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.
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. This can be discussed with the specialist diabetes team at the patient's diabetes clinic appointment. If the patient is considered appropriate they should be given this leaflet which contains the information they require to book themself onto a local education session. Once they have attended the education session a letter will be sent to their GP asking for Freestyle Libre® to be included on the patient’s repeat prescription.
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)
Last updated February 2023