***Following today’s announcement by NICE recommending CGM and Flash should be offered to all people with type 1 diabetes, we are working to update the content on this page***
For latest information about access to CGM and Flash please see our Q&A guidance.
In November 2020 FreeStyle Libre 2 system was added to the NHS tariff. Libre 2 has all the benefits of the FreeStyle Libre system with an update to accuracy and optional real-time alarms. Libre 2 will alert the user to the need to perform a scan when their glucose goes out of target range. Upgrades from Libre to Libre 2 are continuing. Please wait for your next routine appointment to discuss voluntary replacement.
Criteria for NHS funding for flash glucose sensing (England)
NHS England set some criteria in 2019, to reimburse your CCG most of the cost of flash glucose monitoring. This measure was intended to encourage CCGs to prescribe flash to at least 20% of those with type 1 diabetes. This arrangement ended in April 2021, so CCGs now have to fund flash glucose precribing themselves, and are free to set their own criteria.
NHS England said that as at the end of June 2020, 31% of people with type 1 diabetes in England have been prescribed flash glucose monitoring on the NHS. To see how your local CCG compares, visit OpenPrescribing, add your CCG name in the box and press “Show me the data”
Despite the change in funding arrangements, we are pleased to see that prescriptions of Libre and Libre 2 have not decreased since April 2021 and in fact continue to rise. CCGs can now set their own criteria but most seem to be continuing with those set by NHS England in 2019 as shown below.
1. People with type 1 diabetes OR with any form of diabetes on hemodialysis and on insulin treatment who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past three months OR with diabetes associated with cystic fibrosis on insulin treatment
2. Pregnant women with type 1 diabetes – 12 months in total inclusive of postdelivery period.
3. People with type 1 diabetes unable to routinely self-monitor blood glucose due to disability who require carers to support glucose monitoring and insulin management.
4. People with type 1 diabetes for whom the specialist diabetes MDT determines have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support.
5. Previous self-funders of Flash Glucose Monitors with type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of these criteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self funding.
6. For those with type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of hypoglycemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation. However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered.
Added November 2020: people with a learning disability and any type of diabetes who are using insulin
1. Education on Flash Glucose Monitoring has been provided (online or in person)
2. Agree to scan glucose levels no less than 8 times per day and use the sensor more than 70% of the time
3. Agree to regular reviews with the local clinical team
4. Previous attendance, or due consideration given to future attendance, at a type 1 diabetes structured education programme (DAFNE or equivalent if available
Continuing prescription for long-term use of flash glucose monitoring – after the initial 6 months – would be contingent upon evidence of agreeing with the above conditions and that on-going use of the flash glucose monitoring is demonstrably improving an individual’s diabetes self-management- for example improvement of HbA1c or Time In Range; improvement in symptoms such as DKA or hypoglycaemia; or improvement in psycho-social wellbeing.
The Diabetes Technology Network has a position statement on access to flash glucose monitoring (Libre 1 and 2) which recommends access tor all people with type 1 diabetes who are on either mutliple daily insulin injections or insulin pump therapy.
Criteria for NHS funding for flash glucose sensing (Wales)
Health Technology Wales published updated guidance in September 2021 as follows:
“The evidence supports the routine adoption of Freestyle Libre flash glucose monitoring to guide blood glucose regulation in people with diabetes who require treatment with insulin. ”
This means anyone with type 1 diabetes (or with any other type who uses insulin) meets the criteria for accessing flash glucose monitoring on the NHS.
We see this reflected in the statistics, which showed in June 2021 that over half of the type 1 diabetes population in Wales uses flash glucose monitoring.
Criteria for NHS funding for flash glucose sensing (Northern Ireland)
Northern Ireland has the highest level of Flash adoption of all the nations – almost 100% – fairly consistent across all centres. If you have type 1 diabetes, just ask for flash at your diabetes clinic.
The Health & Social Care Board published a pathway is for use by secondary care diabetes health care professionals, to assess if patients are suitable for a trial period of the flash glucose monitoring or for supply of sensors on prescription (for those who have previously been self-funding).
The pathway provides criteria and additional points for consideration to support clinical decision making processes. The application of the points for consideration will be dependent upon clinical judgement and individual patient circumstances.
Criteria for a 3-6 month trial of flash glucose monitoring:
(NOTE: These criteria must also be met when establishing if patients who have been self-funding are now eligible for supply of sensors on prescription).
1. Type 1 Diabetes
2. Have undergone (or willing to undertake) previous ‘advanced insulin self-management education’ e.g. DAFNE, BERTIE, CHOICE.
Additional clinical points to be considered:
3. Using effective basal bolus insulin self-management with evidence of carb counting and correction insulin use with finger prick blood glucose monitoring >4 times daily.
4. Problematic BG management or difficulties maintaining good control, despite the above e.g.
a. Variable blood glucose control with episodic hypoglycaemia impacting on lifestyle.
b. Recurrent hypoglycaemia (> 3 episodes per week or >2 severe episodes in a year).
c. Loss of hypoglycaemia awareness symptoms
d. Persistent raised HbA1c despite insulin dose adjustments.
e. Severe physical, psychological or occupational barriers to effective blood glucose monitoring.
5. Substantial evidence of benefit in maintaining good glucose control with a sensor device.
6. Regular attendance at secondary care clinic.
The Health and Social Care Board sent this pathway to GP Practices and Community Pharmacists in 2017 and it remains unchanged since then.
Criteria for NHS funding for flash glucose sensing (Scotland)
The Scottish Health Technologies Group (SHTG) is a national health technology assessment (HTA) agency, which provides advice to NHSScotland on the use of new and existing health technologies (excluding medicines), likely to have significant implications for people’s care. NHSScotland is required to “consider” their advice.
The Scottish Diabetes Group has endorsed the SHTG recommendations. There is some variation from centre to centre but access for people with type1 diabetes is quite open.
“It is recommended that flash glucose monitoring … is available for individuals with diabetes who are actively engaged in the management of their diabetes and who intensively manage their condition with multiple daily insulin injections or insulin pump therapy.
In keeping with the Scottish Diabetes Group criteria, use should be restricted to those who:
- Agree to attend a locally provided flash glucose monitoring education session;
- Agree to scan glucose levels no fewer than six times per day;
- Satisfy their clinical team that they (or carer) have the required knowledge/skills to self-manage diabetes; for example, having attended a recognised diabetes structured education programme.
Clinical review timescales should be agreed to ensure that use of the device continues to support individuals’ diabetes care management…
Recipients should be encouraged to share data with their care team to facilitate clinical review and to contribute to local and national audit.”
People who do not get Libre on prescription can buy direct from Abbott
Some local pharmacies are selling Libre at a discounted price – ask the diabetes online community on social media for locations of those pharmacies.
If you order from the Libre website & webshop be sure to tick the VAT exemption box.
Need more help/have further questions? Contact us