All 400,000 type 1 Britons to be offered freestyle libre

[Amity Island]

All 400,000 Britons with type 1 diabetes will soon be offered a high-tech implant that monitors their blood sugar level in real time.

The small gadget had been restricted by the NHS because of cost, and made available only to those most in need.

Dr Partha Kar, NHS England's national speciality adviser for diabetes, says patients will now have access to the expensive technology within weeks, marking the end of finger-prick blood tests.

All 400,000 type 1 diabetic Britons to be offered high-tech implant

Dr Partha Kar, NHS England's speciality adviser for diabetes, says patients will have access to the expensive technology within weeks, marking the end of finger-prick blood tests.

www.dailymail.co.uk

* note: I don't agree with the statement about ending finger prick tests, as these are still necessary in some circumstances.
not sure about the "implant" description either.

 

[Amity Island]

I read a short piece about this on Sunday. It ended by saying that the NHS had decided that the cost of providing CGMs was less than the cost of treating people for diabetes complications and would keep more diabetes patients out of hospital.
No-brainer, really.

And not much more (or less) than finger prick testing...

 

[gll]

I'm sure I read somewhere that a sensor costs the nhs about £36 per one and not the nearer £50 self funding folks pay

That's fantastic news for all T1s

 

[Amity Island]

I'm sure I read somewhere that a sensor costs the nhs about £36 per one and not the nearer £50 self funding folks pay

That's fantastic news for all T1s

When i used to pay for them, I was always charged just £36, never £50 list price. £36 is a great price for the benefit one can get, waaaay more useful than finger pricks.

 

[Bruce Stephens]

And not much more (or less) than finger prick testing...

Yes, I'm sure a big driver is the fall in cost caused by Libre. The economic report is available (along with the other documents): https://www.nice.org.uk/guidance/indevelopment/gid-ng10265/documents

(If you only read one, Evidence review - CGM is probably the one to choose.)

 

[Robin]

Oh dear, I was reading the article thinking, so far so good, when I came across the Daily Fail definition of Type 1.

With type 1 diabetes, the pancreas does not produce enough insulin. Without that, blood sugar levels can become dangerously high, causing serious damage to blood vessels that supply vital organs.
If a patient goes untreated, they quickly develop life-threatening conditions such as heart and kidney disease.

Back to school.

 

[Amity Island]

Oh dear, I was reading the article thinking, so far so good, when I came across the Daily Fail definition of Type 1.

With type 1 diabetes, the pancreas does not produce enough insulin. Without that, blood sugar levels can become dangerously high, causing serious damage to blood vessels that supply vital organs.
If a patient goes untreated, they quickly develop life-threatening conditions such as heart and kidney disease.

Back to school.

I saw that too!

 

[Amity Island]

Yes, I'm sure a big driver is the fall in cost caused by Libre. The economic report is available (along with the other documents): https://www.nice.org.uk/guidance/indevelopment/gid-ng10265/documents

(If you only read one, Evidence review - CGM is probably the one to choose.)

The thing that seems to get missed in the reasons (not just money and avoiding long term problems) for making this available to diabetics, is the fact that it changes your life, not just your readings. You can attempt to do things you may not of dared before! You can see things you couldn't see previously. You get full evidence when attending hospital appointments. You get to make decisions that were almost impossible before about timings and doses.

They're grrrreeat!

 

[Bruce Stephens]

The thing that seems to get missed in the reasons (not just money and avoiding long term problems) for making this available to diabetics, is the fact that it changes your life, not just your readings. You can attempt to do things you may not of dared before! You can see things you couldn't see previously. You get full evidence when attending hospital appointments. You get to make decisions that were almost impossible before about timings and doses.

Yes, and I'm sure the information available on reviews is a big part of why previously sceptical consultants have come over. But to be fair to NICE, it's not that they aren't looking at these things (though they're secondary rather than primary outcomes (the primary outcomes are things like HbA1c, hypos, DKA events)). But the studies don't seem to report improvements in the quality of life measures like diabetes distress, fear of hypos, quality of life. See pages 26-27 (of the evidence review for CGMs) for their summary.

I've honestly no idea what's going on. Perhaps these measures just aren't considering the things we find important? (Or perhaps the differences aren't considered significant for some reason: seems obvious that someone with rtCGM ought to be significantly less concerned about nocturnal hypos, but if that fear is generally very low then an improvement might not matter much.)

 

[Amity Island]

Yes, and I'm sure the information available on reviews is a big part of why previously sceptical consultants have come over. But to be fair to NICE, it's not that they aren't looking at these things (though they're secondary rather than primary outcomes (the primary outcomes are things like HbA1c, hypos, DKA events)). But the studies don't seem to report improvements in the quality of life measures like diabetes distress, fear of hypos, quality of life. See pages 26-27 (of the evidence review for CGMs) for their summary.

I've honestly no idea what's going on. Perhaps these measures just aren't considering the things we find important? (Or perhaps the differences aren't considered significant for some reason: seems obvious that someone with rtCGM ought to be significantly less concerned about nocturnal hypos, but if that fear is generally very low then an improvement might not matter much.)

I think it's the age old, employer and employee dynamic. Those making the business decisions are thinking about making/saving money, those employed just want to enjoy their work and life.

 

[mikeyB]

The problem with all 400,000 T1s having access to the Libre may be profit for Abbott, but that 400,000 represents a cross section of society in general. Half would be above average in intelligence and half below, with extremes in both classifications. You need a decent level of brain power to use the system to help you. They don’t help if you ignore BG levels, or are neglectful of self care, or are incapable of applying the system properly. That would be a waste of NHS money.

The same argument would apply to pumps, which are a great help to those who can set all the controls properly, and is fully aware of basal requirements, ratios of carb to insulin at different times of day. They take much more brainpower than CGMs, but can be a life changer. Even closed loops have to be preset with appropriate levels, and being associated with a decent CGM (not the Libre, because it can’t be calibrated).

 

[Amity Island]

The problem with all 400,000 T1s having access to the Libre may be profit for Abbott, but that 400,000 represents a cross section of society in general. Half would be above average in intelligence and half below, with extremes in both classifications. You need a decent level of brain power to use the system to help you. They don’t help if you ignore BG levels, or are neglectful of self care, or are incapable of applying the system properly. That would be a waste of NHS money.

The same argument would apply to pumps, which are a great help to those who can set all the controls properly, and is fully aware of basal requirements, ratios of carb to insulin at different times of day. They take much more brainpower than CGMs, but can be a life changer. Even closed loops have to be preset with appropriate levels, and being associated with a decent CGM (not the Libre, because it can’t be calibrated).

Valid points.

With this cross section of society, what does this mean for Javid's new shift (saving money) from the NHS caring for us to us caring for the NHS? Personal responsibility. If a large proportion of society as you say don't have the ability to make use of for example the freestyle libre, insulin pumps or manage their diet generally or afford decent food what will happen to them?

 

[JJay]

The problem with all 400,000 T1s having access to the Libre may be profit for Abbott, but that 400,000 represents a cross section of society in general. Half would be above average in intelligence and half below, with extremes in both classifications. You need a decent level of brain power to use the system to help you. They don’t help if you ignore BG levels, or are neglectful of self care, or are incapable of applying the system properly. That would be a waste of NHS money.

The same argument would apply to pumps, which are a great help to those who can set all the controls properly, and is fully aware of basal requirements, ratios of carb to insulin at different times of day. They take much more brainpower than CGMs, but can be a life changer. Even closed loops have to be preset with appropriate levels, and being associated with a decent CGM (not the Libre, because it can’t be calibrated).

Presumably they wouldn’t be offered to T1s whose HCPs felt they wouldn’t be able to benefit from them ? And the keyword is “offered” - I’m sure there are a fair few who are quite happy with their current management strategy and just wouldn’t be interested.

 

[Sally71]

There’s no way my mum would want one! She’s a bit of a dinosaur when it comes to technology, wouldn’t want to learn how to use it and wouldn’t be able to see the point anyway, as far as she’s concerned she’s still here after 55 years of fixed dose insulin injections and minimal testing (she sometimes goes whole days without finger pricking once) and therefore why should she change what works! I know there are people out there who are of a similar age to her and been diagnosed the same length of time who have fully embraced pumps and CGMs and so on, but she isn’t one of them and for the amount of finger pricking she does (not much) it wouldn’t be a money saver in her case anyway. My daughter’s consultant would go up the wall if we had such a lax attitude to her diabetes, but mum says she’s happy with how things are for her and wants to keep managing her diabetes the way she always has done, and who is anyone else to argue with that!

 

[Bruce Stephens]

Presumably they wouldn’t be offered to T1s whose HCPs felt they wouldn’t be able to benefit from them ?

I'm sure there'll be discussions, and obviously these aren't going to be forced on people. There ought to be a benefit in making CGM (either isCGM or rtCGM) the standard treatment: apparently right now the chances of a black child getting a CGM is about half that of a white child.

I'm also sure that some people won't get much value out of it. Maybe they'll just use it as a replacement for most finger prick tests. That seems OK to me. Likely they'll end up seeing more information than they did before, and that's a benefit.

And even for people on mixed insulin or people who don't really care that much will be giving their HCP much better information which ought to better inform their advice.

 

[Amity Island]

mum says she’s happy with how things are for her and wants to keep managing her diabetes the way she always has done, and who is anyone else to argue with that!

Nothing wrong with that at all. Nobody should have to take any treatment they don't want or think will have little or no benefit to them. Micromanaging won't suit everybody, and the libre can be overwhelming for some and lead to worse management by over reacting or trying keep in range all the time.

 

[Amity Island]

I thought this news article about Japan was interesting, in terms of the criteria for allocating the freestyle libre. Perhaps the UK will follow and other diabetics besides Type 1's will be offered it?

"ABBOTT PARK, Ill. - Abbott (NYSE: ABT) announced that the Japanese Ministry of Health, Labour and Welfare has approved the expansion of reimbursement coverage for its FreeStyle Libre system to include all people with diabetes who use insulin at least once a day."

ABBOTT'S FREESTYLE LIBRE IS FIRST AND ONLY CGM SYSTEM TO GAIN EXPANDED REIMBURSEMENT IN JAPAN TO INCLUDE ALL PEOPLE WITH DIABETES WHO USE INSULIN

ABBOTT PARK, Ill. - Abbott announced that the Japanese Ministry of Health, Labour and Welfare has approved the expansion of reimbursement coverage for its FreeStyle Libre system to include all people...

www.marketscreener.com

 

[mikeyB]

I also wish the criteria that are applied to those who use insulin in addition to the strict T1 standard that NHS England apply. It is, of course, a cost saving measure because accountants only assess the cost of the system and compare it to fingerpricking. The overall health benefit to diabetics using insulin is not included in their consideration, or to reduce incidence of hospital admissions.

It's the same short sighted accounting philosophy that leaves England as the only country in the UK to make people pay for their prescriptions, so the poor and the lower waged folk in England have to choose between heating and lighting and food plus paying for their medications.

 

[Burylancs]

I thought this news article about Japan was interesting, in terms of the criteria for allocating the freestyle libre. Perhaps the UK will follow and other diabetics besides Type 1's will be offered it?

"ABBOTT PARK, Ill. - Abbott (NYSE: ABT) announced that the Japanese Ministry of Health, Labour and Welfare has approved the expansion of reimbursement coverage for its FreeStyle Libre system to include all people with diabetes who use insulin at least once a day."

ABBOTT'S FREESTYLE LIBRE IS FIRST AND ONLY CGM SYSTEM TO GAIN EXPANDED REIMBURSEMENT IN JAPAN TO INCLUDE ALL PEOPLE WITH DIABETES WHO USE INSULIN

ABBOTT PARK, Ill. - Abbott announced that the Japanese Ministry of Health, Labour and Welfare has approved the expansion of reimbursement coverage for its FreeStyle Libre system to include all people...

www.marketscreener.com

Excellent. T2s not being discriminated against as in Britain.