App Practice Diabetes

Dexcom Vs Libre

Libre by Abbott was launched at the end of September and there are a lot of questions on how this would compare to Dexcom.  I outlined 3 key differences between Libre and Dexcom.

These are:
1.  Technology
2.  Diabetes market
3.  Business structure 

In summary, (spoiler alert) the short term winner is Libre, but Dexcom wins long term, unless Abbott makes some specific changes.

First, there is the matter of technology. Libre uses NFC technology.  This is near field communication (NFC) and works only when two devices are close by. This means that the sensor that’s on the skin and the receiver that actually shows the glucose numbers have to be close to each other in order to see the sugars. You have to wave the receiver over your sensor each time you want to view your sugars.

Dexcom uses bluetooth technology. This means that the two devices are always connected.  This is analogous to your bluetooth headphones, speakers, or your phone to your car.  Your phone does not have to be near to change the song on the bluetooth speaker across the room.

Dexcom’s advantage is the ability to have alerts for sugars as they happen. Your phone will alert you if your sugars are too high or low. This is very crucial for patients on insulin.  You need to know when your sugars increase or decrease right away instead of hours later.  Because of the NFC technology, the receiver will not know when the sugars are critically high or low.

We live in a world of instant gratification.  We want information and we want it now. Bluetooth gives us that.

Technology winner: Dexcom

Second, the diabetes market is the market of patients that each sensor will be appropriate for.  Dexcom has been ideal for patients that are on insulin, with or without the pump.  However, Libre is for all patients with diabetes.  Maybe not that ideal for those taking insulin because of the alert feature, but the market share for Libre is much larger.  About 70% of the 30 million patients, or about 20 million patients do not take insulin.  This is the potential reach for Libre and it is double that of patients taking insulin or insulin and oral medications.

Libre will change the way we manage the patients not taking insulin.  Libre will be the one responsible for destroying the glucometer market.  Why check your fingers when you can use the Libre?

Also, currently, the guidelines do not support to measure sugars all the time in the patient that is not on insulin unless risk of high or low sugars.  You have to consider what long term implications Libre will have on these guidelines.  Will they change and adapt to more sugars.  Can we do more because we have more data?  We shall see.

Diabetes Market winner: Libre

Third is business structure.  I like to call it culture.  The culture of Dexcom has always been to share, share and share.  They have opened up their marketing, hardware and software to integrate with other insulin pump companies, software companies and are always looking to share their data.

The contrast is Medtronic and their long inability to share with other insulin pump or software companies.  Dexcom can share because they only make a CGM and do not make a pump.  Looking at Libre, they are made by Abbott, a very large pharma company which is usually very slow to adopt and partner with others, especially smaller companies.

Going forward, the future will be created by the smaller companies and their ability to create partnerships.  These partnerships will lead to true innovation and the future we are looking for.

Business structure and long term winner: Dexcom

Summary

Libre will change the way we manage patients that are not taking insulin and it will totally destroy the glucometer market.  This is short term.  In order for Libre to come out ahead, Abbott needs to start sharing their data with everyone, get an iphone app (which i hear is coming soon)

Long term, Dexcom will create a system that is similar to Libre.  They will need to lower cost and make it easier for patients to use and get rid of the calibration that is currently required.  All of which they are working on.  This will allow them to compete in the same diabetic market space as Libre.  But the bluetooth technology and the ability to share and look for partnerships will make Dexcom the clean winner long term.

Photo shown is the Dexcom G6, this is dexcom working their way into making things smaller.  Along with this, they will go away from the need to calibrate.  Stay tuned, diabetes just got more exciting.  (as if it wasn’t crazy before)

What are your thoughts?
Do you think all of this will change the way we manage patients?
Do you think this will make your life easier as a patient?

7 comments

  1. All the whiz-bang toys are great for those who can afford them and/or those whose insurance covers them.
    I wore a Dexcom myself for years, and thought it was less than accurate – certainly not enough to forgo finger sticks entirely.
    The inability to take any Tylenol-containing products while wearing a sensor was also a non starter for me.
    As a type 1 person with diabetes for nearly 35 years, it would be nice if basic insurance covered all of the things needed for survival. Right now we live in a world where people with diabetes are being treated like second class citizens or ‘takers’ unworthy of the same consideration as healthy people.

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    1. Libre does not have the Tylenol issue, is far more affordable and smaller than DexCom. You can get started for under $200 for the first month with Libre whereas it will cost you upwards of $1200 with DexCom.

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      1. These are some of the reasons why Libre will win in the short term. Cheaper, no tylenol issue and bigger market to go after (the patients who don’t take insulin). Thank you for posting the $$ amounts!

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  2. Thank you for your summary. I think Libre will be good for Dexcom to continue to adapt technology and cost challenges. I prefer the accuracy and alarms with Dexcom for patients using insulin. I wonder how many patients with Type 2 diabetes will invest the money and be persistent with Libre. Type 2 diabetes doesn’t have the immediate consequence of not monitoring blood glucose like we see in patients with Type 1 diabtetes. I have my guess but I look forward to seeing the outcome in the future.

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    1. It’s all an evolution. We can’t see the world of type 1 without a CGM. How did we ever get along without one? What if the same thing happens in type 2? What if the cost goes down so much and we see more and more value in these patients and we will think the same thing in type 2. I too look forward to the future, it’s very exciting!

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