Tayside Diabetes MCN Handbook 
Flash Glucose Monitoring

NHS Tayside has approved the use of the FreeStyle Libre® system for people with diabetes who fulfil certain criteria. The decision to commence Freestyle Libre® will be made by the Specialist Diabetes Team.

 

What is Freestyle Libre

Freestyle Libre® is a flash glucose monitoring technology which allows people with diabetes to obtain glucose results via a sensor and reader. The system comprises of an adhesive sensor (which lasts for up to 14 days) which measures glucose levels in the interstitial fluid. A reader or mobile phone app is then used to wirelessly scan the sensor to obtain glucose readings.

 

Freestyle Libre® is not intended to completely replace Self Monitoring of Blood Glucose (SMBG) i.e. finger pricking but offers an alternative approach. SMBG will still be required under certain circumstances such as for insulin dose adjustment/bolus advice, illness, where glucose levels are changing rapidly or where readings are not consistent with symptoms being experienced. Also, SMBG is still required to meet current driving licence requirements.

 

Eligibility Criteria

Eligibility criteria are based on the recently published Scottish Health Technology Group Appraisal. Not all patients will meet these criteria and the device may not be suitable in every instance. The criteria are that flash glucose monitoring with Freestyle Libre® should be considered in people with diabetes who:

  • Use intensive insulin therapy - this is multiple (typically 4 or 5) daily injections or insulin pump therapy
  • Undertake the Libre Academy Course – an online training course
  • Attend a locally provided Flash Glucose Monitoring education session
  • Agree to scan glucose levels no less than six times per day
  • Agree to share glucose data with their diabetes clinic
  • Have attended a recognised diabetes structured education programme and/or clinical team are satisfied that the person (or carer) has required knowledge/skills to self-manage diabetes.

 

Access

The decision to commence Freestyle Libre® will be made by the Specialist Diabetes Team.

 

Further information on the criteria and how people with diabetes can access this technology is available on the Tayside Diabetes MCN website www.diabetes-healthnet.ac.uk.

 

  • Patients should be directed to the website where they will find information on the eligibility criteria, access to the online education course and booking for local education session at www.diabetes-healthnet.ac.uk .

 

  • Patients can be given a Patient Information Leaflet from the Diabetes MCN website that will provide the above information.

 

Once it has been confirmed by the Specialist Diabetes Team that the patient meets the criteria and has attended a local education session, a letter will be sent to the GP asking for Freestyle Libre® to be included on the patient’s repeat prescription. See Note at end for people who live outwith Tayside e.g. Fife

 

Review   

The patient will be reviewed six monthly by the Specialist Diabetes Team and the decision to continue/discontinued confirmed. If the use of Freestyle Libre® is to discontinue this will be discussed with the patient and communicated to the GP requesting this be removed from their prescription.

A Shared Care Agreement has been developed to confirm the responsibilities of the Specialist Diabetes Tem and General Practice in relation to the commencement, monitoring and prescribing of this device.

The Scottish Health Technology Group Appraisal criteria for continuation/discontinuation are set out below:

 

The criteria for continuation of Flash Glucose Monitoring are as follows: 

  • Reduction in episodes of Diabetic Ketoacidosis
  • Reduction in admission to hospital
  • Reduction in episodes of severe hypoglycaemia
  • Reduction in proportion of time spent with hypoglycaemia
  • Reversal of impaired hypoglycaemic awareness
  • Reduction in HbA1c of 5mmol/mol or more at 6 months

 

The criteria for cessation of monitoring are: 

  • Failure to achieve any one of the requirements for continuation
  • Failure to attend follow up appointments (2x consecutive “Did Not Attend” or > 4 in 3 years)
  • Failure to scan at least 6 times per day
  • Failure to share data with the secondary care team
  • Failure to engage with the clinical team to optimise glycaemic control
  • Failure to use testing strips and sensors as recommended
  • Evidence of greater harm than benefit on clinical or psychological state (increase number of hypos or psychological burden)

 

NOTE:

If patients who attend the Tayside Specialist Diabetes Service but live in Fife Health Board/Council area their prescriptions are funded by NHS Fife and therefore the criteria for NHS Fife funded Freestyle Libre will be applied. 

 

Last updated October 2018