The FreeStyle Libre 3 is about the size of two stacked 1 USD cents (or 5 Euro cent) coins.

FreeStyle Libre 3 miniaturizes real-time glucose monitoring

I’ve worn the FreeStyle Libre 2 flash-glucose monitor (FGM) on my upper arm for the last three years. As a diabetic, I need to pay close attention to my glucose levels, and the Libre 2 was a revolution compared to finger-prick blood tests every couple of hours. The new Libre 3 system is a highly-anticipated update that massively improves on the Libre 2.

I don’t usually talk about products that I don’t have any first-hand experiences with, but I’m making an exception here. The Libre 3 isn’t yet available in my market, but I’m genuinely stoked about the next-generation FreeStyle continuous glucose monitor (CGM).

The Libre 2 continuously measures glucose levels and optionally sends alerts to your phone when the levels go out of range. To see the glucose readings, you needed to put a reader or your smartphone up to the sensor and hold it there for a few seconds. The last eight hours of glucose readings are transferred to your reader using near-field communication (NFC).

The new Libre 3 still uses NFC to pair and activate the sensor. However, it sends glucose readings every minute over Bluetooth Low Energy (BLE) to your smartphone. The readings can be automatically relayed via your smartphone to a guardian or another person, making it an excellent option for kids. It turns it into a CGM instead of a FGM.

I’m looking forward to not having to do battle with NFC throughout the day. I love my Libre 2, but it’s also frustrating to align two tiny NFC antennas by reaching behind the arm/shoulder. It’s not like I can see what’s going on, and NFC and the LibreLink app are quite unforgiving. Beep! Beep! Beep! Try again.

Better glucose management leads to better long-term health outcomes for diabetics. It’s literally a life-extending diagnostic tool. A CGM lets diabetics more quickly handle glucose events like critical hypoglycemia and hyperglycemia. Without a CGM, the best alternative is an expensive trained diabetes dog that can recognize these changes to your body from changes in your odor.

A CGM is nothing new; they’ve been around commercially since 1999. The revolutionary change is the advances in miniaturization. The Libre 3 sensor is 21 mm × 2,9 mm and weighs 1,1 g. For comparison, the Libre 2 sensor is 35 mm × 5 mm and 5 g.

The FreeStyle Libre’s closest competitor is Dexcom. It has made CGMs for years, but the sensors are the size of a small toy car. Dexcom’s current model, the G6, is roughly four times the size and over five times the weight of the Libre 2. Its upcoming model, the G7, is only slightly larger and heavier than the Libre 2. Just as Dexcom is about to catch up with the Libre system, Abbott significantly increased its lead in the miniaturization of body-worn sensors.

The FreeStyle Libre 3 is currently only widely available in Germany with limited availability in the Netherlands. (Some availability in other regions through resellers of German stock.) Additionally, it should become available through the national health services in Finland, the Netherlands, and the United Kingdom sometime in 2022.

You can also find country-specific apps for Android on the Google Play Store for France, Norway, and Sweden. The Libre 3 is not yet available in any of these countries, however.

Abbott has focused on the European market when launching new FreeStyle Libre systems. The nationalized health care systems throughout Europe have enormous coordinated purchasing power compared to other countries like the United States.

The Libre 3 is compatible with Android in every launch market, and iOS in Germany. Most articles, blog posts, and reviews of the Libre 3 inaccurately claim that it’s incompatible with iOS. Country-specific documentation says the Libre 3 is not compatible with iOS, except in Germany. This suggests it’s an issue of red tape and staggered market roll-out, and not a technical limitation.

Additionally, Abbott now promotes that the FreeStyle Libre system supports some smartwatches: Fitbit Versa 3 (Android and iOS), Apple Watch Series 7 (iOS), and Samsung Galaxy Watch 4 (Android). The integration requires the paired smartphone to be within range to receive the glucose measurements. The phone receives the glucose measurement and then forwards it to the smartwatch. The feature relies on notification mirroring, and should be available through any smartwatch, app, or device that supports notification mirroring.

The Libre 3 has not improved at all on other important aspects of its ecosystem. Users are still obliged to agree with new lengthy shrink-wrap contracts every couple of months to continue using the system. A shrink-wrap contract is a legal document, e.g terms of service or a privacy policy, presented to the customer after they’ve already purchased a product or service.

The data from the sensor is still encrypted, and you’re required to use the FreeStyle Libre app. You can’t transfer your real-time or historical glucose measurements to other health platforms or diabetes treatment apps.

The Libre sensor is still an invasive measurement sensor; meaning it punctures the skin which can be painful and cause infections. The Libre 3 Sensor still only lasts two weeks before you need to replace it. The time limit is partially there to lower the risk of infection and give the skin time to heal.

Abbott has publicly stated that it will match the current price of the Libre 2, the most inexpensive FGM/CGM on the market. Abbott has not announced a stand-alone reader device for the Libre 3, so you need a current model of a mid- to high-tier smartphone to use the system. The Libre 2 Reader device has also been unavailable for months, likely because of the global microchip shortage.

The ongoing cost makes the Libre system unaffordable to many diabetics around the world. There are currently dozens of alternative noninvasive glucose monitor (NIGM) systems in development. An NIGM is the dream (and more affordable) solution. While we wait for NIGMs to hit the market, I’ll cherish a smaller CGM as a welcome improvement.