Cgm article in daily mail

jaywak said:

Thanks derivadow , I read the NICE guidelines and it does say to offer all type 1 diabetics a cgm so I called up the diabetic clinic at my hospital and told them of this to which I was told that they had heard nothing and could not say if and when I would be offered one , I seem to have hit a brick wall !

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Print out the relevant parts of the NICE guidelines and take it to your GP or DSN if they continue to remain ignorant of the facts.

NICE rules are only a guideline though. Your local CCG has the final say in the matter.

Here is Professor Partha Kar's Twitter feed - you can view this on any web browser without enrolling in Twitter.
https://twitter.com/parthaskar/status/1509435559407673344?ref_src=twsrc^google|twcamp^serp|twgr^tweet

Why are people expecting the NHS to suddenly find a magic money tree to fund CGMs for everyone who is insulin dependent?
Yes, the guidelines (only guidelines which can be interpreted differently by each CCG) have been released but it will take time to find the funding.

As I read elsewhere

@ In Response if you read all the information they have been able to prove it’s more cost effective for people to be on Flash/CGMs. People are getting better HBA1Cs and needing hospital care less. So it is not requiring a magic money tree, but actually going to save money long term.

becca59 said:

@ In Response if you read all the information they have been able to prove it’s more cost effective for people to be on Flash/CGMs. People are getting better HBA1Cs and needing hospital care less. So it is not requiring a magic money tree, but actually going to save money long term.

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U don't disagree with the long term value of better monitoring but a cash strapped organisation, needs money to invest now even if it saves money later.
They do not instantly find money to spend now.
It's not as if they can use our longer future lives as insurance for the loans.
As I said previously, do not suddenly expect all T1s to be given CGMs now the guidelines have been published. They need to be funded somehow

In Response said:

U don't disagree with the long term value of better monitoring but a cash strapped organisation, needs money to invest now even if it saves money later.
They do not instantly find money to spend now.
It's not as if they can use our longer future lives as insurance for the loans.
As I said previously, do not suddenly expect all T1s to be given CGMs now the guidelines have been published. They need to be funded somehow

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It has also been said that if you are doing more than 8 blood tests a day , which a lot of us do , it is more cost effective to use a cgm , thus saving money today !

In Response said:

U don't disagree with the long term value of better monitoring but a cash strapped organisation, needs money to invest now even if it saves money later.
They do not instantly find money to spend now.
It's not as if they can use our longer future lives as insurance for the loans.
As I said previously, do not suddenly expect all T1s to be given CGMs now the guidelines have been published. They need to be funded somehow

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While I agree there will be delays, beauracracy and most likely still a postcode lottery, your cost point won't be the obstacle.

If the evidence behind the new guidelines now proves a long term cost benefit of CGM/FGM (fewer testing strips, less medical interventions, amputation surgeries, etc) then the higher initial costs of CGM/FGM won't be a problem. The costs can be amortised over multiple years, supplier (eg Libre) will accept payment over decades for such lucrative/secure business, loans, other more complex financial instruments can be used.

eg
Your old car is expensive to run, so you use a multi year loan to buy a newer, more reliable and efficient car.
A football club buys £100m player, they'll pay installments for them over multiple years, not on day 1.
A hospital buys a multi-million pound MRI scanner - will be either paid or at least accounted for over a number of years.

The future costs benefits will exactly be being used as rationale for whichever chosen financial mechanism of paying for them now.

They don't need to find any extra money now, just be certain that their long term cost benefit analysis is correct.

jaywak said:

It has also been said that if you are doing more than 8 blood tests a day , which a lot of us do , it is more cost effective to use a cgm , thus saving money today !

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But that is the older guidelines for Libre.
This thread is about the new guidelines for CGMs which the Daily Mail reported on.

Draco16 said:

They don't need to find any extra money now, just be certain that their long term cost benefit analysis is correct.

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So how are they going to fund the CGMs for all T1s in England?
Dexcom subscription is £159 per month. The NHS will probably get a discount but even if they only pay £100 that will cost about £200 million (about 2 million people in England have diabetes, 8% have Type 1 - about 160,000. multiplied by £1200 per year).
This reduces the number of finger pricks but, despite was the Mail says, we still need to prick most days.
And I have not included insulin dependent type 2 who are also included in this guideline.
Plus the cost of training because, as has been proven by the plethora of comments regarding Libre, the data is useless if you do not understand how to interpret it and what the limitations are.
Finally (I hope), there is the bureaucratic cost to provide this.

Over time it saves money just like a MRI scanner, but hospitals budget for these years ahead rather than suddenly providing them when NICE suggests it.

In Response said:

So how are they going to fund the CGMs for all T1s in England?
Dexcom subscription is £159 per month. The NHS will probably get a discount but even if they only pay £100 that will cost about £200 million (about 2 million people in England have diabetes, 8% have Type 1 - about 160,000. multiplied by £1200 per year).
This reduces the number of finger pricks but, despite was the Mail says, we still need to prick most days.
And I have not included insulin dependent type 2 who are also included in this guideline.
Plus the cost of training because, as has been proven by the plethora of comments regarding Libre, the data is useless if you do not understand how to interpret it and what the limitations are.
Finally (I hope), there is the bureaucratic cost to provide this.

Over time it saves money just like a MRI scanner, but hospitals budget for these years ahead rather than suddenly providing them when NICE suggests it.

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Hmmm, ok, maybe building on this point will make it easier to understand. But if you think the NHS has ALREADY budgeted for future years / decades the total cost of supporting T1 diabetics in a) treatments/montitoring (medicines, testing strips etc) and b) managing complications (surgeries, etc).

Now they have done some analysis and realised that with better monitoring (FGM/CGM) the total costs (a+b) can be REDUCED.

This is unlikely savings to be in (a) treatments/monitoring (as yes FGM/CGM are expensive) but rather in (b) managing complications. About 80% of the NHS budget on diabetes is spent on managing complications (20% on treatments / monitoring). For T1Ds managing complications costs about £4k per annum on average.

You're exactly right to highlight the total holistic costs of a scheme like this eg training needs to be considered, but also think in 10 years time less eg footcare appointments will be needed. Though sadly don't think Dexcom will be the default!

But really don't worry that they need to find [£200m] out of the blue. They're looking at long term budgets and what is most efficient. As mentioned earlier there are numerous financial instruments and accounting mechanisms to make this viable. Even if the early year costs are higher, where there is a long term multi year benefit you look at these things on a long term time horizon of decades.

We still have to move on eventually we will use cgms as the norm , I suppose they had the same problem years ago moving on from wee tests to blood testing machines !

jaywak said:

We still have to move on eventually we will use cgms as the norm , I suppose they had the same problem years ago moving on from wee tests to blood testing machines !

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From my perspctive, after the Clinitest kits. I felt my first meter was so much more civilised..

If you wish a Libre? Forget the eye glaze over from the DSN. Target your endo & lean on that guy..

Best wishes.

In Response said:

So how are they going to fund the CGMs for all T1s in England?
Dexcom subscription is £159 per month. The NHS will probably get a discount but even if they only pay £100 that will cost about £200 million (about 2 million people in England have diabetes, 8% have Type 1 - about 160,000. multiplied by £1200 per year).
This reduces the number of finger pricks but, despite was the Mail says, we still need to prick most days.
And I have not included insulin dependent type 2 who are also included in this guideline.
Plus the cost of training because, as has been proven by the plethora of comments regarding Libre, the data is useless if you do not understand how to interpret it and what the limitations are.
Finally (I hope), there is the bureaucratic cost to provide this.

Over time it saves money just like a MRI scanner, but hospitals budget for these years ahead rather than suddenly providing them when NICE suggests it.

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The Daily mail reported that there would be about 400,000 type 1s who would be offered a cgm !

In Response said:

But that is the older guidelines for Libre.
This thread is about the new guidelines for CGMs which the Daily Mail reported on.

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I was obviously getting confused , I thought a Libre 2 was a cgm obviously not , could you tell me what the difference is please ?

jaywak said:

I was obviously getting confused , I thought a Libre 2 was a cgm obviously not , could you tell me what the difference is please ?

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Hi. A CGM such as the Devcom G6 continuously send readings to your phone/reader. The Libre2 needs to be scanned (via NFC) to download readings so in that sense it's not 'continuous'

Daibell said:

Hi. A CGM such as the Devcom G6 continuously send readings to your phone/reader. The Libre2 needs to be scanned (via NFC) to download readings so in that sense it's not 'continuous'

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Though there are at least two pretty good free, tried & tested phone apps that make the Libre 2 a CGM. With alarms & wotnot.

Daibell said:

Hi. A CGM such as the Devcom G6 continuously send readings to your phone/reader. The Libre2 needs to be scanned (via NFC) to download readings so in that sense it's not 'continuous'

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Thanks Daibell , I would be happy with swiping a reader / phone over the sensor but they seem to think as I control my type 1 reasonably well it would be of no benefit to me so it would appear I am just being awkward which I must say that is how i am feeling right now !

jaywak said:

I was obviously getting confused , I thought a Libre 2 was a cgm obviously not , could you tell me what the difference is please ?

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A CGM constantly sends data to the receiver (phone or reader). This is the case for Dexcom and Libre3, for example.
Libre 1 and 2 are Flash GMs - you get the readings when you scan the sensor,
Libre 2 has the added advantage that it can alert you if your levels go above or below your target values. But you must still scan to find out the number.

When Libre was approved by NICE, the NHS CCGs set up a separate funding bucket for these. It was only for Libre and not for any CGMs.

Only diabetes consultants (NOT GPs) have access to this funding and can approve Libre. There is little point talking to a GP about getting a Libre unless they have a good relationship with your diabetes consultant.

Was just searching for Dexcom G7 news, but saw that Dexcom One will be available in the UK from May 2022. Dexcom One is the same hardware as the G6 (suspect in time it'll share same hardware as G7), they just seem to have restricted its functionality a little via the software to differentiate the G6/G7 as premium products.

In Europe, Dexcom One costs about £95 per month including tax. Take off the tax and NHS volume buying discount and they'd probably be getting them for £50-60 per month. Expect as NHS rolls out more CGMs this might be a system they offer.