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Comparison of the Freestyle Libre 2 and
Freestyle Libre 3
What are the main differences in the technology?
The latest iteration of the Abbott Freestyle Libre systems, the Libre 3, was approved for sale in the U.S. in early 2022. Unlike the Libre 2 which requires scanning the sensor with a reader or smartphone, the Libre 3 is a real time continuous glucose monitor (CGM). It employs Bluetooth technology to automatically transmit glucose data every minute to either a smartphone or the optional reader. The Bluetooth transmission range is 33 feet, and beyond that range no readings or alarms are received. Once the smartphone or reader is back in range all the missing data is quickly transmitted to the device. The Libre 3 has a MARD (mean absolute relative difference) of 7.9, much improved from the Libre 2 MARD of 9.3.
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The sensor
- The Libre 3 sensor is smaller than the Libre 2 and is about the size of two stacked pennies as opposed to two stacked quarters with the Libre 2.
- Both the Libre 2 and Libre 3 sensors are approved for application to the back of the upper arm.
- Libre 2 has a two-piece and the Libre 3 a one-piece disposable applicator.
- After application, both systems are activated by touching/scanning the sensor with the smartphone or reader and after the ensuing 60-minute warmup, readings will appear on the screen.
Apps
- Libre 2 and 3 have different apps that are not interchangeable.
- After downloading the proper app, a LibreView account can be established to share data with the health care provider and a LibreLinkUp account to share readings and alarms with friends or family.
- Internet connectivity is required to share data.
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Alarms
- Both systems have optional and adjustable high and low glucose alarms. The urgent low alarm is set at 55 mg/dL and cannot be turned off.
- Alarms are communicated by sound or vibration. When an alarm is detected, the glucose is automatically shown on the screen of the Libre 3 while the Libre 2 must first be scanned.
The screen
- The Libre 2 displays 8 hours, and the Libre 3 shows 12 hours of data.
- Glucose is displayed over a color background, green in range, red below 70, yellow above range, and orange over 250 mg/dL. Beside the number are arrows pointing up for rising, level for steady, and down for dropping.
- The remaining sensor life is shown along with dropdown menus for more information.
3MinuteExtraMile suggested action steps:
- Make it clear that the Libre 2 and 3 must be activated by the reader or a smartphone but whichever method is used to activate must be used for the life of that sensor.
- Confirm that the person’s mobile device is compatible. The Libre 3 reader is in short supply and people will need a compatible smartphone. Consult the current device list on the Freestyle website.
- Get familiar with the Libre system apps and offer to help patients interpret data. People with low numeracy skills can use colors and lines instead of numbers to see cause and effect.
- Be prepared to explain why, when using a blood glucose monitor to verify a CGM reading, the readings may not match, especially when glucose is changing rapidly.
Resources
Danatech (educator’s site)
Diabetes Wise Pro (all the diabetes technology here)
Freestyle
August Pharmacy newsletter featuring CGM Monitoring for Pharmacists
James Bennett BsPharm, BCGP, CDCES
Bozeman, MT
The Montana Department of Public Health and Human Services does not endorse any, specific diabetes product. This is for informational purposes only.
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