CGM on Prescription

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Peteh

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Type 2
T2 injecting twice per day, I have been self funding cgm sensor for about a year, as I have quite severe neuropathy in my hands also a musician, so not keen on constant finger pricking. Self funding wasnt too bad when I was working, but since I retired, having to find that money each month is difficult. My GP practice diabetic nurse says according to the rules that she has , as I inject twice per day I should be able to get the sensors on prescription. I wrote a letter to my GP, in which I explained about the neuropathy, and that i would often have to prick several times to get enough blood to test, the fact that my hobby of guitar and banjo playing makes me reluctant to finger prick, and that since using the cgm, I have been able to control my diabetes far more accurately. He said he doesnt have the budget for that, and passed it on the the local Diabetic Centre at the hospital. They refused the request to fund cgm for me. Any help and advice from people here would be greatly appreciated.
 
I am also T2 I went directly to my GP and he offered me the Libre 2 on prescription as I quality, i wasn't aware it depended on the GPs funding, as for your hospital i don't understand why they would refuse you, i wonder it there is any way you can appeal.
 
my GP said he wasnt able to fund it, that it had to be funded from the hospital
 
Peteh said:
my GP said he wasnt able to fund it, that it had to be funded from the hospital
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That isn't true anymore. It used to be the case that it had to be authorised by the hospital specialist but I think it changed about April last year and GPs can now prescribe CGM directly from their budget.... of course he may be reluctant because they have to manage their budget I believe, which is why they are sometimes also reluctant to refer people to specialists. I do however think it may be discretionary as regards Type 2 even on 2 or more injections of insulin a day. @Bruce Stephens may be able to quote the relevant NICE guidance which you could examine in depth and perhaps take with you to show your GP. I also wonder if Dr Partha Karr might be able to advocate for you. He is the diabetes lead in England and was instrumental in getting the NICE guidelines changed. I believe he has advocated for Type 1s who were having difficulty in obtaining it.
 
rebrascora said:
I do however think it may be discretionary as regards Type 2 even on 2 or more injections of insulin a day.
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It is a bit, yes. (Similar to the situation for Type 1 before the guidance change, though with slightly different criteria.)

Recommendations | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk www.nice.org.uk

I presume @Peteh would be going for neuropathy and this one
  • they have a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them)
But it's an argument that would need to be made and I could imagine different teams ending up deciding differently. The others are more clearcut so if one or more of those apply then definitely mention those.
 
To put it in context, the cost of a two-week FreeStyle Libre 2 sensor is about £50 if you buy it online, and probably about £35 to the NHS. Thus the annual costs are about £1300 and about £910, respectively.
Whether you (or your doctor) regard this as a large amount might depend on the annual cost of the other medication (including test strips, pen needles, and so on) which you might be making use of...
 
Some meters allow alternative site testing if you can’t fingerprick. Perhaps you could look into that option?
 
Peteh said:
my GP said he wasnt able to fund it, that it had to be funded from the hospital
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Are you asking for a specific CGM? if this is the case then it a no no. I think you are entitled to the Dexcom 1 or a libre on prescription.
So do check if this is the case and also that you qualify due to only having two injections a day and it's not type 2's using MDI that qualify.
Looking at the guidelines kindly posted by @Bruce Stephens you do qualify :

Offer intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as 'flash') to adults with type 2 diabetes on multiple daily insulin injections if any of the following apply:

  • they have recurrent hypoglycaemia or severe hypoglycaemia
  • they have impaired hypoglycaemia awareness
  • they have a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them)

You have a disability thus you qualify.
 
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@Peteh do you drive? Not sure if you need to be careful of saying you are unable to fingerprick and thus qualify for libre, if you do drive. This is because if you can’t fingerprick then you aren’t able to drive because there are times the DVLA insist on a fingerprick. So you would need to find a way of fingerpricking (eg alternative site testing, different fingerpicker, etc) or stop driving I’d imagine.

This may not apply if you don’t drive though.
 
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