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Patients with type 1 diabetes are missing out on flash glucose devices, finds BMJ investigation

BMJ 2018; 363 doi: (Published 07 November 2018) Cite this as: BMJ 2018;363:k4675

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  1. Gareth Iacobucci
  1. The BMJ

Tens of thousands of UK patients with type 1 diabetes are being denied the potential benefits of “flash” glucose monitoring devices because they are not being recommended in some areas, an investigation by The BMJ has found.

Flash glucose monitoring, which works from a sensor attached to the skin, has been available on prescription since 1 November 2017. Users get glucose readings by scanning the sensor with a portable reader or a smartphone app. The reading shows an arrow that indicates whether glucose concentrations are rising or falling.

Abbott’s FreeStyle Libre is currently the only such device available in the UK.

NHS England has advised clinical commissioning groups which patients should get prescriptions for the devices (box 1). It said that the flash device has the potential to improve patients’ quality of life, supports self management, and could save money in the long term by reducing complications and hospital admissions, although it has acknowledged gaps in the evidence base. But a year after the device became available, around a quarter of CCGs in England are not recommending it for patients even if they meet NHS England’s criteria, The BMJ’s investigation shows.

Box 1

Who should get a FreeStyle Libre prescription?

The NHS’s Regional Medicines Optimisation Committee for the North of England says that, at present, FreeStyle Libre should be used only by people with type 1 diabetes aged 4 years or above who need to have multiple daily injections of insulin or insulin pump therapy and who meet one or more of the following criteria1:

  • Undertake intensive monitoring at least eight times a day

  • Meet the current NICE criteria for insulin pump therapy (HbA1c >8.5% (69.4 mmol/mol)) or disabling hypoglycaemia (as described in NICE guidance TA151)

  • Have recently developed impaired awareness of hypoglycaemia

  • Frequent admissions (at least two a year) with diabetic ketoacidosis or hypoglycaemia …

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