'Postcode Lottery' Complaints Persist for Diabetes Monitor

Peter Russell

October 24, 2018

UK access to a continuous glucose monitoring device for people with diabetes, which is used by Prime Minister Theresa May, remains dependent on where patients live.

The FreeStyle Libre glucose monitoring system (Abbott) was designed to improve glycaemic control by measuring interstitial fluid glucose levels in people with diabetes.

A sensor is worn on the back of the upper arm and provides glucose readings on a scanner waved over the area. It is sometimes referred to as 'flash' monitoring. The device is intended as an alternative to usual blood glucose monitoring in people with type 1 and 2 diabetes who use insulin.
 

Local Funding Decisions

The National Institute for Health and Care Excellence (NICE) developed a medtech innovation briefing (MIB) on the FreeStyle Libre, which it last updated in September 2017.

In the absence of NICE guidance on the kit, decisions on whether to fund the technology on the NHS in England must be taken locally by Clinical Commissioning Groups (CCGs).

Although in principle, the device has been available on the NHS since November 2017, an investigation by Diabetes UK in May this year found availability for those meeting local criteria in Northern Ireland and Wales. In England, the device was available for prescription in 127 out of 195 areas, and in Scotland in 11 out of 14 NHS Boards.

The charity said the devices made it easier to monitor and better control blood sugar levels, improved lives and would save the NHS money by reducing the risk of serious diabetes-related complications. "People’s health should not depend on an unfair postcode lottery," said Helen Dickens, assistant director of campaigns and mobilisation.

Issue Raised in Parliament

Steve McCabe, the Labour MP for Birmingham Selly Oak, asked the Prime Minister in the Commons last week whether, as a user of the FreeStyle Libre herself, she was prepared to "make that benefit available to the half a million people who are denied it because of NHS rationing".

Theresa May replied: "There is no one system that is right for everyone; what is important is that those systems are now available on the NHS."

NHS England said that 144 out of 195 English CCGs have now approved FreeStyle Libre for NHS use. A spokesperson said: "At the start of the year NHS England wrote to local GP groups reminding them of their responsibilities and of the guidance that exists when it comes to flash glucose monitoring, and other treatments for people with type 1 diabetes.

"NHS England continues to work with them to strongly encourage them to adopt best practice but ultimately it is their responsibility to take this into account as they make these decisions."

NICE said it could not say when it planned to update its MIB. Last year it was unable to calculate the cost to the NHS of providing the device to patients, although the commercial VAT-inclusive list price was £57.95 for the reader, plus £57.95 for a disposable sensor that needed to be replaced every 2 weeks.

Evidence from five studies, including two randomised controlled trials, suggested that using FreeStyle Libre for up to 12 months reduced time spent in hypoglycaemia compared with self-monitoring of blood glucose using finger-prick tests, and reduced the average number of finger-prick blood glucose tests needed, NICE said.

The Scottish Government said the FreeStyle Libre was now available in 13 out of 14 NHS Board areas.

A spokesperson said: "The Scottish Health Technology Group has recommended to Scottish Health Boards that flash glucose monitoring is available to individuals actively engaged in the management of their diabetes, requiring multiple daily insulin injections or insulin pump therapy. 

"NHS Boards are expected to consider this advice and whether to provide the device on prescription based on a range of issues including general population, prevalence, clinical decisions and appropriateness for the patient concerned."

Device Update

An updated version of the FreeStyle Libre will be launched this autumn with an optional alarm to alert the user to high and low blood glucose levels. The updated version will use Bluetooth technology rather than the near-field communication (NFC) on the original device.

Early indications were that the price of the new version would remain unchanged from the original system.

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