CGM = continuous glucose monitoring
MDI = multiple Daily Injection (basal bolus treatment)
LCHF = Low Carb Higher Fat ( a lifestyle choice to reduce carbs in the diet aiming for nutritional ketosis and mostly adopted by T2s).
If many type 1s take this NICE guidance to heart, then unless they can test bg levels about 6-8 times per day (many UK GPs are now trying to reduce the amounts of teststrips prescribed to be no more than 150 per month) or follow a lower carb way of eating food to reduce the swings, then I can see that trying to achieve an hba1c of 6.5% or under, is going to put an increased demand on call outs for paramedics to deal with hypoglycaemia and admittance to A&E because tight control usually impairsc awareness to recogonise the hypo feeling at a safe bg level or for the need for 3rd party assistance. Hopefully the wise will look at the buccal lining route and using Glucogel in a bottle and give 3rd party help silently. Sadly, the funding of cgm is still a very costly business and unless the prices reduce, then a CCG wont be able to fund cgm and pumps. CCGs would need to approach government officials and ask where the money is going to come from, if not from taxes?
At the end of the day, the guidance on bg levels is down to a dsn or hospital consultant to advise on and not NICE unless it will be to someones benefit to obtain a pump or to prevent nerve damage complications from getting worse.
As for the CGM - we'd all love one but given the expense involved the guidelines are clearly saying "these are for people who desperately need the help". And why not? Testing between 4 & 10 times a day should be more than sufficient to build the picture and gain confidence with what is going on with your BG levels. Naturally, this can change and you'll need to get obsessive now and then to allow for changes.
But are you factoring in the cost of continuing to test at least 5x per day with Dexcom to meet manufacturers recommendations on calibration tests and pre-dosing tests?The thing is, if you are testing at 10 times per day and you are adhering to the guidelines to replace lancets every time, then you are spending £1800 of the NHS's money annually if you are using AccuCheck Aviva test strips and the fastclix lancets (at NHS prices).
A Libre costs (at retail, not NHS, prices) £1,290 per annum, and a Dexcom using xDrip without purchasing a receiver (or maybe the G5 with smartphone app) costs around £1,600 per year.
If you are driving a lot then perhaps there needs to be some work with the NHS and DVLA to understand how the CGM model works, but the costs are not as prohibitive in relation to finger prick testing as everyone seems to think.
By the way, I fall into the high volume of testing line to keep my bg levels on track.
No, because I was basing it on being twice a day, which is I believe the recommendation. Or when you are more than 20% out, which you won't know if you aren't testing your BG anyway :sBut are you factoring in the cost of continuing to test at least 5x per day with Dexcom to meet manufacturers recommendations on calibration tests and pre-dosing tests?
Hum... Interesting question. Once I'm happy with the sensor, then I test very infrequently (days go between blood tests). With the Libre, at £1,290 for year one, you still have more than enough "budget" for 3-4 finger pricks per day.I realise Abbot say no calibration needed for the Libre but I believe that has not held up in practical use?
Tbh I never followed Dexcom's recommendation which is to finger prick test before every bolus. I guess you could double two of those up with calibration tests so that's 3-4 per day rather than 5-6.No, because I was basing it on being twice a day, which is I believe the recommendation. Or when you are more than 20% out, which you won't know if you aren't testing your BG anyway :s
Hum... Interesting question. Once I'm happy with the sensor, then I test very infrequently (days go between blood tests). With the Libre, at £1,290 for year one, you still have more than enough "budget" for 3-4 finger pricks per day.
Three weeks use on the Dex sensors - that seems to be the consensus of stretching with xDrip and others. That makes up the £1600. If you go for two weeks, it becomes more expensive.What if any sensor reuse did you assume for your £1800/year number?
So the problem is that NICE couldn't make recommendations based on practices that violate the manufacturer usage instructions. Which rules out Dexcom as no reuse jacks the annual cost up into the region of £4-5K even assuming a free receiver. I think there is still a strong argument there for the Libre though.Three weeks use on the Dex sensors - that seems to be the consensus of stretching with xDrip and others. That makes up the £1600. If you go for two weeks, it becomes more expensive.
You know where the life comes from though... Not the amount of time it will stay attached but the amount of time the sensor reagent is certified for accuracy...Or if NICE grew huge balls it could say to Dexcom, we will approve your product for NHS supported use in the UK provided that you officially recognise and support sensor reuse for (say) 3 weeks per sensor. Not even guarantee it, just support it and don't prohibit it.
Yes, that's where they are coming from on sensor life, but I also know it can remain accurate for approaching 6 weeks in some cases. NICE and Dexcom could study reuse jointly to put some parameters on it.You know where the life comes from though... Not the amount of time it will stay attached but the amount of time the sensor reagent is certified for accuracy...
NICE and Dexcom could come up with a guideline saying discard sensor and don't reuse after X instances of Y discrepancy in calibration.You know where the life comes from though... Not the amount of time it will stay attached but the amount of time the sensor reagent is certified for accuracy...
Don't worry, I know it ain't gonna happen. :-/NICE are meant to be independent. That would also involve getting different approval by the EU and manufacturer guarantees...
Its not all down to NICE.
So the problem is that NICE couldn't make recommendations based on practices that violate the manufacturer usage instructions. Which rules out Dexcom as no reuse jacks the annual cost up into the region of £4-5K even assuming a free receiver. I think there is still a strong argument there for the Libre though.
Or if NICE grew huge balls it could say to Dexcom, we will approve your product for NHS supported use in the UK provided that you officially recognise and support sensor reuse for (say) 3 weeks per sensor. Not even guarantee it, just support it and don't prohibit it.