Freestyle Libre Prescribing Signature for Patients with Diabetes
The proper prescribing signature for Freestyle Libre in patients with diabetes should be "Freestyle Libre sensor, apply one sensor every 14 days to back of upper arm, scan as needed for glucose monitoring." 1, 2
Patient Selection Criteria
The Freestyle Libre is indicated for:
- Adults with Type 1 diabetes on multiple daily injections or insulin pump therapy 1, 2
- Adults with Type 2 diabetes on basal insulin or multiple daily injections 1, 2
- Youth with Type 1 diabetes 1
Prescribing Details
Basic Prescription Components
- Device: "Freestyle Libre sensor"
- Quantity: "One sensor"
- Frequency: "Apply every 14 days"
- Location: "To back of upper arm"
- Instructions: "Scan as needed for glucose monitoring"
- Duration: Typically 3-month supply (6 sensors)
Special Considerations
- For patients with chronic kidney disease: Include "Use with caution, confirm readings with fingerstick testing when making treatment decisions" 1
- Contraindication: Do not prescribe for patients on peritoneal dialysis due to potential interference with glucose measurements 1, 2
- For hemodialysis patients: Consider adding "Use for pattern recognition rather than specific glucose values" 1
Clinical Pearls
- Accuracy is highest during days 5-7 of wear (MARD 7.8%) and slightly lower during days 0-1 and 13-14 (MARD ~14.5%) 3
- No fingerstick calibration is required as the device is factory-calibrated 2
- The sensor provides real-time glucose readings when scanned with the reader or compatible smartphone 2
- Patients should be advised that salicylic acid and high doses of vitamin C may affect sensor accuracy 1, 2
- Unlike some CGM systems, Freestyle Libre is not susceptible to acetaminophen interference 1
Expected Outcomes
- Reduction in hypoglycemia time and severity 4, 5
- Improved time in target glucose range 4, 5
- Increased frequency of glucose monitoring (average 8-11 scans/day compared to 2-3 fingersticks/day) 4, 5
- Improved treatment satisfaction 4
- Potential HbA1c reduction of 0.4% in patients with Type 2 diabetes 4
Follow-up Recommendations
- Schedule follow-up within 2-4 weeks of initial prescription to review data and adjust insulin regimen as needed 2
- Assess adherence to sensor replacement schedule and proper scanning technique
- Review time in range, time below range, and glycemic variability metrics 2
By following this prescribing guidance, healthcare providers can optimize the use of Freestyle Libre in appropriate patients with diabetes while avoiding use in contraindicated populations such as those on peritoneal dialysis.