NHS FreeStyle Libre Adoption Already Changing Patient Lives

Liam Davenport

October 30, 2019

LONDON — Changes to the funding of continuous glucose monitoring systems on the NHS in England has led to a dramatic uptake in the use of FreeStyle Libre by type 1 diabetes patients and improvements to patient care and quality of life, the latest figures reveal.

Prof Partha Kar, associate national clinical director for diabetes for NHS England, told Diabetes Professional Care 2019 that, between the device becoming available on prescription in April this year and August, there was a more than 60% increase in its adoption by eligible patients.

Latest Patient Data

The potential impact of this increased availability of glucose monitoring technology on the care of type 1 diabetes patients was shown by audit data from the Association of British Clinical Diabetologists (ABCD), also presented at the meeting.

Dr Bob Ryder, diabetes consultant & clinical lead at City Hospital, Birmingham, said that their analysis of more than 6500 patients given the device since the end of May revealed significant reductions in the time spent in hypoglycaemia and, crucially, in hypoglycaemia-related admissions.

Not only did this lead to improvements in blood glucose levels but also to improvements in diabetes-related stress for patients.

This initiative forms part of a wider move by NHS England to leverage the latest research and technology to reduce the time lag between discoveries and their availability to patients.

Type 2 Diabetes Remission

One example is in the use of low-calorie diets to achieve type 2 diabetes remission.

Prof Jonathan Valabhji, national clinical director for diabetes and obesity, NHS England, told the conference that in "my almost 3 decades of experience at the clinical coal face, I haven’t seen a piece of research quite capture the imagination of both the public and healthcare professionals", as the DIRECT study, led by Prof Roy Taylor.

As reported by Medscape News UK, this showed that type 2 diabetes patients who achieve rapid weight loss with a calorie-restricted liquid diet, followed by gradual food reintroduction and a weight loss maintenance programme, can achieve and maintain remission, at 46% at 1 year and 36% at 2 years.

This mirrored similar findings achieved by Susan Jebb and Paul Aveyard in the DROPLET study, with total meal replacements achieving what Prof Valabhji described as a "staggering" average weight loss of 11 kg.

"So we have two well conducted randomised controlled trials to show us what can be achieved," he said, "and we wanted to run with this."

Long-term Plans

With funding from the NHS Long Term Plan, they have been working on how to administer the programme in the NHS, with an initial pilot to be launched in April 2020.

The aim, Prof Valabhji said, is to provide the programme to 5000 people in different areas across the country, "and if we can at least partly reproduce the success of the trial, then there will be a very strong case for scaling up" for a national rollout.

Speaking to Medscape News UK, Prof Valabhji explained that the focus on reducing the time taken for innovations to reach the NHS has been "a deliberate push on our part".

He said previous research estimated the time lag between research publication and changes in clinical practice at an average of 17 years, and NHS England and NHS Improvement want "to do our best to concertina that".

The DIRECT study was a case in point, as the programme was put forward for inclusion in the NHS Long Term Plan 6 months after the one-year data was published in March 2018.

By the time the second-year data was shown in March 2019, "we were already working up to delivering it in a live environment," Prof Valabhji said, "so that’s a pretty concertinaed piece".

Flash Monitoring

Turning to the availability of FreeStyle Libre on the NHS, Prof Kar echoed Prof Valabhji‘s comments, saying: "One of the things that we do, and that’s an encouragement to all people within academic research, etc, is try to marry research with policy.

"There’s no point in doing fantastic research if it stays in a PowerPoint slide or in a paper, you’ve got to bring it to the population. That’s where the DIRECT study comes into being and that’s where this concept comes into being."

In addition to that, Prof Valabhji underlined that the drive to make flash glucose monitoring available to type 1 diabetes patients came from an appreciation of the needs of patients themselves.

Prof Valabhji told Medscape News UK that if he were to ask his patients over the two and a half decades that he has been running his weekly type 1 diabetes clinic, "what would make the biggest difference to your life, I think there’s a high change they’d say ‘not having to prick my finger all the time, doctor’".

"The flash glucose monitor is the first opportunity we’ve had," Prof Valabhji said, to deliver on that, "so the demand, understandably has been huge".

Flash Monitoring Uptake

Presenting the latest data on its availability, Prof Kar reiterated the NHS England commitments that the flash glucose monitoring system should be given to type 1 diabetes patients who have a clinical recommendation to have the device and, by 2020/2021 to all pregnant women with type 1 diabetes.

Prof Kar said that now, every clinical commissioning group (CCG) in the UK is  offering FreeStyle Libre to qualifying patients, although there are differences in uptake rates.

"This," he said, "follows changes made in April which meant people eligible are able to get them on prescription, regardless of where they live in the country."

Consequently, adoption of FreeStyle Libre has increased rapidly, rising from 10.7% of eligible type 1 diabetes patients in April to 17.6% in August.

This was underlined by data released by NHS England last week showing that 28,453 patients have received the glucose monitors, with 177,521 devices prescribed within the first 3 months.

"Providing flash monitors on the NHS is a huge leap forward and it is fantastic to see the roll out make an instant impact," Prof Kar told Parliament when the figures were announced.

"I’m thrilled with how many people are already benefitting from the device and doing away with inconvenient finger-prick checks."

He also told  the BMJ that the move "has been a huge success and a very pleasant surprise to see every single part of the country now providing flash within just 4 months of launching the NHS Long Term Plan".

"It’s a real achievement for the NHS, but we have also seen the life-changing benefits it is already bringing to patients with type 1 diabetes."

Gold Scores

This was underlined by the first results from the ABCD FreeStyle Libre Audit.

In a separate session, Dr Ryder told delegates that, as of May 2019, 156 sites in 114 centres in England have taken part in the initiative, submitting data on 6644 patients.

Analysis so far has shown that there has been a significant improvement in mean Gold scores of hypoglycaemia awareness among patients given the device, reducing from 2.85 to 2.46 (p<0.0001.

This was accompanied by a reduction in hypoglycaemia-related hospital admissions, from 2.71% to 0.5%.

Moreover, 31% of patients reported a reduced rate of hypoglycaemia, 39% reported a reduced rate of nocturnal hypoglycaemia, and 79% said that they spent less time in hypoglycaemia while using the device.

Unsurprisingly, this was associated with a significant improvement in Diabetes Distress Scores, from an average of 3 at baseline to 2 at follow-up (p<0.0001).

Dr Ryder added that "even HbA1c improved as a result of the use of this device", reducing by a significant -0.6% (p<0.0001), with the result that patients derived "a tremendous benefit from" using the device.

Keeping Up to Date With Guidance

However, Prof Kar still called out the slow uptake by clinicians on the ground, echoing comments he made earlier this year at the Diabetes UK Professional Conference.

He expressed frustration at doctors who are not up to speed with, for example, long-standing guidance from the National Institute for Health and Care Excellence (NICE) on the use of insulin pump therapy for type 1 diabetes in adults and children.

Expressing the need to "challenge that", he said: "It is absolutely down to healthcare professionals...Either train up, or give your type 1 diabetes patients to someone who cares."

Prof Valabhji agreed with the importance of clinician awareness and training.

He explained that when they look at introducing technologies such as FreeStyle Libre, "we foresee that one of the biggest challenges will be actually skilling up the workforce to deliver on these technologies".

"The technologies change pretty damn quickly, to be honest."

Prof Valabhji added: "That means that, as part of our annual continuous professional development, I think exactly as Partha said this morning: If you’re running a type 1 diabetes clinic you need to be keeping up to speed with the technologies.

"They’re changing and they’re changing fast."

No conflicts of interest or funding declared.

Diabetes Professional Care 2019: Keynote: NHS Diabetes Team Update; Learning from Real Life Data – highlights of the national ABCD programme. Presented 29th October.

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