Why is Abbott’s FreestyleLibre system like Viagra?

This week viagra went on general sale. I remember when it first came out, in fact, I think I’ve still got the keyring, the rep told me they would be collector’s items! When it was launched it hit the news for several reasons, it was a revolutionary treatment, it was about sex which the British find difficult to talk about and the government worried it would bankrupt the NHS and therefore heavily restricted its use. There were fears everyone would want it, and demand presumably 2 or 3 tablets a day and this would cost a fortune. So we had crazy rules introduced where you had to for example prove to a consultant psychiatrist that it was causing you severe mental distress before you were eligible. The reality was apart from some banter down the pub – most people who wanted it, wanted it because they were having problems and usually found it really difficult (I almost said hard) to come in and ask for it. Men still do. In reality, not that many asked for it, most genuinely needed it and actually most only needed it a few times as a lot of ED is psychological and a few good goes rebuilds confidence. Now it’s on general sale and ok the cost has come down but it’s not bankrupted anyone.

We see this over and over with new drugs. They come out and people panic they are going to bankrupt the NHS then a few years later everyone is using them. Ok when they first come out they tend to be very expensive and that worries, however, I suspect while some of this is to try and recoup the expensive development costs, some of it is to help with the marketing budget, some of it is everyone knows uptake will be slow. You wonder if a deal was done whether the launch price could be a lot cheaper if there was a guaranteed usage from day 1.

The other issue is lack of joined-up budgets. Let’s go back to Viagra. Everyone was bothered about the drugs budget, largely because the medicine management people have a strong voice and their budget is easily reported on and they fear for their jobs. In reality, how many GP appointments at £46 a time, how many referrals to urology and psychiatry happened at who knows what cost? how many people found it harder to get in to see their GP because they were clogged up explaining why they could prescribe it?

We see this over and overweight loss drugs are the latest. The NHS is afraid of weight loss drugs despite there being some really good ones out there at the moment which seem to work.

So to FreestyleLibre, despite our prime minister wearing one and presumably finding it useful, we are currently being locked down from using it. What is it? well, its a clever sensor that sticks to your upper arm, a little needle sticks into your arm and detects interstitial glucose which approximates blood glucose – a measure we use all the time. You can read it with a NFC device and you can either get instant readings or you can get a time profile. Its revolutionary and potentially a game changer and I’m sure in a few years we will be giving everyone one – or an improved successor product. We will be using it in all diabetics and I believe in pre-diabetics who if they can alter their lifestyle and behaviour they can prevent or delay the onset of diabetes which would be a huge win – though not in the same financial year – another issue the NHS has!

I’m actually quite familiar with the device, in my clinical trials unit at the surgery, we used a version of it several years ago and I was blown away by it then. We used the PRO version which was only retrospective readings and we piloted some of the reporting tools they used. We used it on insulin-treated type 2 diabetics and the data it presented was amazing.

2 highlights were –

HBA1C levels which by their very nature are averages are no real indication of control. Some patients with normal(ish) HBA1cs had sugars all over the place. In INR terms we are now used to thinking about TITR time in therapeutic range, for HBA1C we could do with something similar, the equivalent of standard deviations from the mean – vague recollections of statistics here…

Second, it was frightening how many people were hypo overnight despite being normal during the day.

I could go on, showing people the effect of different foods and exercise on their sugar levels could be huge, linking sugar levels to automatic or AI dosing particularly with insulin pumps or the like could produce more physiological dosing, suffice to say watch this tech – its the future starting now and in a few years it will be commonplace.

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