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Access to Diabetes Management Supplies

H

Hannibee90

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5
Hi everyone,

my name is Hannah and I am a student from Germany. I, myself, do not have diabetes but I am researching how people with diabetes in the UK gain access to blood glucose meters, test strips, lancets, lancing devices and control solutions and who carries the cost. So far, I am unfortunately very lost in the British health care system and was wondering if someone would be willing to answer a few of my questions.
I understand that this forum is primarily for people with diabetes to give advice and exchange views on new treatments. However, I would be eternally thankful if you could help me out, even if it is by answer a tiny part of a question.

1) When the doctor diagnoses you with diabetes type 1 or 2 and they tell you that you need to monitor your blood glucose levels, I assume they will give you a prescription for a blood glucose meter, test strips, lancets, lancing devices and control solution. You would then go to a pharmacy (or another type of store?) and get the supplies, right? As usual with the NHS, if I understand correctly, you wouldn't have to pay for it, right?

2) Who decides what blood glucose meters and supplies are available to you? I read about local clinical commissioning group. Does that mean, that for each region, the clinical commissioning group decides what supplier to contract? Do they negotiate contracts with the manufacturers or the pharmacies regarding the price of the supplies?

3) I also found out that the NICE has published a guideline on how many test strips a person with diabetes type 2 should use. Are there similar guidelines for people with diabetes type 1? And if so where can I find all these guidelines?

Again, if you could share your expertise with me, I would be very thankful.
Have a good day everyone,
Hannah
 
I can understand why you are confused - it is confusing and variable.

1) If your diabetes is treated with insulin or tablets, you are entitled to free prescriptions. If you are not entitled to free prescriptions, there is currently a cost of £8.60 per item. Many people with type 2 diabetes are not provided with glucose meter and test strips.

2) You are correct, each regional CCG decides which BG meters, pumps, etc. to supply. As a consumer of these supplies, I do not know how they make the decision on how to spend their budgets and how much each CCG negotiates with the manufacturers.

3) I am not aware of any guidelines for the number of test strips for some one with type 1. Unfortunately, some GPs have tried to limit test strips but there have been a number of campaigns and surveys to change this. For example, https://www.diabetes.org.uk/profess...ring/access-to-test-strips-a-postcode-lottery.
It is a requirement for anyone who treats their diabetes with insulin to test their BG with a finger prick before driving. Therefore, any attempt to restrict test strips to people treated with insulin, is restricting their ability to drive.

Can you explain why you are asking these questions?
 
Wow, thank you so much for such a fast response. My major in uni is health technology and I am especially interested in health care systems. I am asking these questions because I am working on a report comparing the accessibility and distribution channels of blood glucose self monitoring devices in different European countries. I also take into consideration if there are copayments, maximums amounts of coverage or limits on quantities provided. I hope to gain an understanding of advantages and disadvantages in the different systems and of possible implementations that guarantee good health care while maintaining a feasible cost level.
It was easier to figure it all out for Germany, since I am somewhat acquainted with the system. In the UK everything seems to work entirely different, so I figured I'd ask the people who know best :)
As for the limitation on test strips, I had read about it and I am really surprised to see that. I didn't find any limitation in either Germany or France for people using insulin.
I had no idea, you were required to test your blood glucose before driving! Could you also test your interstitial glucose with a FreeStyle Libre or a CGM? As far as I know the CGM is not usually paid for by the NHS, except in individual cases. The FGM FreeStyle Libre however has been approved quite recently, right? I also read that it is awaiting approval of the local health economies now. Does that mean the CCGs get to decide again whether or not to pay for the FGM system, or is there like a local NHS institution that gets to make decisions as well?
Thank you so much :)
 
Type 2s not on insulin are very rarely prescribed meters and strips. This is a NICE recommendation that doctors seem to follow to the letter. Even if a meter is supplied to a non-insulin user, the strips are generally limited to an inadequate number.

https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2


Self-monitoring of blood glucose
1.6.12 Take the Driver and Vehicle Licensing Agency (DVLA) At a glance guide to the current medical standards of fitness to drive into account when offering self‑monitoring of blood glucose levels for adults with type 2 diabetes. [new 2015]

1.6.13 Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless:

  • the person is on insulin or

  • there is evidence of hypoglycaemic episodes or

  • the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or

  • the person is pregnant, or is planning to become pregnant. For more information, see the NICE guideline on diabetes in pregnancy. [new 2015]
1.6.14 Consider short-term self-monitoring of blood glucose levels in adults with type 2 diabetes (and review treatment as necessary):

  • when starting treatment with oral or intravenous corticosteroids or

  • to confirm suspected hypoglycaemia. [new 2015]
1.6.15 Be aware that adults with type 2 diabetes who have acute intercurrent illness are at risk of worsening hyperglycaemia. Review treatment as necessary. [new 2015]

1.6.16 If adults with type 2 diabetes are self‑monitoring their blood glucose levels, carry out a structured assessment at least annually. The assessment should include:

  • the person's self-monitoring skills

  • the quality and frequency of testing

  • checking that the person knows how to interpret the blood glucose results and what action to take

  • the impact on the person's quality of life

  • the continued benefit to the person

  • the equipment used. [2015]
Personally, I am a Type 2 and not on any medication. I control it by diet only, and therefore am in as much need of a meter and strips as anyone else in order to keep control. I have to self-fund my meters, strips, and a part-time Libre sensor. (Too expensive to use full time). Most Type 2s are in this situation. As I am a pensioner over 60 I am entitled to free prescriptions but this isn't much use to me as I am not on any medication, yet!
 
Different EU countries have different rules about accessing to needed medicines for diabetes treatment. I guess most of the users here will be interested in seeing the results of your research. Actually if interested I can help you about Poland and Slovakia. As EU insured person is good to know that we have the same rights when we are travelling as locals so it can be useful to use the healthcare system which is more favourable for our case for the prescription.

For instance, I'm always taking my supplies in Poland as in Slovakia Toujeo insulin I'm using it's only covered when HbA1C is more than 8% (which is quite high as my is always around 6,0%) and same with strips (only one 50pcs box per two month when applying insulin one time per day or 75pcs every month if more than one). In Poland, it's better to take testing strips limits (almost unlimited when your doc decided how much you need to test). No needles and lancets refunded in Poland which is refunded in small amounts in Slovakia.

What about creating some travelling guide about how to proceed when needed any of kind diabetes supplies abroad? It would be nice to provide also information about the prices expected to pay when insured and how all local prescription can be achieved. To take to consideration in Slovakia the only diabetologist can prescribe insulin which can during tourist visit almost impossible to reach.
 
Bluetit1802 said:
Personally, I am a Type 2 and not on any medication. I control it by diet only, and therefore am in as much need of a meter and strips as anyone else in order to keep control. I have to self-fund my meters, strips, and a part-time Libre sensor. (Too expensive to use full time). Most Type 2s are in this situation. As I am a pensioner over 60 I am entitled to free prescriptions but this isn't much use to me as I am not on any medication, yet!
Click to expand...

Thank you so much. I am sorry it is such a financial burden on you. I will take a look at the guideline. This very useful to me :)
 
Grzegorz_Gd said:
For instance, I'm always taking my supplies in Poland as in Slovakia Toujeo insulin I'm using it's only covered when HbA1C is more than 8% (which is quite high as my is always around 6,0%) and same with strips (only one 50pcs box per two month when applying insulin one time per day or 75pcs every month if more than one). In Poland, it's better to take testing strips limits (almost unlimited when your doc decided how much you need to test). No needles and lancets refunded in Poland which is refunded in small amounts in Slovakia.
Click to expand...

It's fascinating (from a very academic point of view of course) how differently countries regulate their health care system. Thank you for your answer. Unfortunately, I won't be looking at either Poland or Slovakia in my research. But nevertheless, I am fascinated to learn about the differences!
 
Hannibee90 said:
Wow, thank you so much for such a fast response. My major in uni is health technology and I am especially interested in health care systems. I am asking these questions because I am working on a report comparing the accessibility and distribution channels of blood glucose self monitoring devices in different European countries. I also take into consideration if there are copayments, maximums amounts of coverage or limits on quantities provided. I hope to gain an understanding of advantages and disadvantages in the different systems and of possible implementations that guarantee good health care while maintaining a feasible cost level.
It was easier to figure it all out for Germany, since I am somewhat acquainted with the system. In the UK everything seems to work entirely different, so I figured I'd ask the people who know best :)
As for the limitation on test strips, I had read about it and I am really surprised to see that. I didn't find any limitation in either Germany or France for people using insulin.
I had no idea, you were required to test your blood glucose before driving! Could you also test your interstitial glucose with a FreeStyle Libre or a CGM? As far as I know the CGM is not usually paid for by the NHS, except in individual cases. The FGM FreeStyle Libre however has been approved quite recently, right? I also read that it is awaiting approval of the local health economies now. Does that mean the CCGs get to decide again whether or not to pay for the FGM system, or is there like a local NHS institution that gets to make decisions as well?
Thank you so much :)
Click to expand...

At then moment dvla (government driving authority) does not recognise cgm so you’d still have to finger prick before driving. And Altho libre is theoretically available from 1st November, from posts I’ve seen on here I don’t think any ccgs have approved it as yet. Hope that helps.
 
Hey everyone,
you all have helped me so much already. I have since looked a bit at other countries and am now revisiting Great Britain. I have a few new questions now and was hoping to get some answers here.

1) Where can you get your blood glucose monitor, if you qualify for one? Does your GP give it to you? Do you get in in diabetes centers or hospitals? Do you go to the pharmacy? Are all of the above options?

2) Do you happen to know if the NHS has to pay for the meters or do the companies usually supply them for free, so that the NHS funds lots of their test strips?

3) Do you happen to know how NHS prices for test strips are set? Does the NHS negotiate with manufacturers? Does someones else (like the CCGs) negotiate? Or are there public tenders? Where can I find more information on this?

I'd appreciate any help I can get :)
Have a good day everyone!
 
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