Update on the prescribing of the Freestyle Libre® glucose monitoring system

Following publication of the NHS England Regional Medicines Optimisation Committee recommendation, NHS West Cheshire Clinical Commissioning Group will fund the prescribing of Freestyle Libre® sensors for selected patients with Type 1 diabetes. The use of Freestyle Libre® is not commissioned for patients with Type 2 diabetes.

Patients with Type 1 diabetes (including those who currently purchase the sensors) must meet the following criteria;

The diabetes specialist team has assessed that the use of Freestyle Libre® is appropriate AND at least one of the following must apply;

1. Patients who undertake intensive monitoring greater than (>) 8 times per day

2. Those who meet the current National Institute for Health and Care Excellence (NICE) criteria for insulin pump therapy (HbA1c >8.5% (69.4mmol/mol) or disabling hypoglycaemia as described in NICE Technology Appraisal 151) where a successful trial of Freestyle Libre® may avoid the need for pump therapy.

3. Those who have recently developed impaired awareness of hypoglycaemia. (It is noted that for persistent hypoglycaemia unawareness, NICE recommend continuous glucose monitoring with alarms and Freestyle Libre® does currently not have that function).

4. Frequent admissions (>2 per year) with diabetic ketoacidosis or hypoglycaemia requiring third party assistance.

5. Those who require a third party to carry out monitoring and where conventional blood testing is not possible.

6. Those aged between 12 and 25 years who have not reached individualised HbA1c target as a result of infrequent testing.

Assessment of the appropriateness of the use of Freestyle Libre® will be undertaken only by the diabetes specialist team at patients’ routine outpatient appointments.

The diabetes specialist team will ensure patients are trained to use the system and will provide the Freestyle Libre® reader and two sensors to cover the first month of monitoring.

Patients will be required to agree a contract with the diabetes specialist team that details the aims of treatment and targets to be achieved for prescribing to continue. The specialist team will undertake an audit of specific indicators at 6 months to ensure monitoring is effective and delivering the agreed outcomes.

GPs are not permitted to initiate prescribing of Freestyle Libre®. GPs are commissioned to provide ongoing prescribing of two sensors per month. If sensors fail, patients must obtain a replacement from the company (Abbott) directly. If the diabetes specialist team decides at the 6 month review that Freestyle Libre® is not effective, the GP will be informed and prescribing will cease.

It should be noted that the Freestyle Libre® system does not include an alarm to indicate hyperglycaemia, hypoglycaemia or impending hypoglycaemia. The device measures interstitial rather than capillary glucose levels so readings are slightly delayed. This means that users will still need to perform finger-prick tests, including prior to and (when stopped and safe to do so) during journeys to meet current Driver and Vehicle Licence Agency (DVLA) requirements.

For further enquiries about the prescribing of the Freestyle Libre® glucose monitoring system in West Cheshire please contact enquiries.wcheshireccg@nhs.net / telephone 0800 132996.

ENDS
 

Date added: 14/05/2018

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