Freestyle Libre's Data-Driven Approach to Diabetes

Tim Dunn, PhD, the director of clinical and computational research at Abbott Diabetes Care, sat with MD Mag at the American Diabetes Association's 78th Annual Scientific Session to discuss the benefits the Freestyle Libre continuous glucose monitoring system (CGM) provides for both the patients and providers.

The system, approved by the US Food and Drug Administration in September 2017, reduces the requirement of “fingerstick” testing, where patients with diabetes would be required to prick their fingers to gather a blood glucose sample. The system uses a small sensor wire that is inserted below the surface of the skin and continuously monitors and measures levels.

Dunn emphasized how the data the system provides allows providers to examine trends and variations in their patients' use of the CGM, as well as a route to focus the required discussions about improving their outcomes quickly. He also noted how, for patients, the focus for the system has been to streamline the ease of use, as well as ensuring that the system is affordable.

Tim Dunn, PhD:

The focus from the beginning has been ease of use for the patient, and the big step forward has been the factory calibration of the device. The sensor does not require calibration of the fingerstick, [patients] just simply place it—it's very easy to use insert, it's a 1-step process for putting it on—and then they're able to check the glucose without doing routine a fingerstick. That's, I think, the first step in terms of the hassle factor of just getting the system to work.

Then, simply by having it work wirelessly, with quick scans and being very discreet, it can be very quick. They're able to get that information they need in terms of the current glucose, the trends that they're going [through], and also the recent 8-hour history. That's been the big focus—how do we make it quick and easy for the patient, and with some level of discretion, so that they're able to manage [their glucose]. That's why we see some of these good adoptions and frequent use of the system.

Then the cost has also been a continuous focus for us, in terms of how do we make it perform for the patients’ needs, but also at a price that is reasonable? That's been an ongoing focus for us.

The Freestyle Libre reader stores 90 days of memory, so when [patients] go to the clinician, or even from home, they can use the cloud-based reporting software, upload the data, and then there are a number of reports. The quick summary reports do show very important things about what's the average, what's the variability, what's the pattern over the day, so you get that full glycemic picture to make the focus on what the primary issue is to address.

Then, there are also summaries of how often the scans are being done—checking the glucose, how often is that done—and when are they being done during the day, so it focuses a discussion really quickly on what's important for that patient. I think there has been a really strong adoption of that.

There have been a lot of nice case studies shared at our symposium from Irl Hersh, [MD, from the University of Washington Medical Center] and Kurt Midyett, [MD, from Saint Luke’s Health System] on their experience with it. The discussion between the patient and clinician, it's directed really quickly depending on what the data show, and if it is a question of “you’re not checking often enough, that should be something we should focus on,” that becomes the discussion. Or it might be a discussion on hyperglycemia, or maybe it's the discussion about high glucose levels, so it is really enriched with what [physicians have] been telling us about the discussion of what they're able to talk about [based on the reports].

We do try to be as clear as possible, and I think the meta-analysis [presented at the conference] is very much in line with what people expected, in terms of collecting a lot of studies and getting that overall impact analyzed. I think from the real-world data, I do want to emphasize that people are using it. They're checking the glucose a lot—that is normal, what we're seeing. On average, people are checking 13 times per day, and 50% of all people are somewhere between 8 and 17 times per day, so that's typical use. That is, I think, something to consider when people are seeing [its use] on a personal basis.

Transcript edited for clarity.

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