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

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4675 (Published 07 November 2018) Cite this as: BMJ 2018;363:k4675

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

Would you drive a car without a speedometer? Or with a fuel gauge you could interrogate only 4 times a day and at discomfort to yourself? If not, then maybe glucose monitoring is where evidence-base must step back and patient choice and common sense take over?

It turned out to be a shrewd marketing move on the part of Abbott to make their Flash Glucose Monitor "Libre" available to the public direct, bypassing medical say-so. Yes, it came at a cost to the individual, and not an inconsiderable one, but its popularity soon spread. It spread by social media and word-of-mouth, not to mention that photo of our Prime Minister in a long red sleeveless dress standing alongside the President of the USA with her sensor clearly visible.(1)

Those of us who work in diabetes had clients turning up for 6 monthly review who had bought their own "Libre", taught themselves how to use it and described it changing their lives. Sometimes their HbA1c had dropped by 10mmol/mol or more. More often they were delighted to be finger-pricking less and aware of their glucose and its direction of travel more. They could see if they were "heading for a hypo" and intervene before the situation acquired urgency. Teachers could surreptitiously swipe their arm with a 'phone-like gadget without the humiliation of drawing blood in front of a class of teenagers.

And those of us who work in diabetes want our clients who can't afford the sensors to have the same liberation from living without knowledge of where their glucose is taking them.

It feels to me as if people with type 1 diabetes are being penalized for having a common condition. The cost of "Libre" sensors would not be insurmountable if it were tackling a rarer illness or one more imminently life-threatening. But the very prevalence of type 1 diabetes should be the NHS's most effective bargaining tool. The NHS needs at a national level to strike a deal with Abbott (and let's hope there are competitors on their way) which means the sensors are affordable. Leaving rationing to CCGs is not a sensible, patient-focused or evidence-based way forward.

(1) https://www.express.co.uk/news/uk/988255/Theresa-May-arm-patch-red-dress...

Competing interests: I have family members who use a variety of glucose monitoring devices.

09 November 2018
Mary Charlton
Specialty Doctor in Diabetes
Birmingham UK