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FreeStyle Libre Glucose Monitoring System Summary

This summary discusses key points about the FreeStyle Libre glucose monitoring system, current prescribing policies in WSCCG, significant developments, cost implications, feedback from users, and proposed new policy recommendations. The system involves a hand-held reader and sensors for continuous monitoring of glucose levels, offering benefits such as painless monitoring, trend analysis, and potential insulin dose adjustments. However, cost considerations raise questions about funding for wider implementation among diabetic patients. The proposed new policy targets specific groups for potential inclusion, aiming to improve overall control and reduce complications while balancing financial constraints.

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FreeStyle Libre Glucose Monitoring System Summary

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  1. FreeStyle Libre Glucose Monitoring System Date of meeting: 17 January 2018Presented by: Linda Lord and John Clark

  2. Purpose • To summarise key points about FreeStyle Libre • To discuss current Prescribing Policy in WSCCG • To suggest significant developments in this Policy?

  3. Key Points (1) • FreeStyle Libre is a flash glucose monitoring system which monitors glucose levels using interstitial fluid levels. • Consists of a hand-held reader and a sensor with a microfilament, which is sited on the back of the arm. • When the reader unit is passed over the sensor, the reader shows a reading based on interstitial fluid glucose levels. • A smartphone with the relevant free app can also be used as the reader. • The sensor lasts for 14 days, then needs to be replaced.

  4. Key Points (2) • Reader shows a trace over the last 8 hours and displays an arrow showing the direction the glucose reading is heading. • Glucose levels lag about 5-10 minutes behind blood glucose levels. • Results can be obtained through clothing. • Results can be downloaded on computer with various displays (last 24 hours, last 7 days etc).

  5. Key Points (3) • FreeStyleLibre was added to the Drug Tariff on 01/11/17. • Cost = £35 - £50 per sensor, which last 2 weeks. • There are currently no NICE recommendations for this system. • If all eligible patients in West Suffolk were switched to FreeStyleLibre, the additional investment required is a lot! But there would be cost savings on testing strips and lancets. • FreeStyleLibre is available to buy on line and some patients have chosen to self fund.

  6. Costing • Equivalent to 8 finger prick tests daily • £50 / 2 weeks • £100 / 28 days

  7. Feedback from people with T1DM • Hate doing finger prick testing • New system is “life-changing” • Can quickly see effect of exercise and diet on glucose levels • Can see trends in blood glucose and make adjustments to insulin dose (eg patient this morning)

  8. However • You probably need to be motivated • Some will need guidance on adjusting insulin

  9. Current WSCCG Prescribing Policy • Do not prescribe in WSCCG

  10. Consequences? • NHS Diabetic patients poorer control, more complications more cost to NHS • Private Practice (affluent) Diabetic patients major health benefits Private

  11. Ideal Worldwho would receive system? • Most people with T1DM • Insulin treated T2DM • Theresa May

  12. Real WorldCGC in deficit • Pregnant T1DM – high risk and already doing 8 tests daily • All children with T1DM (to avoid pain) • Small number of adult T1DM with hypoglycaemic unawareness? • Adults with T1DM already doing 8 tests daily?

  13. What about • Poorly controlled T1DM who do not test? • T1DM with frequent admissions (DKA or hypos) • Poorly controlled T1DM who do test • Well controlled T1DM • All the above, but apply to insulin treated T2DM as well!

  14. Exit Criteria • Must attend initiation session with DSN • Must attend follow up with DSN and be using system • Improved HbA1c? • Improved quality of life? • Less hospital admissions?

  15. Proposed New WSCCG Policy? • Pregnant T1DM • Children with T1DM • TIDM already doing 8 tests daily • T1DM with hypoglycaemic unawareness

  16. New Policy - Cost • Additional cost would be children with T1DM • Small extra cost from adults groups, but many already doing 8 tests daily.

  17. Summary • Virtually painless continuous glucose monitoring system that actually works • Potential to improve control and reduce risk of complications • But cost! • In current financial climate can we persuade CCG to fund a minority of T1DM?

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