Abbott Removes Freestyle Libre Diabetes Monitor From Diasend Platform

Liam Davenport

February 20, 2020

It has emerged that patients with diabetes using the FreeStyle Libre glucose monitor can no longer connect the device to a popular open data management system widely used by clinics and patients alike to help manage the condition after Abbott unilaterally blocked its FreeStyle Libre device from connecting to the system.

Although patients can still upload their data via a direct USB link, they can no longer wirelessly connect the Freestyle Libre to the diasend by Glooko data management system, in a move described as "very strange" by a diabetes expert.

The announcement was made January 20 on the patient frequently answered questions (FAQ) section of the diasend by Glooko website and attracted a swift response from the UK National Health Service (NHS), which bemoaned the "unnecessary work and cost" involved with closed, rather than open, intraoperable systems.

In a letter, the NHS underlines the need for interoperability between devices and systems in an "open and standardized format" and raises the prospect of linking such interoperability to future funding decisions.

Simon O'Neill, director of health intelligence and professional liaison at Diabetes UK, said the charity "strongly supports" the NHS's call for greater interoperability. In a blog post, he underlined it is "vital" that wearable diabetes devices "can upload the data they store to the same systems."

He added that noninteroperable devices risk entrenching a so-called "postcode lottery" for access to care in the UK, in which healthcare commissioners in certain areas "are forced to reduce the number of devices available to patients in order to reduce the number of systems they have to pay for."

Although Abbott provided Medscape Medical News with a statement, it is still not entirely clear why the company has made this decision. Twitter users have suggested the company "is pushing" its own similar platform, called LibreView.

Decision Affects All Countries Except Sweden and Norway

The FreeStyle Libre flash glucose monitoring device is very popular among patients with type 1 diabetes in Europe. In the UK, only patients with type 1 diabetes are eligible to receive a FreeStyle Libre on the NHS.

The FreeStyle Libre is also available in the United States, although many experts believe it may be used to a greater extent by patients with type 2 diabetes.

Many American patients with type 1 diabetes prefer more sophisticated continuous glucose monitors (CGMs) such as those made by Dexcom, which have more advanced features than the FreeStyleLibre.

All such glucose monitors can be paired with data management systems, such as diasend by Glooko, which is described as "the world's premier diabetes data management platform." The two companies, diasend and Glooko, were initially competitors based primarily in Europe and the United States, respectively, but a few years ago they merged to form one company

Such platforms enable patients to sync data from devices such as insulin pumps and glucose monitors so that all of the information can be viewed in one place. They can also log meals and activities, for example, inputting information from fitness trackers. 

Speaking to Medscape Medical News, O'Neill explained that one of the most common uses for pairing devices with such platforms is when patients with diabetes come to clinic. "They take the device off...and download the data, so that when [they] see the consultant, all that data is there, already shared in the simplest way possible," he said.

Anders Sonesson, general manager of Glooko AB, added that, using their system, patients can also upload their data remotely on a regular basis.

"Sometimes they pick up the phone and talk to the clinic, saying: 'I want to discuss my values from last week' or 'I have issues with [blood glucose values] during nights or after lunch,'" he explained to Medscape Medical News.

Glooko learned late last year that Abbott had decided to end the ability for Freestyle Libre to upload data from the LibreLink mobile app to diasend in all countries, aside from Sweden and Norway. (In the United States, this ability was never available.)

Sonesson explained that they entered into discussions with Abbott to try to understand the decision and convince them to change their minds, but to no avail, and the move was announced by Glooko just before Christmas.

In their patient FAQs, Glooko says that, from January 20, 2020, the ability to upload data was removed "until further notice" and that diasend by Glooko "truly regret this development and want to clarify that this decision is certainly not our wish."

Glooko adds: "We fully understand that this will have a negative impact on your diabetes management and share your frustration."

O'Neill described the decision as "very strange," adding: "What we're not sure about is exactly why they [Abbott] have taken that decision. It seems to us a slightly backward decision when the technology itself can still connect to diasend but just in a cabled way, rather than wirelessly."

However, one diasend by Glooko user, who described Abbott's decision as "a bit of a pain, as I certainly find diasend much easier than LibreView," suggested: "I guess Abbott just don't want anyone else getting in on the act."


Device-Specific Proprietary Formats Create Unnecessary Work and Cost

In response to Abbott's move, the NHS in England, together with NHSX — which oversees the digital transformation of the NHS and social care — penned its letter, aimed at the FreeStyle Libre manufacturer and other device companies in the diabetes field.

The letter, which was signed by Simon Eccles, deputy chief executive at NHSX, and Partha Kar, MBBS, MD, the national specialty advisor for diabetes at NHS England — and is available to view on Kar's Twitter account (@parthaskar) — says that using device-specific proprietary formats "creates unnecessary work and cost, particularly when there are existing and widely used solutions to view data which are device-agnostic."

"In addition, holding patient data in silos will impact wider innovation, which could have otherwise used this data should individuals wish."

Eccles and Kar say they "expect that diabetes monitoring devices must be capable of providing patients and clinicians data in an open and standardized format."

"Having interoperability features is a strongly desirable characteristic as we look ahead and consider how best to provide greater access to technology in type 1 diabetes care."

Sonesson welcomed the letter from NHS England and NHSX, saying that their call for greater interoperability between diabetes devices "truly makes sense, and I think other countries will do the same."

Meanwhile, Hilary Nathan, director of policy communications at JDRF, a type 1 diabetes charity that recently launched a report setting out recommendations to ensure people with type 1 diabetes can access wearable technology, said in a press release that JDRF is "delighted to see this clear message from NHS leaders."

Nathan continued: "Standardizing the way people living with type 1 diabetes can use their data alongside their healthcare teams makes absolute sense and will help people to make choices about the devices that best suit their needs without having to worry about learning to navigate new data platforms too."

The NHS letter also underlines that "the use of international open standards and interoperability solutions will be a key consideration for funding decisions for existing and new technologies which come to the market."

Unified Way of Viewing Data From Diabetes Devices Will Be Required

Sonesson said that similar communications to that issued by the UK NHS have been published in Norway and Sweden, and that some regions in Sweden have even made open data solutions — for the benefit of patients and clinics alike — a requirement of their tenders.

He noted that, with the wealth of novel devices coming to market — including "connected" insulin pens as well as new CGMs — clinics, governments, and even companies will "realize that they need to have a unified way of viewing data."

O'Neill agrees, saying, "As we get more and more tech in this field for diabetes, with people using multiple devices, the importance of them talking together is just going to become more and more paramount."

"So we really hope that all manufacturers take heed of this and make sure they do try and make their systems interoperable."

Sonesson hopes that, in the long run, companies such as Abbott will focus most on developing their devices and leave the data management side to the market.

And what if Abbott were to come back and say they would like to reconnect to the diasend by Glooko system?

"We would love them to come back," Sonesson said, "and we would love to have all the other devices as well, as it makes it so much easier for everyone involved."

Abbott Responds...

In a statement issued to Medscape Medical News, Abbott said it "recognizes the importance of interoperability," adding it "supports tools that facilitate secure, reliable, and easy access to continuous glucose data for patients, their caregivers, and healthcare professionals."

"We have been engaging with key stakeholders and health systems globally to incorporate glucose data into physician and other caregiver workflows as well as electronic medical record systems for greater efficiencies," Abbott adds.

The statement continues that, as well as providing "free digital health services," the company is "actively partnering with insulin delivery and digital coaching companies to provide a more connected and seamless experience for customers."

Sonesson is an employee of Glooko.

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