Updates to NICE guidance for CGM

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rayray119 said:
However I offen found I needed to double check with a finger pick when I had a libre thef hadnt failed yet but because it would be hit and miss sometimes really acurte other times far out that's while they weree working. The things inserts me about dexcom is the dropping fast alerms
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Yeah, it doesn't seem to work for everyone. And some people just don't like it (find the extra information itself stressful). I can understand both.
 
Bruce Stephens said:
Yeah, it doesn't seem to work for everyone. And some people just don't like it (find the extra information itself stressful). I can understand both.
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Yeah I'll still be interested in trying something else if opportunity came along just to see if that worked. Sometimes extra informalion is stressful and sometimes useful to know what's happening(you just can't win)
 
Pattidevans said:
That is interesting that they are taking into account health economics when doing the studies. I think it goes further than DKA/ambulance call outs though... the long term has to be taken into account too... blindness, amputations etc. If all those can be avoided in addition to the ambulances/hospital visits etc. then it has to be win-win.
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Yes for the 2015 update alongside the evidence review, they undertook a completely novel piece of computer modelling which took the potential A1c improvement (based on published studies) and the risk reduction vs cost of complications treatment based on an ‘average’ T1 (using data from the National Diabetes Audit among others).

The snag was that in the published studies that met the PICO criteria (right population, intervention, comparator and outcomes), the HbA1c improvement data just weren’t that impressive :( At least, not for an intervention at that price point.

Interestingly NICE aren’t just interested in survival either, they measure the quality-of-life side of things with a measure called QALY (quality adjusted life years). And the price tag for ‘cost effectively’ giving someone a whole extra year in full health is pretty hefty.
 
Yes, I see what you are saying Mike.
everydayupsanddowns said:
The snag was that in the published studies that met the PICO criteria (right population, intervention, comparator and outcomes), the HbA1c improvement data just weren’t that impressive :( At least, not for an intervention at that price point.
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My Hba1c has actually not improved at all, but time in range has improved so much... which should reduce complications. It's hard to quantify really.
 
strangelly enough if i was a child it looks like I would qualify now for dexcom or likewise.
 
nekromantik said:
hello
in November the guidance to NICE for CGM funding on NHS was changed to make it easier to get one.
anyone in a CCG that has agreed to give them one?
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I.m pretty new to CGM .. I.ve self funded over the past 2 months.. and have asked consultant to prescribe for me .. he said his hands are tied and unless I.m type 1 ..its a no.
I.m insulin dependent type 2. ..
I understand the difference..
I'd love to come off insulin .but no matter what changes I make or what I do.. I need more and more..
Help a newbie (to CGM out ,)
I.m.also in N.ireland so we are 5 yrs behind in health ..
 
SaltyMermaid said:
I.m pretty new to CGM .. I.ve self funded over the past 2 months.. and have asked consultant to prescribe for me .. he said his hands are tied and unless I.m type 1 ..its a no.
I.m insulin dependent type 2. ..
I understand the difference..
I'd love to come off insulin .but no matter what changes I make or what I do.. I need more and more..
Help a newbie (to CGM out ,)
I.m.also in N.ireland so we are 5 yrs behind in health ..
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Wasn’t it said that flash would be available for some type 2s?
 
howver i have trobule with docotrs and dsn understanding nice guidelines as it is, with regards to testing. i forgot bring things up with the consudents yesterday I had planed to put the the nice guidelines in fount of them.
 
rayray119 said:
do you recon is it type 1s can get a choice of cgm over flash like pervoislly implied? its only a month now that the guidelines are due to published right.
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I only know what's been published. The corresponding page for T1 is this one https://www.nice.org.uk/guidance/indevelopment/gid-ng10265/documents

The (proposed) guidance does say to offer patients a choice. The evidence review for CGM also talks a lot about patient choice being significant (see pages 36, 37).

It seems clear the intent is to offer everyone some kind of CGM (isCGM or rtCGM), and inevitably the initial default is likely to be isCGM (in the form of Libre 2). When that just doesn't work for someone I presume there'll be an attempt to find something that does.

But how all this will translate to what happens once CCGs look at the costs and clinics consider the devices they can support isn't something I can judge. (I note there's an economic report there which I found interesting. The main findings are summarised in the overall evidence review. The evidence review notes the changing landscape of what's available, meaning that rtCGM is getting cheaper and isCGM is gaining some of the same features as rtCGM.)

I still find it surprising that there's not much difference in reported quality of life between CGM and SMBG. That seems very odd to me: while some people report not liking the devices (finding data from them overwhelming), most seem to, with Partha Kar and other consultants regularly reporting patients crying with happiness when they're able to get Libre on prescription. And, of course, many of us bought (and buy) CGM devices out of our own pockets.
 
Bruce Stephens said:
I only know what's been published. The corresponding page for T1 is this one https://www.nice.org.uk/guidance/indevelopment/gid-ng10265/documents

The (proposed) guidance does say to offer patients a choice. The evidence review for CGM also talks a lot about patient choice being significant (see pages 36, 37).

It seems clear the intent is to offer everyone some kind of CGM (isCGM or rtCGM), and inevitably the initial default is likely to be isCGM (in the form of Libre 2). When that just doesn't work for someone I presume there'll be an attempt to find something that does.

But how all this will translate to what happens once CCGs look at the costs and clinics consider the devices they can support isn't something I can judge. (I note there's an economic report there which I found interesting. The main findings are summarised in the overall evidence review. The evidence review notes the changing landscape of what's available, meaning that rtCGM is getting cheaper and isCGM is gaining some of the same features as rtCGM.)

I still find it surprising that there's not much difference in reported quality of life between CGM and SMBG. That seems very odd to me: while some people report not liking the devices (finding data from them overwhelming), most seem to, with Partha Kar and other consultants regularly reporting patients crying with happiness when they're able to get Libre on prescription. And, of course, many of us bought (and buy) CGM devices out of our own pockets.
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i already know that the libre wasn't working for me.
 
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