New NICE guidance for CGM/Libre in T1 and T2

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everydayupsanddowns

everydayupsanddowns

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Well this is exciting!

Just spotted this from Nick Cahm on the FB Libre group (who is a very reliable source).

NICE have finally commented on Libre.

1.) Everyone with T1D to have access to real time CGM (eg Dexcom) available as a first option with Flash as a second option.
2.) People with T2D on multiple daily insulin injections to have access to Flash if any of:
a.) Recurrent or severe hypos
b.) Impaired hypo awareness
c.) Have a condition which means they cannot SMBG but could use flash
d.) They would otherwise be advised to test 8 times/day

Closed loop guidance to follow next year.

Likely to be implemented April 2022 with exact mechanism yet to be defined. Links below.

1637741520640.jpeg

Products - Diabetes | Topic | NICE

www.nice.org.uk www.nice.org.uk
 
This is good news as I self-fund a Libre 2. The point about recurrent or severe hypos I find strange. Like many of us it's a constant battle to avoid hypos whilst keeping A1c down. It tends to be a personal choice defined by the user and not the body. I tend to keep my BS high enough to only have infrequent hypos but my A1C is higher than it should be (55 mmol). Perhaps I should plan to have more hypos and hence justify a free Libre 2!
 
I believe Nick took it from Partha Kar's post although I think Partha's was a bit more detailed, could be wrong though as can't remember 100% lol xx
 
Am I reading that right that all Type 1s can have Dexcom if they want it?? Or am I misunderstanding it? That seems like a huge change of policy and a very expensive one!
Pleased for Type 2s on MDI although they will no doubt have to push and jump through hoops to get it, as many Type 1s have had to do.
Personally I am quite happy to continue with Libre 1 for now. It serves my purposes very well.
 
rebrascora said:
Am I reading that right that all Type 1s can have Dexcom if they want it?? Or am I misunderstanding it? That seems like a huge change of policy and a very expensive one!
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Yes, sort of. From https://www.nice.org.uk/guidance/gid-ng10265/documents/draft-guideline
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. See box 1 for examples of factors to consider as part of this discussion. [2022]​

So I think it ought to dramatically increase rtCGM, but maybe it'll be flash for most of us? (And maybe Libre 3 will be out by the time this comes into effect anyway.)
rebrascora said:
Pleased for Type 2s on MDI although they will no doubt have to push and jump through hoops to get it, as many Type 1s have had to do.
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Yes, looks rather similar to the current T1 advice. Which is a big step forward.
 
You are lucky - you have to be a Special Case for our CCG to consider it - and our CCG is not alone!

So don't move to Coventry and Warwickshire is my advice .....
 
Just because NICE say it's best practice does not mean anyone will get it! - we already know this and there are still plenty of hospitals and D consultants that don't support pumps let alone anything newer.
 
trophywench said:
Just because NICE say it's best practice does not mean anyone will get it! - we already know this and there are still plenty of hospitals and D consultants that don't support pumps let alone anything newer.
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True, but most CCGs and consultants like to at least pretend they follow NICE guidance. I wouldn't assume anyone that wants a Dexcom can have one, but it should be that anyone that wants a Libre will get one.

And anyone using a pump and self funding a CGM to provide some level of automation has a much better chance of getting that funded.
 
This is not called "best practice", it is called "guidelines".
Neither have to be followed but there is s precedent for a CCG being sued for NICE guidelines not being followed.

I have seen discussion around where CCGs are going to get the extra funding required for real time CGMs. Or to put it crassly "which cancer patient is going to have their treatment removed to fund CGM for everyone with Type 1 and some with type 2?"
Ok, do that is an extreme but CGMs are not free and CCG budget is on an annual basis rather than spending money now reducing chance of complications (cost) in 10 years or more.
 
helli said:
I have seen discussion around where CCGs are going to get the extra funding required for real time CGMs. Or to put it crassly "which cancer patient is going to have their treatment removed to fund CGM for everyone with Type 1 and some with type 2?"
Ok, do that is an extreme but CGMs are not free and CCG budget is on an annual basis rather than spending money now reducing chance of complications (cost) in 10 years or more.
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Yes, true enough. It would be nice if (as happened with Libre) there was some money allocated to this. On the other hand, there aren't that many of us and for most Libre will be fine and they're not that costly. And there's evidence that use of Libre cuts down on DKA and serious hypos which are short term costs, and around 60% of T1 are already getting Libre. (Caveat: I don't have a feeling for how many T2 are on MDI.)
 
Bruce Stephens said:
Yes, true enough. It would be nice if (as happened with Libre) there was some money allocated to this. On the other hand, there aren't that many of us and for most Libre will be fine and they're not that costly. And there's evidence that use of Libre cuts down on DKA and serious hypos which are short term costs, and around 60% of T1 are already getting Libre. (Caveat: I don't have a feeling for how many T2 are on MDI.)
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40% of T2s are on insulin, we outnumber T1s by 4 to 1. Just too expensive to allow us access to the technology we need. We're 2nd Class citizens again as confirmed by this advice. If you're in a bad way you can have Flash, the 2nd Class option.
 
By the time Libre 3 comes to the UK, so will the Dexcom G7, which is smaller and said to be more accurate - and is ready to read after 30 minutes, compared to the Libre 1 hour. I doubt there will be any great price change in either, though with Libre kit being made in China for the reader and the sensors In Eire compared to Dexcom in the USA, who knows what inflation willl have on prices, or any tariffs after Brexit that will no doubt have to paid by the consumer. The G7 will be a boon for those who use other non proprietary Apps, because it will connect with all the main ones in real time. The sensor, which is small and circular (though deeper than the Libre) has an applicator more or less identical to the Libre, so quicker than the G6. Dexcom know that the sensors will last up to 15 days, but it will only be marketed as 10, because of guaranteed accuracy for that period. Third quarter of 2021 for the full launch in Europe, early 2022 in the US (waiting for FDA approval). It has a new algorithm tuned to arm or abdomen application.

One caveat: like the Libre initially, the G7 won’t talk to Apple phones, but have said they will continue producing the G6, which does. By the time it arrives in the UK, that may already be fixed.
 
Burylancs said:
40% of T2s are on insulin, we outnumber T1s by 4 to 1. Just too expensive to allow us access to the technology we need. We're 2nd Class citizens again as confirmed by this advice.
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Yes, though it's not just "insulin", it's MDI that matters, I think. (Or "intensive insulin use"? Something like that.) But yes, I presume the problem's money.

It's still an advance: it looks like some people with T2 will have to jump through the hoops that everyone with T1 has to now.
 
Shame this still doesn’t go far enough for T2s on MDI, we do seem to be permanently second class, but pleased for the T1s
 
I have actully been wanting to try dexcom to see if i get ob with it beter but cant aford it
 
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