...


You have already written me a similar reply to the same post if you look on page 2 of this thread you should find it.

As I have stated in another post, it is best practice for CCGs to adhere to the guidelines but like you have said, they don’t have to. 

Following this guidance by NICE a vast amount of CCGs would probably offer Libre 1 or 2 and would less often prescribe Libre 3 or equivalent. ( it may play out differently but this seems probable)


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## rayray119 (May 2, 2022)

Lily123 said:


> The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding


I thought they said it should be a choice between the two


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## Lily123 (May 2, 2022)

rayray119 said:


> I thought they said it should be a choice between the two


The guidelines state that every adult with T1 is entitled to either Flash or CGM. _But _ that doesn’t mean that is how CCGs will enforce it


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## rayray119 (May 2, 2022)

Lily123 said:


> The guidelines state that every adult with T1 is entitled to either Flash or CGM.


Hmm yes partha clarifyed it as a per however my ccg in their stamenment said something along the lines "we will update the pathways prople with diabetties will need to follow" there wasn't supposed be any.


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