The benefits of Flash Glucose Monitoring have been summarised in the ‘Diabetes UK Consensus Guideline for Flash Glucose Monitoring’ published in September 2017 and endorsed by the Association of British Clinical Diabetologists. From the 1st November 2017, Freestyle Libre glucose sensors will be available for prescription in the United Kingdom.
NICE has published Medtech innovation briefing [MIB110], but there is currently limited good quality clinical trial data to support long-term clinical evidence, benefits and cost-effectiveness for FreeStyle Libre. (information on a Medtech briefing)
Until such time when there is a fuller evidence base, the advice below, broadly in line with the Diabetes UK consensus guideline, has been developed by the Scottish Diabetes Group (Type 1 Diabetes Subgroup) to help identify people who should be considered for NHS funded Flash Glucose Monitoring in Scotland.
Flash Glucose Monitoring should be considered in people who:
- Use intensive insulin therapy (multiple daily injections or continuous subcutaneous insulin infusion); and
- Agree to attend a locally provided Flash Glucose Monitoring education session; and
- Agree to scan glucose levels no less than six times per day; and
- Agree to share glucose data with their diabetes clinic;
- have attended a recognised diabetes structured education programme. And/or clinical team are satisfied that the person (or carer) has required knowledge/skills to self-manage diabetes.
The recommendation to commence Freestyle Libre should originate from a secondary care diabetes specialist. Prescriptions for Freestyle Libre sensors (like blood glucose test strips) should be issued by the patient’s primary care provider.
In addition, a small supply of finger-prick blood glucose measurements will still be needed, such as when a person is ill or to meet the requirements of the Driver and Vehicle Licensing Agency in assessing fitness to drive.
Continuing prescription for long-term use of Free Style Libre would be contingent upon evidence of compliance with the above conditions and that on-going use of the Freestyle Libre is demonstrably improving an individual’s diabetes care. This will be assessed every 6 months by a secondary care diabetes specialist. Individuals should receive no more than 26 sensors per annum (unless there are exceptional circumstances).
Commencement of Flash Glucose Monitoring should be recorded in SCI-Diabetes in all cases to permit appropriate assessment of outcomes on a national basis.
Further information on individual boards here
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