What is FreeStyle Libre?
The Abbott FreeStyle Libre (FSL) flash glucose monitoring system is a factory-calibrated glucose sensor that measures interstitial fluid (not blood) glucose levels in individuals with diabetes mellitus. It is worn on the back of the arm and sensors last 14 days. Interstitial glucose readings are taken using an associated reader device or a compatible smartphone which is held over the sensor and downloads the last eight hours worth of data, providing a graphical display of interstitial glucose levels. This reduces the need to perform fingerprick glucose measurements. However, glucose monitoring is still required for driving (correct as of January 2019), testing for hypoglycaemia or suspected spurious results, and to enable accurate calculation of insulin correction doses.
Who can prescribe the Freestyle Libre?
GPs can prescribe FSL, and should do so, only for individuals identified by the secondary care diabetes team as being eligible based on clinical need and criteria as proposed by the Scottish diabetes Group/MCN Leads and endorsed by a Scottish Health Technology Group Assessment on the cost effectiveness of FSL.
Who is eligible to receive prescriptions for FSL?
- Individuals with Type 1 DM (T1DM) who are attending secondary care diabetes services and treated with intensive insulin therapy, with multiple daily insulin injections, or insulin pump therapy, who are already performing multiple (5 or more) fingerprick blood glucose tests per day.
- Individuals with recently developed impaired awareness of hypoglycaemia who are not yet candidates for (more costly) continuous glucose monitoring systems
- Women planning pregnancy or who are currently pregnant
- Those who required a third party to perform monitoring, or where dexterity or disability denote that conventional testing is difficult or impossible.
What other criteria must be met for the FSL to be prescribed?
- To have attended a recognised diabetes structured education programme (eg HEIDI), and/or be deemed by the team to have the required knowledge and skills to effectively self-manage their diabetes.
- Attendance at a local education session on the use of FSL.• Completion of the online Libre Academy modules prior to attending the education session https://freestylediabetes.co.uk/freestyle-libre/academy
- To agree to measure/“swipe” a minimum of six times per day.
- To use sensors and strips as recommended.
- To obtain a monthly supply of complementary blood glucose test strips from Abbott, if a driver.
- To agree to share glucose monitoring data with the diabetes clinic and complete any associated clinical questionnaires.
How will ongoing effectiveness of the device be assessed?
Individuals will be asked to sign a contact to agree to the above criteria and failure to attend two consecutive clinic appointments will result in a recommendation to the patient’s GP to discontinue the prescribing of FSL. Ongoing prescription of FSL will require effective use of the technology to improve self management as determined by the specialist diabetes team at their review appointments, eg reduction in hypoglycaemia, improvement in HbA1c, reduction in hospital admissions.
What are the associated costs?
FSL was added to the NHS prescribing tariff in November 2017 at a reduced acquisition cost compared to when purchased privately. The annual prescribing cost for FSL and associated sensors is £910 per patient, roughly equivalent to 8 or more glucose test strips per day. This is a significant saving compared to private purchase by patients. However, prescription should be limited to those identified by the specialist team as being suitable.
What if an individual is already self funding Freestyle Libre?
If an individual with type 1 diabetes is already self funding FSL then it is likely that prescription of FSL will be recommended by the specialist team provided that they are satisfied that it has led to improvements in the management of the individual’s diabetes, ie improved HbA1c, reduced hypos, less hospital admissions with DKA (if applicable). However, as above, please do not prescribe FSL unless on the advice of the secondary care diabetes team.
What if an individual is having technical problems with the sensors?
Individuals should contact Abbott directly rather than contacting their GP or the diabetes team.
Abbott UK General Customer Service telephone number: 0800 1701177
8am to 8pm, Monday to Friday; excluding bank holidays
How do individuals obtain their free supply of test strips?
Drivers can obtain the free supply of test strips by contacting Abbott Customer Services at the above number. This offer should remain valid whilst DVLA regulations continue to stipulate the need for fingerprick glucose monitoring for driving.