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FreeStyle Libre Glucose Monitoring System

FreeStyle Libre Glucose Monitoring System. Date of meeting: 17 January 2018 Presented by: Linda Lord and John Clark. Purpose. To summarise key points about FreeStyle Libre To discuss current Prescribing Policy in WSCCG To suggest significant developments in this Policy?. Key Points (1).

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FreeStyle Libre Glucose Monitoring System

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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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