Episode 39, Abbott FreeStyle Libre 2 Plus and 3 Plus

Why this episode exists

Most people wearing a FreeStyle Libre will, at some point, have had a hypo their clinician could not see. The number on the phone said three; the download in clinic said nothing. The conversation that follows is often awkward and often unnecessary, because the explanation is structural and the structure is rarely explained. This episode is the version that puts it on record.

It is also the version that goes through the accuracy data, the form factor decisions on the Libre 3 Plus, the LibreView Pro integration into electronic health records, and the continuous ketone monitor Abbott has in validation. Each of those topics has practical clinic consequences. The hypo that does not show up on a download is just the easiest one to start with.

In this episode

Michael Skarlatos trained as a diabetes specialist dietitian, spent years at University Hospitals of Leicester supporting structured education, technology onboarding, and clinical research through the Eden team, before moving to Abbott’s UK Medical Affairs function. He brings a perspective unusual in a manufacturer representative: he has delivered the clinical education he now supports from the other side, and he has worked with the people for whom these devices are daily life.

The conversation moves from the accuracy baseline, iCGM approval and what the 20/20 and 40/40 performance figures mean, through the form factor story of the Libre 3 Plus, into pump integrations, the LibreView platform, electronic health record integration, and a frank discussion about what Abbott has in development for continuous ketone monitoring. John adds his clinical and lived experience throughout, including a candid view of why Abbott’s market position happened and what it means for people with type 2 diabetes who still cannot access CGM through their ICB.

Watch or listen

Key themes

Accuracy that supports insulin dosing

Both the FreeStyle Libre 2 Plus and 3 Plus hold iCGM approval from the FDA: the highest international accuracy standard currently available, and the closest thing to a global benchmark for insulin dosing safety. In practical terms, 20/20 performance of approximately 95 to 96% means the reading is within 20% or 20 mg/dL of the reference value in that proportion of cases. The outside-40/40 figure, readings so far from true that acting on them could cause harm, sits at 0.2%. Abbott and Dexcom are the two systems that meet the bar for insulin dosing decisions, and the episode opens with that foundation before moving on to everything else.

Why 70% smaller matters beyond convenience

The FreeStyle Libre 3 Plus is approximately the size of a pound coin. The Libre 2 Plus is approximately the size of a two pound coin. The Libre 3 Plus is 70% smaller than its predecessor, and more than half the size of the Dexcom G7. Against Roche Smart Guide, CareSens, and iCAN, it is at least 50% smaller. John’s observation is direct: he has never knocked the Libre 3 Plus off a door frame. For teenagers and young adults, the smaller sensor is sometimes the difference between consistent wear and the data gap that does not get explained in clinic. Diabetes stigma is real, and form factor is one of the few dimensions a manufacturer can directly address.

The all-in-one applicator and what simplicity enables

The FreeStyle Libre 3 Plus combines sensor and applicator in a single unit. The Libre 2 Plus uses a separate turning-screw step. The difference matters at scale: in a starter clinic, in a primary care consultation, in an A and E department. Abbott’s onboarding is designed to be impossible to get wrong, pictorial instructions inside the packaging, multilingual resources, and a companion app that walks through setup. For a device now prescribed by GPs as well as specialist teams, onboarding simplicity is part of why the Libre 2 reached high market share before commissioners had fully decided to commission it.

Pump integrations, live and coming

The FreeStyle Libre 3 Plus integrates with Ypsomed and works with CamAPS FX. The FreeStyle Libre 2 Plus integrates with Omnipod 5. In the US, Tandem’s T:slim with Control-IQ+ is paired with Libre 2 because both hold iCGM and ACE pump interoperability status, meaning no new clinical trial is required for each new pairing. The equivalent framework does not yet exist under CE marking in Europe, which is why Tandem integration is not on the UK market the same way. Abbott’s stated direction is to be the most connected sensor, not just one more AID option.

LibreView Pro, from a separate tab to the clinical record

LibreView Pro integrates directly into SystmOne and EMIS. Time in range, GMI, and average glucose are now SNOMED coded within the electronic health record. For clinicians, the practical effect is a single consultation window rather than toggling between platforms. For health systems, SNOMED coding opens a different door: if CGM metrics live in the same record as HbA1c, prescribing history, and clinical encounters, they become auditable. John raises the QOF implication directly: if CGM metrics are recognised as contributing to quality outcome framework points, the financial incentive for primary care to engage with CGM data changes. That is not confirmed policy, but the infrastructure for it now exists.

The data gap that catches clinicians out

FreeStyle Libre measures interstitial glucose every minute and transmits to the phone every minute. The historic graph and clinical download, however, record every five minutes. A real hypo at 3.8 mmol/L (68 mg/dL) that lasts four minutes, treated quickly and well, can appear in full on the phone and be completely invisible in a LibreView clinic download. The low glucose event threshold compounds this: Abbott only logs a low glucose event if glucose is below 3.9 mmol/L for 15 or more continuous minutes. Someone who treats lows promptly will appear, in the record, to have had fewer hypos than someone who treats them slowly. Good management can produce an apparent undercount. If a patient says they had a hypo, they had a hypo.

Continuous ketone monitoring, who it is for

Abbott has a continuous ketone monitor in validation. The device would measure ketones in the same interstitial space as glucose, two signals from one wearable. The clinical questions being worked through are not the hardware but the alarm calibration: how high, for how long, before an alert fires. Set too sensitive and it becomes noise; set too conservative and it misses the window when action changes outcome. The populations with the most to gain are those on AID systems (rising glucose plus rising ketones is an early signal of infusion-set failure), those with a history of frequent DKA, and pregnancy. John and Michael agree to return for a follow-up episode when the product launches publicly.

CGM for type 2 diabetes, advocacy made it happen for type 1

National guidance now supports CGM access for people with type 2 diabetes on insulin. In practice, access through ICBs remains inconsistent (Birmingham is specifically named). The parallel John draws is precise: people with type 1 did not wait for commissioners to decide CGM was worthwhile. They wore the devices, shared the data, and made the case through lived experience. The same mechanism is available to people with type 2 on insulin. ICBs commission what they are asked to commission, and patient pressure is a legitimate lever. For clinicians in areas where access is blocked, the advocacy role is part of the job.

The FreeStyle Libre, in detail

The features the episode references, condensed to the form the GNL Abbott device guide carries. The hypo-event recording quirk lives in the disclosures below because it is the structural detail that surfaces most often in clinic conversations.

Practical exploration

For people wearing a FreeStyle Libre

The settings that decide whether the data record is honest are the ones easiest to get wrong without anyone telling you.

• Keep the LibreLink app running in the background at all times. Swiping up to close it disconnects Bluetooth from the sensor and creates gaps in the data record.
• Place the LibreLink app on your home screen or bottom dock so you can check it without unlocking multiple screens.
• If connectivity drops, clearing the phone cache usually resolves it before more complex troubleshooting is needed.
• If a hypo you treated does not show up on your LibreView download, that is the known five-minute gap, not your memory. Bring it up in clinic if the conversation goes the wrong way.
• Keep a finger-prick meter in date and accessible. Even the most accurate CGM produces occasional readings outside the 40/40 error band.

For clinicians and educators

The structural gaps in the data are not a fault of the person wearing the sensor; they are a fact of how the data is recorded.

• When reviewing a LibreView download where someone reports hypos you cannot see, explain the five-minute recording interval rather than questioning the account.
• The low glucose event count undercounts hypos in well-managed wearers: events are only logged below 3.9 mmol/L lasting 15+ minutes.
• If your system runs SystmOne or EMIS, explore LibreView Pro integration. It removes the multi-tab clinic workflow and creates SNOMED-coded CGM metrics within the EHR.
• Abbott starter clinics are available for face-to-face and remote support; they take the onboarding workload off primary care teams.
• For people with type 2 diabetes on insulin where national guidance supports access and the ICB is not commissioning it, advocacy has a documented track record of changing that.

About the guest

Michael Skarlatos is a Medical Educator and Registered Dietitian at Abbott UK and Ireland, based in Medical Affairs. He trained as a diabetes specialist dietitian, graduating in 2013 and specialising in diabetes at University Hospitals of Leicester from 2015. At Leicester he supported structured education programmes, technology onboarding, the Eden HCP education team, and clinical research. Before joining Abbott he worked with both the people for whom these devices are daily life and the healthcare professional networks that now form part of his remit in industry.

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