What are the guidelines for prescribing Freestyle Libre 3 (flash glucose monitoring system) to patients with diabetes?

Guidelines for Prescribing FreeStyle Libre 3 for Diabetes Management

FreeStyle Libre 3 should be prescribed for patients with diabetes who require intensive insulin therapy, experience frequent hypoglycemia, or have difficulty achieving glycemic targets with conventional monitoring methods. 1

Patient Selection Criteria

Primary Indications

• Patients with Type 1 diabetes on multiple daily injections or insulin pump therapy 2
• Patients with Type 2 diabetes on intensive insulin regimens 2
• Individuals with unexplainable severe hypoglycemia, recurrent hypoglycemia, or nocturnal hypoglycemia 1
• Patients with high glycemic variability despite optimized insulin therapy 1

Special Populations

• Chronic Kidney Disease: Use with caution in patients on hemodialysis as accuracy may be reduced (MARD 19.5% vs standard 7.8% in stable patients) 2
• Peritoneal Dialysis: Not recommended for patients on peritoneal dialysis due to potential interference with glucose measurements 2

Device Specifications and Performance

• FreeStyle Libre 3 is a factory-calibrated continuous glucose monitoring system with 14-day wear duration 3
• Latest generation shows improved accuracy with overall MARD of 7.8% compared to venous blood glucose reference 3
• Performance remains stable throughout the 14-day wear period, though slightly less accurate on days 1 and 14 4
• System provides real-time glucose readings without requiring fingerstick calibration 2

Prescription Process

1. Documentation Requirements:

   • Diagnosis of diabetes (Type 1 or Type 2)
   • Current insulin regimen (multiple daily injections or pump)
   • History of hypoglycemia or glycemic variability
   • Previous self-monitoring blood glucose (SMBG) records showing need for more intensive monitoring

2. Initial Prescription:

   • Prescribe one sensor every 14 days (2-3 sensors per month)
   • Include reader device if patient doesn't have compatible smartphone
   • Specify "FreeStyle Libre 3 Continuous Glucose Monitoring System"

3. Follow-up Plan:

   • Schedule follow-up within 2-4 weeks of initiation to review data
   • Assess time in range, hypoglycemic episodes, and glycemic variability
   • Adjust insulin regimen based on CGM data patterns

Patient Education Requirements

• Proper sensor application on the upper arm (primary site) 5
  • Alternative sites (chest, back) may be used but with potentially reduced accuracy 5
• Scanning technique and frequency (minimum once every 8 hours)
• Data interpretation using ambulatory glucose profile
• Technical troubleshooting for common issues
• Understanding limitations in specific situations (rapid glucose changes, exercise)

Clinical Benefits to Emphasize

• Reduction in hypoglycemia time and severity 2, 1
• Improved glycemic control without increasing hypoglycemia risk 1
• Better understanding of glucose patterns and trends 1
• Immediate feedback allowing for informed decisions about food intake and insulin dosing 1

Important Considerations and Limitations

• Accuracy Considerations:

  • Less accurate during first and last days of sensor life 4
  • May be less accurate during rapid glucose changes or exercise 5
  • Potential interference from acetaminophen and high doses of vitamin C 2

• Device Comparison:

  • Accuracy comparable to other CGM systems like Dexcom G6 4
  • Factory calibration eliminates need for fingerstick calibrations 2

• Cost and Coverage:

  • Verify insurance coverage before prescribing
  • Consider patient's ability to afford ongoing sensor costs

Documentation for Insurance Approval

• Document medical necessity based on:
  • Hypoglycemia risk or history
  • Glycemic variability
  • Intensive insulin regimen
  • Failed attempts to achieve targets with conventional monitoring
  • Need for improved glucose data to optimize therapy

By following these guidelines, clinicians can appropriately prescribe FreeStyle Libre 3 to patients who will benefit most from continuous glucose monitoring technology, leading to improved glycemic control, reduced hypoglycemia risk, and better quality of life.