Freestyle Libre flash glucose monitoring - An update on commissioning in England
Since launching our guidelines on FreeStyle Libre (FSL) we have been encouraged that some areas have adopted FSL. Diabetes UK have developed a very useful map to track FSL policy decisions made across the country and it makes encouraging reading.
Many areas have adopted a cautious approach and have followed the Regional Medicines Optimisation Committee’s (RMOC) criteria which have been adapted from the ABCD guidelines. We welcome the fact that forward thinking CCGs have embraced the opportunities offered by FSL for people with diabetes (PWD).
Unfortunately, there is still a considerable amount of variation between CCGs/STPs, something our guidelines sought to prevent. Some of the decisions made have tried to unpick the RMOC criteria or have created criteria that have simply sought to limit numbers of patients eligible rather than provide effective care for PWD. Others have requested data that simply does not exist, such as the expected number of patients falling into each RMOC category. Whereas we understand the difficult financial position the NHS is currently in and the understandable caution around FSL given the paucity of the current research, every day clinicians are seeing first-hand the remarkable difference this device can make to those living with diabetes.
Our aim is make care for people with T1DM the best it can be, the best for patients and the best for the NHS in the long-term. This is an opportunity not to be missed.
We urge drug policy groups to make use of the available guidelines and to seek clinical input in their decision making and consider including a review date in their policies at a point when more complete data will be available to aid decisions. We encourage all CCGs to take part in the Association of British Clinical Diabetologists (ABCD) FSL audit which, in the absence of valuable RCT data, will provide an insight into the effectiveness of this intervention and will hopefully provide clarity as to which PWD will benefit from this device. This data should be available within 12 months.
Marc Atkin & Rob Gregory
On behalf of the ABCD Type 1 Diabetes Clinical Collaborative-UK / Association of British Clinical Diabetologists