Freestyle Libre 3

[helli]

I assume MARD is Mean Absolute Relative Difference which measures the accuracy of CGMs.
In my experience with multiple different CGMs, this varies significantly per person.
Dexcom is often quoted as if it is the gold standard of CGMs. For me, Libre with xDrip (I understand this is not an option for you @BadaBing) was far more accurate.
I don’t take too much notice of the “average accuracy”. The ability to calibrate is the most important factor for me and I don’t understand why Libre excludes this capability from their native apps.

 

[BadaBing]

It sounds to me it‘s about your (or my) lifestyle.
I work at a desk with my mobile as my only phone. It is far far easier and far less intrusive to glance at my phone lockscreen whilst I am on a video call (or in a face to face meeting) than to scan my arm.
i don’t want to be “the woman with diabetes” which having to scan identifies me as. As I use my phone and CGM/Libre, I could be glancing at an email or a text or a WhatsApp message which are all things that are completely normal in my business.
My pump is also controlled via my phone so everything is in one place. I can have a lunch meeting without anyone knowing I am checking my levels or dosing my insulin. They probably think I am responding to an urgent email.

When not at work, I use my phone to listen to podcasts or navigate whilst walking as well as checking the news and keeping in contact with friends and family. My phone lives in my leggings’ or jeans pocket. Not at the bottom of my bag. I try to avoid taking a bag out with me.

Well said helli! I feel exactly the same. I don't want to be treated differently because I have diabetes.

I believe the Libre 3 would much better protect my right for my medical condition to remain private.

 

[BadaBing]

I assume MARD is Mean Absolute Relative Difference which measures the accuracy of CGMs.
In my experience with multiple different CGMs,m this varies significantly per person.
Dexcom is often quoted as if it is the gold standard of CGMs. For me, Libre was far more accurate.
I don’t take too much notice of the “average accuracy”. The ability to calibrate is the most important factor for me and I don’t understand why Libre excludes this capability.

I don't take much notice of MARDs either day-to-day. But the fact that the claimed MARD is reducing all the time (the Libre 1 MARD is 11 I think) can only be a good thing from a health perspective.

As well as the fact that Dexcom, Abbott and the others are competing continually to make their product better than their rivals.

 

[Paulbreen]

Thanks Paul

I understand you are based in Germany. Is that right?

The information you have given is very helpful indeed.

As I said when I started this thread, I want to get a sense of just how much of a gatekeeper function hospital trusts in England are going to operate in terms of allowing diabetics living in England to access real time cgms now the NICE eligibility criteria have been updated.

Yep, I live in Germany, but more than experienced with the NHS, things are aa little different here and when something becomes available the health insurance companies will decide if they will pay for the new treatments, most of the time they do and you dont have to wait too long for said items to get to the people who need them, there are no multiple layers of interference from the government both nationally and locally.
As a guess 2023 maybe 2024 the Libre3 will come over there, your normally 18 months to 2 years behind what happens here.

 

[Paulbreen]

I don't particularly understand why "not having to scan" is such a big deal, but maybe this is because I use a reader rather than the phone, which picks up the sensor more easily than I am lead to believe a phone does
It takes me less time to scan than it does to dig my phone out of my bag and look at it. Maybe it's just that i find phones an intrusion rather than a convenience and the bigger phones these days are more cumbersome to handle. I guess this is proof that I am becoming an old fogey!

Hey Barbara, I've never really looked at the phone to see what my BG was doing, I just set the alarms to give me a good enough warning to be ready to do something about it, and I'm with you being a progressive old fogey lol, I'm just a bit of a nerdy one. have a great weekend

 

[Jgarrity]

The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding

Hi I just saw you said that everyone is entitled to at least libre 1 is this true? I have a friend who is in his 30s a scaffolder and has just been diagnosed with type one and I know this would help him massively I have already told him to bring it up with his gp but would love further confirmation to help him out
Thanks
James

 

[Lily123]

Hi I just saw you said that everyone is entitled to at least libre 1 is this true? I have a friend who is in his 30s a scaffolder and has just been diagnosed with type one and I know this would help him massively I have already told him to bring it up with his gp but would love further confirmation to help him out
Thanks
James

It says it is best practice so should be

NICE guidance

Offer adults with type 1 diabetes a choice of real-time continuous glucose monitoring or intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) based on their individual preferences, needs, characteristics, and the functionality of the devices available.

 

[helli]

Hi I just saw you said that everyone is entitled to at least libre 1 is this true? I have a friend who is in his 30s a scaffolder and has just been diagnosed with type one and I know this would help him massively I have already told him to bring it up with his gp but would love further confirmation to help him out
Thanks
James

As @Lily123 says, thsee are the current NICE guidelines
However, they are only “guidelines” so maybe interpreted differently (or ignored) by each CCG and it is recent guidelines so may take some time to be implemented for everyone with Type 1. They are not an “entitlement”.
That said, before the recent guidelines were published, more than 50% of people with Type 1 in England, had Libre.
Therefore, it is definitely worth your friend asking but he may have a higher chance of getting Libre on prescription if he asks his diabetes team rather than GP. It was only a diabetes consultant who had access to the “Libre fund bucket”.

 

[BadaBing]

The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding

Hello Lily123

With all due respect, I don't agree with your interpretation of the new guidelines.

First, the NICE guidelines are simply guidance, not law. NICE have now recommended that if patients meet the stated criteria then hospital trusts should offer real time cgms or flash cgms having regard to the patients individual characteristics, preferences and wishes.

I agree that hospital trusts cannot be compelled to do so (although if their reasons for refusing are unreasonable or irrational, those reasons may be subject to challenge in court).

Of course not every T1 (nor every T2s who meet the criteria) who meet the criteria will get a real time cgm. That goes without saying.

But if one thinks about the actual language that has been used in the updated NICE guidelines, it envisages that some patients ought to receive the Libre 3 (or another real time cgm) if they prefer to have one.

If I am wrong about that, it begs the question: why have the NICE guidelines been updated in such a manner to hold out the reasonable expectation that some within our cohort may receive a real time cgm if in fact and practice it will never be offered?

Of course, I may not be eligible to be offered a Libre 3 (or another real time cgm). But if I understand your reasoning correctly, it means that no one else would either; even if they meet squarely one or more of the new criteria and it is their "preference," "wish" or because of their "individual characteristics" (words that appear clearly and unambiguously in the updated NICE guidelines) they want to have a real time cgm rather than a flash cgm.

 

[Lily123]

Hello Lily123

With all due respect, I don't agree with your interpretation of the new guidelines.

First, the NICE guidelines are simply guidance, not law. NICE have now recommended that if patients meet the stated criteria then hospital trusts should offer real time cgms or flash cgms having regard to the patients individual characteristics, preferences and wishes.

I agree that hospital trusts cannot be compelled to do so (although if their reasons for refusing are unreasonable or irrational, those reasons may be subject to challenge in court).

Of course not every T1 (nor every T2s who meet the criteria) who meet the criteria will get a real time cgm. That goes without saying.

But if one thinks about the actual language that has been used in the updated NICE guidelines, it envisages that some patients ought to receive the Libre 3 (or another real time cgm) if they prefer to have one.

If I am wrong about that, it begs the question: why have the NICE guidelines been updated in such a manner to hold out the reasonable expectation that some within our cohort may receive a real time cgm if in fact and practice it will never be offered?

Of course, I may not be eligible to be offered a Libre 3 (or another real time cgm). But if I understand your reasoning correctly, it means that no one else would either; even if they meet squarely one or more of the new criteria and it is their "preference," "wish" or because of their "individual characteristics" (words that appear clearly and unambiguously in the updated NICE guidelines) they want to have a real time cgm rather than a flash cgm.

You have already written me a similar reply to the same post if you look on page 2 of this thread you should find it.

As I have stated in another post, it is best practice for CCGs to adhere to the guidelines but like you have said, they don’t have to.

Following this guidance by NICE a vast amount of CCGs would probably offer Libre 1 or 2 and would less often prescribe Libre 3 or equivalent. ( it may play out differently but this seems probable)

 

[rayray119]

The new guidelines state that every adult with type 1 is entitled to a isCGM like Libre 1 or Libre 2 . Libre 3 is an rtCGM like Dexcom so you won’t automatically get funding

I thought they said it should be a choice between the two

 

[Lily123]

I thought they said it should be a choice between the two

The guidelines state that every adult with T1 is entitled to either Flash or CGM. But that doesn’t mean that is how CCGs will enforce it

 

[rayray119]

The guidelines state that every adult with T1 is entitled to either Flash or CGM.

Hmm yes partha clarifyed it as a per however my ccg in their stamenment said something along the lines "we will update the pathways prople with diabetties will need to follow" there wasn't supposed be any.