The decision to commence Flash Glucose Monitoring (FGM) and Continuous Glucose Monitoring (CGM) will be made by the Specialist Diabetes Team.
FGM and CGM technology allows people with diabetes to obtain glucose results via a sensor and reader. The system comprises of an adhesive sensor 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. You can also set an alarm to sound if sugar levels go too low or high.
One of the other main benefits of FGM or CGM is being able to review what sugar levels do every minute of the day and night. With the charts and graphs, you can see and understand how food, activity, and other things affect sugar levels.
Self Monitoring of Blood Glucose (finger prick) will still be required under certain circumstances such as illness, where glucose levels are changing rapidly or where readings are not consistent with symptoms being experienced.
FreeStyle Libre 2/2 Plus
Sensors available on the Scottish Drug Tariff
FreeStyle Libre 2 Plus sensor is the latest FreeStyle system. It conveniently works with the current FreeStyle Libre 2 reader and FreeStyle LibreLink◊ app. See here for FAQs about the change over from FreeStyle Libre 2 to Freestyle Libre 2 Plus and here for patient information leaflet. Freestyle Libre 2 Plus has:
- 15-day sensor wear
- 15 day accuracy4
- Optional glucose alarms¤
- Indicated for ages 2 years and older
Eligibility Criteria
Eligibility criteria are based on the Scottish Health Technology Group Appraisal:
- Use intensive insulin therapy - this is multiple 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 2 Plus will be made by the Specialist Diabetes Team. 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 2 Plus to be included on the patient’s repeat prescription.
Review
The patient will be reviewed 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.
Freestyle Libre 3
Sensors available on the Scottish Drug Tariff
The FreeStyle Libre 3 system is a real-time CGM system, whereby glucose levels are automatically and continuously recorded and stored in the sensor and streams continuous, real-time readings directly to patient’s smartphone2 every minute. Glucose levels, trends and variability can be accessed using the FreeStyle Libre 3 mobile application (app) that continuously collects glucose data and presents the results on a smartphone.
The FreeStyle Libre 3 system can link with the Ypsomed pump to create a Closed Loop System for people with Type 1 diabetes.
Eligibility Criteria
Eligibility criteria are based on the SIGN Guideline 170:
Single-hormone closed-loop systems should be available to people with type 1 diabetes (paediatric and adult) who: under their current diabetes care plan continue to have suboptimal glycaemic control, a high risk of severe hypoglycaemia, or impaired awareness of hypoglycaemia, or experience diabetes-related distress, measured using a validated tool, that adversely affects their quality of life or ability to manage diabetes, and which is likely to be improved by moving to a closed-loop system.
Access
The decision to commence FreeStyle Libre 3 will be made by the Specialist Diabetes Team. Training will be provided by the Specialist Diabetes Team and then a letter sent to the GP asking for Freestyle Libre 3 to be included on the patient’s repeat prescription.
Review
The patient will be reviewed by the Specialist Diabetes Team and the decision to continue/discontinued confirmed. If the use of FreeStyle Libre 3 is to discontinue this will be discussed with the patient and communicated to the GP requesting this be removed from their prescription.
Dexcom ONE/ONE+
Sensors available on the Scottish Drug Tariff
Dexcom ONE and ONE+ is a new simpler and cheaper CGMS for people with type 1 or type 2 diabetes using multiple daily injections. It is standalone and does not connect with insulin pumps. It is suitable for ages 2 years and?older. It has an up to 10-day wearable sensor which sends glucose readings and trends automatically to a smart device every 5 minutes. It features optional high and low alerts that warn when glucose levels are out of range.
Eligibility Criteria
Eligibility criteria are based on the SIGN Guideline 170:
Offer adults with type 1 diabetes a choice of continuous glucose monitoring based on their individual preferences, needs, characteristics, and the functionality of the devices available
Access
The decision to commence Dexcom ONE/ONE+ will be made by the Specialist Diabetes Team. Training will be provided by the Specialist Diabetes Team and then a letter sent to the GP asking for Dexcom ONE/ONE+ to be included on the patient’s repeat prescription.
Review
The patient will be reviewed by the Specialist Diabetes Team and the decision to continue/discontinued confirmed. If the use of Dexcom ONE/ONE+ is to discontinue this will be discussed with the patient and communicated to the GP requesting this be removed from their prescription.
Dexcom G6/7
Sensors only available through Procurement and not on Scottish Drug Tariff
The Dexcom G6 and G7 are best for people with type 1 diabetes who may need extra support such as people who are hypo unaware, pregnant or children or those that want connectivity with insulin pumps to create a Closed Loop System.
Eligibility Criteria
Eligibility criteria are based on the SIGN Guideline 170:
Single-hormone closed-loop systems should be available to people with type 1 diabetes (paediatric and adult) who: under their current diabetes care plan continue to have suboptimal glycaemic control, a high risk of severe hypoglycaemia, or impaired awareness of hypoglycaemia, or experience diabetes-related distress, measured using a validated tool, that adversely affects their quality of life or ability to manage diabetes, and which is likely to be improved by moving to a closed-loop system.
Access
The decision to commence Dexcom G6/7 will be made by the Specialist Diabetes Team. Training, ordering of supplies and monitoring will be undertaken by the Specialist Diabetes Team.
Review
The patient will be reviewed by the Specialist Diabetes Team.
Medtronic Guardian 4
Sensors only available through Procurement and not on Scottish Drug Tariff
Medtronic CGM systems can be used by people with type 1 diabetes on multiple daily injections but are most useful for those using Medtronic insulin pumps, as the sensor can communicate directly with the pump to create a Closed Loop System.
Eligibility Criteria
Eligibility criteria are based on the SIGN Guideline 170:
Single-hormone closed-loop systems should be available to people with type 1 diabetes (paediatric and adult) who: under their current diabetes care plan continue to have suboptimal glycaemic control, a high risk of severe hypoglycaemia, or impaired awareness of hypoglycaemia, or experience diabetes-related distress, measured using a validated tool, that adversely affects their quality of life or ability to manage diabetes, and which is likely to be improved by moving to a closed-loop system.
Access
The decision to commence Dexcom G6/7 will be made by the Specialist Diabetes Team. Training, ordering of supplies and monitoring will be undertaken by the Specialist Diabetes Team.
Review
The patient will be reviewed by the Specialist Diabetes Team.