Free. Style Libre Glucose Monitoring System Date of meeting: 17 January 2018 Presented by: Linda Lord and John Clark 1
Purpose • To summarise key points about Free. Style Libre • To discuss current Prescribing Policy in WSCCG • To suggest significant developments in this Policy? 2
Key Points (1) l l l 3 Free. Style 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.
Key Points (2) l l Glucose levels lag about 5 -10 minutes behind blood glucose levels. l Results can be obtained through clothing. l 4 Reader shows a trace over the last 8 hours and displays an arrow showing the direction the glucose reading is heading. Results can be downloaded on computer with various displays (last 24 hours, last 7 days etc).
Key Points (3) l l Cost = £ 35 - £ 50 per sensor, which last 2 weeks. l There are currently no NICE recommendations for this system. l If all eligible patients in West Suffolk were switched to Free. Style Libre, the additional investment required is a lot! But there would be cost savings on testing strips and lancets. l 5 Free. Style Libre was added to the Drug Tariff on 01/11/17. Free. Style Libre is available to buy on line and some patients have chosen to self fund.
Costing l Equivalent to 8 finger prick tests daily l £ 50 / 2 weeks l £ 100 / 28 days
Feedback from people with T 1 DM Hate doing finger prick testing l New system is “life-changing” l Can quickly see effect of exercise and diet on glucose levels l Can see trends in blood glucose and make adjustments to insulin dose (eg patient this morning) l
However l You probably need to be motivated l Some will need guidance on adjusting insulin
Current WSCCG Prescribing Policy l Do not prescribe in WSCCG
Consequences? l NHS Diabetic patients poorer control, more complications more cost to NHS l Private Practice (affluent) Diabetic patients major health benefits
Ideal World who would receive system? l Most people with T 1 DM l Insulin treated T 2 DM l Theresa May
Real World CGC in deficit Pregnant T 1 DM – high risk and already doing 8 tests daily l All children with T 1 DM (to avoid pain) l Small number of adult T 1 DM with hypoglycaemic unawareness? l Adults with T 1 DM already doing 8 tests daily? l
What about Poorly controlled T 1 DM who do not test? l T 1 DM with frequent admissions (DKA or hypos) l Poorly controlled T 1 DM who do test l Well controlled T 1 DM l All the above, but apply to insulin treated T 2 DM as well! l
Exit Criteria Must attend initiation session with DSN l Must attend follow up with DSN and be using system l Improved Hb. A 1 c? l Improved quality of life? l Less hospital admissions? l
Proposed New WSCCG Policy? l Pregnant T 1 DM l Children with T 1 DM l TIDM already doing 8 tests daily l T 1 DM with hypoglycaemic unawareness
New Policy - Cost l Additional cost would be children with T 1 DM l Small extra cost from adults groups, but many already doing 8 tests daily.
Summary Virtually painless continuous glucose monitoring system that actually works l Potential to improve control and reduce risk of complications l But cost! l In current financial climate can we persuade CCG to fund a minority of T 1 DM? l
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