A Diabetes Monitor That Spares the Fingers
For the past year and a half I’ve been buying a medical device from Italy that has improved my life immeasurably. It wasn’t easy: I roped in a good friend who had moved to Milan to buy the device and ship it to me because it wasn’t yet available in the States. And it was expensive: over $1,600 a year.
But my black-market purchase helps me manage my Type 1 diabetes without the need to draw blood from my callused fingers 10-plus times a day to track my glucose level, a ritual that had been an unpleasant part of my life for decades.
The FreeStyle Libre, made by Abbott, is a flash glucose sensor that allows people with diabetes to view our blood sugar every minute of the day without a single finger prick. While there are similar devices on the market — called continuous glucose monitors, or CGMs — the Libre is the least invasive one I’ve seen. It takes readings from a sensor under the skin but doesn’t require finger sticks for calibration, and is about the size of a quarter and as thick as two. And it’s helping me keep my diabetes under better control.
There have been some challenges: The Milanese UPS store wanted a letter detailing exactly what was in the box. My credit card’s fraud department called (“Yes, the charge for $365 from Milan is mine”).
So I was thrilled to learn that the Food and Drug Administration recently approved the sale of the Libre in the United States, a decision that may help some of the 29 million Americans with diabetes.
The Libre I buy from Italy has a self-adhesive, waterproof white sensor that sticks to my arm for 14 days. It took some trial and error to get used to it. One sensor flipped off from over-aggressive toweling at the gym; another came loose after a backpack strap nicked it. Finally, rather than the spot on my outer arm that the manufacturer recommends, I tried putting the sensor on the inside of my arm, which is where it rests right now. It’s barely noticeable, although occasionally a small child will demand to know what it is.
I can see real-time results on a small digital reader (or an Android phone app): an arrow going up, down or level alongside my blood glucose number. The resulting data set — averages, trends and patterns — monitors my glucose status 24/7.
At first, scanning the Libre to check my results after breakfast, lunch or dinner was like bingeing on my favorite Netflix show. I’d show the readout, a blue line with peaks and valleys, to friends and family: Look how I stayed in the normal range all day!
Or the flip side: Look what happened after an intense workout. Even without food in my stomach, my blood sugar often, but not always, rose during exercise, which made planning tricky. The device gives me a window to the impact of cortisol, a stress hormone, which prompts a rush of glucose into my bloodstream.
After a year and a half of paying well over $2,000 out of pocket — six sensors every three months along with shipping fees — my condition has improved. My hemoglobin A1C now clocks in around 6.3 to 6.5, down from 7.0, and my doctor is thrilled. (An A1C level of 5.7 percent is considered normal in people without diabetes.)
Jeffrey Brewer, the chief executive of Bigfoot Biomedical, got his hands on a Libre early (on eBay) and plans to use it as a component of the artificial pancreas his company is working to develop. Mr. Brewer, who has a son with Type 1 diabetes and is a former president of the Juvenile Diabetes Research Foundation, said it’s the first glucose monitor “that people really love.”
Dr. David Lam, associate director of the Mount Sinai Diabetes Center in New York, currently prescribes a Dexcom CGM, a device similar to the Libre but which requires calibrating with a finger stick twice a day, to his patients with Type 1 diabetes. (Insurance companies typically cover the cost of these devices for people with Type 1 but not Type 2 diabetes) Dr. Lam sees potential benefits in using the Libre or similar devices for anyone with diabetes. “It’s not only a diagnostic tool, it’s an educational tool. You learn how foods affect your body, you can see trends, and you can predict lows and highs,” he said.
Dr. Pratik Choudhary, a senior lecturer and consultant at the diabetes center at King’s College London who previewed the Libre early on, said there are limits to its usefulness. “It is just not cost effective at current prices,” he said. Dozens of studies have shown that continuous glucose monitoring leads to lower hemoglobin A1C results but for someone with tight control (like me), a half point percent change in A1C is a “minimal improvement to quality of life.”
Still, how do we quantify peace of mind?
The treasure trove of data I get from the Libre — days, weeks and months of data — has made it easier for me to manage my life. Learning that it would be available by prescription at major pharmacies in the States late this year seemed like great news.
But the model sold here will have a 10-day sensor, rather than the 14-day sensors used worldwide, along with an extended warm-up time — 12 hours for the F.D.A.-approved version versus one hour for my Italian model. That seems like a step backward. I also don’t know how expensive it will be, or whether my insurance under the increasingly shaky Affordable Care Act will cover it. Until those questions are answered, I may stick with my Milan-to-Manhattan route.