1. FreeStyle Libre Glucose Monitoring System
Date of meeting: 17 January 2018 Presented 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)
FreeStyle Libre 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 FreeStyle Libre, the additional investment required is a lot! But there would be cost savings on testing strips and lancets.
FreeStyle Libre 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 World who would receive system?
Most people with T1DM
Insulin treated T2DM
Theresa May

12. Real World CGC 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?