T2 Qualifying for CGM technology

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Have you read the NICE guidelines?
These are only guidelines so could be applied differently in different postcodes but are a great starting point for the kind of justification your DSN or doctor will be looking for.
The guidelines are all available on line. Google has found them easily in the past.
 
My GP has referred me with a recommendation for a CGM ad I have arthritis in my hands and am finding it difficult to test so much. I have read the NICE guidelines but wondered how in practise they are applied.
 
Susanann1955 said:
My GP has referred me with a recommendation for a CGM ad I have arthritis in my hands and am finding it difficult to test so much. I have read the NICE guidelines but wondered how in practise they are applied.
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Ah, that’s great your doctor has referred you and made that recommendation. That should help 🙂 As said above, it can be a bit of a postcode lottery. I think @Bruce Stephens might know a few more facts as he’s quite up on the latest information.

You could also try a free trial of the Libre if it’s still available on their website. That way, if you benefit, you can add that as proof that getting it prescribed will help you.
 
Susanann1955 said:
Hi yes I am using the free trial one at the moment - it’s a life changer! Also enabling me to track rises after wasting certain foods.
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That’s great news 🙂 With your GP supporting you, I’d hope you’d get it prescribed. Your trial will show that it benefits you. You could also make a few notes explaining the benefit - eg the number of times you now scan compared to when you tested; problems you’ve been able to identify/ward off; improvements in your after-meal results, etc etc.
 
Libre can be prescribed for T2 if on 2+ insulin injections a day but it depends where you live, it’s not prescribed in my area. It is prescribed in some areas though. What medication do you take?
 
Hi thank you for that - I am able to test more with the trial sensor so have much more detailed information on what my levels are doing - rising every time I eat or even just a cup of coffee with semi skimmed milk can make it rise. Hopefully if I can have access to the CGM Senor on the NHS as well as being able to test myself and not wait for help to test I will be able to reduce by Hb1 which was 103 last week. My GP has suggested 4 times a day rapid acting insulin with a long term acting insulin working in the background. So let’s hope the diabetes centre agree with what my GP is suggesting.
 
That insulin regime is known as a basal/bolus regime, with the basal being the long-acting background insulin, and the bolus being the rapid-acting insulin to deal with meals. This should hopefully help you a lot, and that and the Libre should make a big improvement to your HbA1C.
 
Susanann1955 said:
So let’s hope the diabetes centre agree with what my GP is suggesting.
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It's not the Diabetes Centre who will need convincing, but the Integrated Care Sytem (ICS) who have to approve the financial principle. The NICE Guidance from 2022 for CGM made it possible for GPs to use their clinical competence and judgement to write the prescription without needing a Specialist or independent authorisation. Some GPs don't seem to be aware that this is in their gift; yours may be more up to date.

Before July 2022, GPs got their financial allowance for prescribing from a Cost Centre Group (CCG); but after 1 July 2022 all CCGs across England and Wales (not sure about Scotland and NI) were absorbed into much larger regional ICS and these ICS are supposed to provide a more cost effective process for the NHS overall. But in practice ICSs have inherited long standing financial overspends by CCGs and have used the last 9 months to procrastinate and generally stall any new expenditure by having a process of reviewing the affordability of anything that is new or 'different'. CGM for T2 is new and different, so will inevitably incur new cost to the ICS budget. In my region, the new Bucks, Oxford and Berks (BOB ICS) are certainly in place and being quoted as the reason for "no authorisation yet for something" - but alas despite being a public body the BOB ICS as at last month still had no contact address or phone number and were only contactable through the BOB ICS Patient Liaison Service (PALs) by email - who simply replied "not yet authorised", with no explanation nor indication of when that might change.

Despite the amended and more helpful NICE Guidance in 2022 widening the possible availability of CGM for T2s, ICS are not legally obliged to implement NICE Guidance and can delay any implementation until that is affordable. NICE Guidance notes are recommendations, not absolutely binding.

So, your (already very busy) GP will be trying to make a financial business case to the ICS that justifies the GP's medical opinion that YOU as a T2 should have CGM, which will cost the ICS approx £800+ per annum. In practice the GP might pass that task of compiling the business case to whatever part of their Surgery that deals with allowable prescribing and prescription budgets. In my local GP Surgery there is no in-house pharmacy and so they have a subcontract with an Agency, that also has no address or contact details (so you can't ask them directly for a progress report, never mind see whether they have even started). That Agency deals with all prescription queries on behalf of my Surgery. No one within the Surgery seems able to promptly answer a request for progress - just tell me its been passed to their "in- house" pharmacy services, which is not actually "in-house", either geographically or commercially.

Once financial approval is given by the regional ICS, the medical item will be put on the regional ICS "Formulary" list allowing the GP to actually write the prescription and then the Surgery Pharmacy or any local Pharmacy/ Chemist will be able to provide it. If its not on the ICS Formulary the GP can't find it on the computer listing and so can't tick that box - thus no actual typed prescription can be created. Even is a handwritten prescription was raised, local Pharmacies would still not be able to find it on the Fomulary and so not actually pass it over a counter.

Anyway, once that bit of bureaucracy is beten into submission I hope your future basal/bolus Multiple Daily Injections (MDI) help you find a much more acceptable way of managing your D.
 
I’m also type 2 and on basal/bolus, ( semglee and Novo rapid )
A CGM like the Libra 2 is a must it really is a game changer, I would now feel completely naked without it.
My Hba1c has dropped to 7% old school I couldn’t have done this without a CGM ( no hypos )
The CGM helps give you back control if you use it properly.
For the first time in a long time, I feel I’m now in control of my diabetes instead of it controlling me.
 
@Susanann1955 What medication and dietary measures are you taking already.
I wonder if you are taking steroids as they have a reputation for increasing blood glucose.
 
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delboy said:
I’m also type 2 and on basal/bolus, ( semglee and Novo rapid )
A CGM like the Libra 2 is a must it really is a game changer, I would now feel completely naked without it.
My Hba1c has dropped to 7% old school I couldn’t have done this without a CGM ( no hypos )
The CGM helps give you back control if you use it properly.
For the first time in a long time, I feel I’m now in control of my diabetes instead of it controlling me.
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Do you self fund or have you managed to get it prescribed?
 
No steroids Just Metformin.
They have thrown everything at me the last 3 years but nothing was working.
Dropped all other meds 4 months and since starting insulin Hba1c has been dropping to the levels they are now.
 
i have a very nice professional healthcare nurse that has prescribed my libra 2,
 
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