If a glucose meter could make cappuccino, I’d be all over that.
That's what I expected with Abbott Diabetes Care’s newest meter, the FreeStyle Precision Neo, launched here in the States earlier this Spring. But sadly, the meter doesn’t deliver on the promise of delivering my metaphoric cappuccino. It hardly even brews drip coffee, if we’re keeping to the caffeine analogy.
An international version of this meter has been available outside the U.S. for more than a year, going by the FreeStyle Optimum Neo name, and the FreeStyle Precision Neo finally made it to the American market in mid-April following FDA regulatory approval last fall. Since both go by the “Neo” name, you might think this Americanized version would offer the same features as its international cousin does -- checking glucose, testing blood ketones, tracking insulin, and warning us of high or low patterns.
But that’s not the case, unfortunately. The Precision Neo is as skinny as a supermodel and looks pretty good for a glucose meter, but that’s about all it has going for it. Once again, as it has done in the past, Abbott has castrated an innovative device for the American market by eliminating the bells and whistles that made it special.
The reason, according to Abbott, is by design: they’re marketing this to people with diabetes in the States who don’t want to fuss with insurance, or worry about excessive copays or high costs of test strips. The lower-cost Precision Neo goes for $22 to $28 for the meter itself, and the strips range from $14 to $17 for a box of 25.
Of course, lower-cost meters and strips have been around in some stores for a long time, but traditionally they haven’t been from the big-name brands. Not until recently, that is. With this Precision Neo meter targeted at the low-cost crowd, Abbott joins JnJ-owned Lifescan that also recently launched a “back to basics” meter of its own. That OneTouch Verio isn’t aimed at sidestepping insurance like this new Precision Neo, but it also removed the more innovative features found in the Verio IQ and VerioSync line in order to target simplicity.
We get the need for affordability and simplicity for meters and diabetes supplies, but is there seriously a need for these meters that really don’t offer anything new and actually take away some of the features we’ve come to expect from contemporary meters? What are these companies thinking?
The Precision Neo arrived at my door a few weeks ago, and I had the chance to play around with it and see what it does offer.
Sorry, Sans Ketones
When I first heard Neo was coming to our shores, I was looking forward to a new blood ketone testing platform, as I didn’t realize American Neo had been castrated. I still didn’t get it when my review sample arrived without blood ketone strips. I figured they just forgot to send me some for testing, so I emailed Jessica Sachariason, the Public Affairs Manager of Abbott Diabetes to ask for some. Her reply? “The FreeStyle Precision Neo meter is intended to be used with FreeStyle Precision Neo blood glucose test strips only.”
Turns out, the company line on this is that our USA market is unique due to insurance premium costs, the rising price tag of employee health claims, and the burden of medical claim paperwork. As a result, this super-simple meter scratches the itch mandated by our system.
“Abbott identified a gap in the overall segment of over-the-counter blood glucose systems being sold in the U.S. without a prescription -- many of the current offerings are lesser known brands and may have different standard of accuracy,” Sachariason wrote via email. “To address this need, Abbott launched the FreeStyle Precision Neo at a lower cost but without sacrificing the high standard of accuracy that is used within all of Abbott's FreeStyle family of products.”
I didn’t ask exactly how deleting already-existing features makes the meter so much cheaper to target the “low cost, no insurance needed” market segment. But based on past history asking these questions – anyone remember our coverage of the FreeStyle Insulinx meter a few years ago about Abbott taking away the insulin calculator? -- it seems like the answers would be corporate-speak anyway and wouldn’t tell the real story: that it’s not regulatory rules limiting these devices, but the Abbott decision-making to not even try and get them approved in the States.
Very disappointing, because again it feels like we finally got access to a much-desired cappuccino maker but instead it only gives us coffee. And decaf, at that.
Even hearing that official Abbott response, I wasn’t ready to give up on my precious ketone testing just yet. I wondered if they really altered the meter, or just told us so. Maybe there was a workaround. To find out, I pissed away $8 and stuck one of my precious Abbott blood ketone strips into the Neo, just to see what would happen...
It didn’t work. I got a very large and clear Error 7 message, which means the strip is damaged, used, or the meter doesn’t recognize it. Because it's been castrated, all right.
So, what does this Neo actually give us?
It’s flat, I’ll give it that. So flat that I kept losing it in the clutter on my desk. The marketing people say it’s thinner than a AAA battery. It’s lightweight without seeming ticky-tacky. It has a touch screen that actually seems to like my fingertips and works. So far, so good.
But what I love most about the Neo is also what I hate the most: A beautiful E-Ink screen (à la Kindle PaperWhite), which as far as I know is the first time this type of technology has been used in a glucometer. The problem is, it’s only beautiful half the time -- and the wrong half at that.
When you scroll back through the meter’s 1,000-number memory, the test results are displayed with black numbers on a white background. It’s amazing. Clean, sharp, and easy to read in dim light and full sunlight alike. But when you actually test your blood sugar, the screen displays as a reversal, with white numbers on a black field (more of a battle-ship grey field) that ends up low-contrast and hard to read in any light.
And no, in case you’re wondering: this Precision Neo doesn’t have a backlight, has no test strip port light for checking in the dark, and if you don’t get enough blood on the strip the first time, it only gives you 5 seconds to reapply before an error message pops up.
Bottom line: the testing results most PWDs never look at are easy to read -- the best I’ve ever seen in a BGL meter -- but the ones we need to see are hard to read. What moron set that up?
More Devja Vu
All right, so all USA Neo does is test blood sugar. How well does it perform?
I took out a strip to test it for myself.
Wait a minute. We’ve seen this blood glucose test strip before, haven’t we? Oh, yes. I remember now, the National Geographic Society found some of these when excavating Cro-Magnon caves in France. Yeah, this test strip has been around that long. At least it looks like the originals: Individually foil wrapped, each attached to the next in a perforated ribbon. For the sake of good science, I stuck one in my old Precision Xtra meter that I carry to check blood ketones, and got yet another error message, so maybe it just looks like a clone of its ancestor.
Of course the real problem is that the strips don’t seem all that great at doing their job.
The official product data tells us it meets the existing FDA standards for test strip accuracy, coming in at within 20% of a lab glucose test every time, when blood sugars are 75 mg/dL or lower. When BGs are above that range, the strips tend to be within that accuracy range 99% of the time.
But for me, it didn’t seem as good as what I’m already using. I compared the Neo strips to my WaveSense Presto and found they always ran low (no surprise given the Neo doesn’t compensate for hematocrit), but frustratingly, the strips were erratic in how low they ran—and I found them highly inconsistent from test to test.
The reincarnated FreeStyle Precision Neo test strips require .6 micro-liters of blood on each strip, which isn’t much but it constitutes a boatload compared to other FreeStyle meters and pretty much any other strip on the planet.
What’s sadly ironic is that Abbott was the company that broke down technological barriers back in the day, introducing the 3/10th microliter blood sample with their FreeStyle Flash. But in the 5+ years since that meter was discontinued, I guess all the folks who’d developed the Flash left the company and went to work for other tech businesses like Apple that were improving gadgets and doing new things.
To their credit, I will say the included FreeStyle Lancing Device II is a fingerpoker that I actually like a lot. It’s smallish, seems robustly built, can be used one-handed, has a ring of nerve-numbing nubs on the snout that ensures a painless lancing experience, and it does not use a special or propriety lancing needle. So, there’s that – but the lancing device itself isn’t really what Abbott is marketing, is it?
‘Skip the Copay’ Marketing Madness
Abbott is going full court press to push this new product, including a multi-media video campaign. Since the meter has absolutely no features aside from the basic function, I believe Abbott’s using what I tend to think of as smoke and mirrors to generate sales. The new advertising campaign is built around the tagline: “Skip the copay.”
The idea: Just pay the low price of the meter and/or strips in the store, without a prescription, you're on your way. No need for high copays or fussing with savings cards. Avoid any insurance coverage issues or medical claim processes that are often needed when buying costly name-brand test strips off-the-shelf. Hey, perfect for those PWDs on a budget, right?
Abbott is trying to make their end-run around the health plans sound like a good deal and a huge boon to PWDs, but it’s simply not true. I ran the math. The strips are sold online via Wal-Mart, CVS, and the Abbott store.
- Per strip, Wal-Mart has the best price at 39.9 cents per strip ($19.94 per box of 50)
- CVS costs 44 cents each ($21.99 per box of 50)
- Abbott charges more still, at 48 cents per strip ($24 for a box of 50)
If you’re a PWD testing four times a day, the lowest you’d have to pay out of pocket is $48.55 each month.
Comparing to other Abbott strips available, you'd pay roughly $88 for a box of 50 of their FreeStyle Lite strips; and the costs are just as high, if not higher, for the same amount of other brand-name strips. Other low-cost strips like the Wal-Mart ReliOn strips that I use come in at 18 cents a strip or a total of $9 for a box of 50. And when you talk accuracy and reliability on many of these products, it’s often in the eye of the diabetic beholder doing the fingerstick test.
So was this meter even necessary? Fully featured, hell yeah. Gutted and basic? I don’t know why they wasted their time. And ours. Don’t we already have enough meters that just test blood sugar and nothing else? I want the ketone testing. I want the data tracking algorithm, the insulin dose tracking feature, and the rest. The name-brand doesn’t make the difference to me.
If I am trying to pinch pennies on the glucose meter and test strips, I may be more closely looking at these newer “back to basics” meters. Maybe not everyone wants the same bells and whistles that some of us have come to expect from new glucometers. But there are already options on the table, and those off-brand meters don’t try to sneak in under the radar by keeping the name but not offering the features that go along with it.
Getting back to my metaphor, it feels like I'm going into the store to buy a new cappuccino maker. I see a brand that I know makes good cappuccino. But then when I get it home, I realize it doesn't do what I thought it did based on the model's familiar name. Instead, it only makes cappuccino for customers abroad, while here it only makes coffee. And I don't just want coffee, especially day-old coffee. Not when I had my heart set on cappuccino.