New update to NICE Guideline for T1 Adults

[Pumper_Sue]

My maths work out at £345/ year for a transmitter Plus £46/ month for a sensor, equals £897 per year. That's obviously using a pump with a receiver already integrated.

 

[Redkite]

My maths work out at £345/ year for a transmitter Plus £46/ month for a sensor, equals £897 per year. That's obviously using a pump with a receiver already integrated.

Well that's true as well, that people do get longer use out of each sensor - however NICE have to cost them on the licensed usage (e.g 6 days for Medtronic enlites). Although if their use became more routine and widespread, perhaps the unit cost would fall? Government health providers and the big medical insurance companies surely have a lot of bargaining power when it comes to negotiating prices - and Medtronic etc. would make bigger profits selling more sensors at a reduced price than a marginal quantity at a high price.

Maybe the benefits cannot yet be clearly demonstrated because there aren't enough "ordinary" type 1's routinely using sensors, and therefore the statistics are skewed towards the "difficult cases"!!!!

 

[Flower]

Thanks for this information Mike, it's really interesting.

I'm glad to see guidelines for the use of CGM, previously there weren't any specific guidelines. They do cover the issues that my consultant explained to me a few years ago when we applied for funding.

As a life saving piece of technology it's worked for me as I haven't gone unconscious for the past 3 years since using it and as a plus my HbA1c has fallen to 6.2%- but its first and main aim was for my complete lack of hypo awareness. It was weighed up against the cost of a pancreas transplant which was the route I had started to go down and not just on the costs of additional test strips and admittance to hospital.

It will be very interesting to see how and where the Libre fits in to funding considerations.

 

[Phil65]

Thanks for the read Mike, although I now have RSI in my scroll finger! 😉
A couple of stand-outs for me are:

A1C target of 6.5 = unhappiness from my D team! (I fully understand the benefits of tight control but correct me if I am wrong ....is there a NICE guideline on the SD?)
Good that they recommend testing 4-10 times a day but many GPs will be aghast at this and the cost implication in prescription strips.
Excellent ref the need for Carb Counting courses and the importance of them.
HbA1C testing every 3-6 months....also good.

I am sceptical about the effectiveness of NICE, for instance my consultant 4 years ago said that I didn't meet the NICE guidelines for a pump as my control was very good. I pushed hard and asked whether I should let my control slip to meet the criteria! .....I got a pump! I wonder how many will get CGM this way?

 

[everydayupsanddowns]

A1C target of 6.5 = unhappiness from my D team! (I fully understand the benefits of tight control but correct me if I am wrong ....is there a NICE guideline on the SD?)

Well not as such... but the BG targets were reviewed and updated too. And if (by some miracle) we were all able to hit those targets - which have evidence to say they are the right ones to go for - guess what? I reckon we'd have an A1c of sub 6.5.

The 6.5% was recognised to be quite a *big thing*, but the evidence was pretty clear. The benefit increases way down past 7.5 and if a person *can* get there while at the same time keeping a lid on hypoglycaemia, then good for them. Clearly it's an aspirational target and it's important to recognise that individualised targets are stressed as vital.

Let's hope it stops people being told off for having an A1c that's 'too low' 😉

 

[pippaandben]

I am type 2 - possibly 1.5- and on MDI of insulin. Took 18 months to reach this point and have now been on insulin for 18months. I am now beginning to have to up both basal and carb ratios slighty as I presume my resistance is increasing. Is any of this covered in the new guidekines for type 1s - or would that be a totally separate guideline issue?p refuses to test to see what camp I fall in on the basis that treatment is the same!!!

 

[heasandford]

Excellent thread - although I haven't had time to read the actual report yet! Great comments from everyone.

I have to say, the Libre has showed up how little I appear to be able to do to alter my results, I did expect it to be transforming and I would always be in target! Well, not exactly, but I think many of the tips I've picked up here, and being constantly 'on the case' have had a better effect on my HbA1c,(49-56 year before pump, 48-53 this year, 48 this week) and I don't see any improvement in the future due to Libre, judging by the results. Likewise the SD which is my constant downfall. However I really, really love the Libre and maybe that has a longterm effect on my mental health and burnout?

 

[everydayupsanddowns]

I am type 2 - possibly 1.5- and on MDI of insulin. Took 18 months to reach this point and have now been on insulin for 18months. I am now beginning to have to up both basal and carb ratios slighty as I presume my resistance is increasing. Is any of this covered in the new guidekines for type 1s - or would that be a totally separate guideline issue?p refuses to test to see what camp I fall in on the basis that treatment is the same!!!

Not really pippaandben - the guideline isn't a textbook in that way. It's more of a review of clinical evidence and best practice. eg What options are available for rapid insulins, and which work best for most people?

In your shoes I'd probably be looking for something a bit more 'hands-on' and practical. Something like 'Using Insulin' by John Walsh/Ruth Roberts or 'Think Like a Pancreas' by Gary Scheiner. Those are both brilliant, practical books that can help you understand basal-bolus better and fine ture your approaches.

 

[heasandford]

Is there any update since the consultation finished?

 

[everydayupsanddowns]

The consultation comments (received from stakeholders like INPUT, professional bodies and pharma) now need to be reviewed by the Guideline Development Group before the final guideline is published - due end of the Summer/early Autumn I think.

 

[heasandford]

Thanks - I have to admit I missed the deadline, but recognise what I would have said would have made no difference in light of your (very straightforward) comments. I am just interested if they are going to make any changes and of course what that might mean for the future.