Meter & Test Strip Restriction

[JJay]

Now been on Libre for years and never found any real differences to blood BG such that I test blood BG maybe once every 2/3 months, usually if hypo or sensor failure. Perhaps you should talk with your DSN about placing / inserting the sensor?

I can assure you that my sensors have been placed exactly as recommended and in 4 years I have only lost 3 of them (due to careless interaction with door frames!) 2 have failed due to faults acknowledged by Abbott. Reading around this forum and others you will find that my experience is by no means unusual, and of course neither is yours!

 

[everydayupsanddowns]

This sounds like a very difficult situation for you @JJay

I’m going to ask the information team at Diabetes UK if they are aware if this is a widespread practice. I am not aware of any general guidance that suggests this level of strip restriction for people who are using Libre.

 

[JJay]

This sounds like a very difficult situation for you @JJay

I’m going to ask the information team at Diabetes UK if they are aware if this is a widespread practice. I am not aware of any general guidance that suggests this level of strip restriction for people who are using Libre.

Thank you for that, Mike.

To be fair, the strips prescription may not be restricted in the sense that I will only be allowed 50 per 3 months. My previous prescription was for 100 but was on an "as and when" basis rather than every 28 days like my non-diabetes meds, so hopefully this will be the same. Interestingly the prescription for the new lancets remains at 100!

 

[Proud to be erratic]

This all highlights that the NHS have clearly abrogated their responsibility for contract management of Libre 2 procurement. No-one in the NHS or NICE knows what the true failure rate is for Libre 2. Yes, the NHS contract manager could ask Abbott, but the Treasury have a long established and justifiable principle of 'not trusting a contractor to measure their own performance'. Abbott will never reveal detrimental contract information, but might tell the NHS all problems raised were resolved with a replacement sensor.

The OP includes extracts that includes: Your use of back up finger prick blood glucose tests should be infrequent. The FreeStyle Libre 2 flash glucose monitoring system has a very high level of accuracy. You should only need to carry out a finger prick blood glucose test if your glucose readings don’t match your symptoms, a test isn’t needed when glucose levels are low, falling or changing rapidly. One pot of 50 test strips should last for approximately 3 months."

How do they know the FS Libre 2 system has a very high level of accuracy?
And the idea that a test isn't needed when glucose readings are low 'beggars belief'.
Do the authors of such nonsense have any understanding of how inconvenient it can become when a sensor fails early and the neeed to revert to finger pricking until a new sensor is fitted and bedded in.

As said elsewhere there will be cost savings from a wider use of Libre 2 - in the long term. Those of us who use it extensively (lean on it?) are already getting better long term management of their D. But short term savings are downright dangerous and morally wrong.

 

[Lucyr]

How do they know the FS Libre 2 system has a very high level of accuracy?

Not sure why you’ve posted the same thing on two threads but as on the other thread it’s the same answer. They find out accuracy levels using trials, where they compare pairs of blood and libre readings in real people and compare how often the difference is acceptable or not

 

[Proud to be erratic]

Not sure why you’ve posted the same thing on two threads

Posted again here because it's more relevant to this thread and potentially a digression on the other thread.

but as on the other thread it’s the same answer. They find out accuracy levels using trials, where they compare pairs of blood and libre readings in real people and compare how often the difference is acceptable or not

I have concerns about the results of trials. No supplier is going to bring something to market with adverse trial results; but it takes a sharp mind to interrogate manufacturers' results and spot the missing info from the overall picture.

There is a lot of money involved in such contracts, and lucrative lobbyist payments to promote something the lobbyist knows very little about. Lobbying is a legal activity in the US and becoming increasingly common here in UK where our laws are not particularly robust.

If you are in any doubt about that look at how, at the start of the Covid pandemic, very obscure suppliers were being awarded huge contracts for things they subsequently couldn't deliver. No doubt the Parliamentary Public Accounts Committee will in future years investigate and conclude good practice was poor; but no-one ever ends up in jail after the event. It's sad and shameful, but happens.

 

[Leadinglights]

Maybe people should be reporting these failures of Libre sensors though the Yellow Card scheme to highlight the failure rate to the authorities as it does seem to be something hidden if people are not able to feedback to the NHS.
They may do of course.

 

[everydayupsanddowns]

@Proud to be erratic I understand your concerns, but I think that’s exactly why published research papers are peer reviewed, which is arguably an imperfect way of holding authors to account, but it does provide helpful checks and balances, and a degree of welcome scrutiny. And studies have to jump through quite a few hoops before they are even undertaken to ensure they are robustly constructed.

As for failure rates - any sensor provided by Abbott either directly to people self-funding, or via the NHS, which does not perform as expected should be reported to Abbott and will be replaced if it was faulty. The only snag would be if people mentally de-value sensors which they get on prescription as being ‘free’, and then don’t chase up/report issues as they almost certainly would if they had paid for them.

 

[Proud to be erratic]

@Proud to be erratic I understand your concerns, but I think that’s exactly why published research papers are peer reviewed, which is arguably an imperfect way of holding authors to account, but it does provide helpful checks and balances, and a degree of welcome scrutiny. And studies have to jump through quite a few hoops before they are even undertaken to ensure they are robustly constructed.

Thank you @everydayupsanddowns for providing some balance to my cynical perspective. I agree peer review does provide checks and balances.

Alas, there was a peer review process with Thalidomide which was overtaken by intense lobbying for that super drug; European countries succumbed and the Secretary of State in the USA was under huge pressure to also give way to the lobbyists - when fortuitously the scandal emerged in Europe and she was vindicated. But overall the peer review process is a considerable help.

Whether I accept that Libre is generally reliable doesn't really matter; there is no current evidence since development and launch of Libre 2 to verify that and no apparent monitoring by the NHS Manager responsible for this contract. I have no issue with all you say below, reporting failures to Abbott is the only recourse users have. But that soesn't change the omission of an NHS Contract Manager from the fault reporting process. It's Public money being spent and seems to be outside the normal Treasury rules for such circumstances; the rules are often tedious, but do provide good safeguards. Contract Managers spending public money should be fully involved with their contract.

As for failure rates - any sensor provided by Abbott either directly to people self-funding, or via the NHS, which does not perform as expected should be reported to Abbott and will be replaced if it was faulty. The only snag would be if people mentally de-value sensors which they get on prescription as being ‘free’, and then don’t chase up/report issues as they almost certainly would if they had paid for them.

 

[Piglet]

Hi all,

Nice Guideline 17 (type 1 Diabetes) does not specify which meters are to be used so it is up to each trust to decide. hence the variation. To me it would make sense to prescribe the test strips for the Libre scanner as this also doubles up and a blood glucose monitor hence negating the cost of a different metre and strips.

Recommendations | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE

www.nice.org.uk

HTH

 

[littlevoice359]

On the plus side, using Freestyle test strips has the advantage of being able to pretty easily upload finger-prick test results to Libreview - the process is reasonably straightforward but not trivial. However, I have noticed quite a bit of variation in control solution tests (I do this test each time I open a box of strips, as recommended by my diabetes nurse). In my experience, Contour Next test strips are much more consistent. As with everything, your mileage may vary…