freestyle libre

d14678 said:

Even when the libre is available on NHS in April 2019, there are still criteria you have to meet to be prescribed the Libre. If I have good HbA1c does that mean I wont be able to get it?

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No, not if you finger prick more than eight times daily to get it.

Why would I finger prick more than 8 times a day when scanning with my sensor provides more useful information on trends? Is the expectation that we should be doing both just to show what would be obvious that we ‘would’ likely be using that number of strips if we were not using sensors?
It is the wrong approach when looking at cost savings to just compare what I assume would be a comparable costs of 8+ strips per day versus the cost of sensors and not consider the long term savings from the better control achieved by use of the sensors. There is such a saving by those that get better control so why wouldn’t they issue them to all that wish to have them on CONDITION that they show they are regularly scanning their levels and, in addition, they could also stipulate that HbA1c levels improve*. Very easy to assess after say 3 or 6 months.

*Not sure reduced HbA1c reduction is necessarily a good measure given that it could be a result of significant number of low readings but prefer the ‘daily patterns’ or other logs like ‘time in target’ when looking at assessing improvements.

tim2000s - as you are showing as an ‘expert’ on this forum do you know if is still the local CCG and/or our local consultants that have the say on how these RMOC rules/guidance are applied as it sounds from the threads that there are differing opinions.

AndyGW said:

Why would I finger prick more than 8 times a day when scanning with my sensor provides more useful information on trends?

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I don't think the RMOC guidelines expect you to prick 8 times a day after you get libre. I read them as meaning if you are pricking 8 times a day at the moment, then you should get libre to save you having to prick so much.

I'd be tempted to just give my meter to my nephew and say, "look, kid, there's a tenner for you if just do this 8 times a day for the next few weeks, deal?"

Partha Kar, who is fairly high up in the NHS diabete world, and has done a lot to push the libre message, has tweeted that the RMOC guidelines are a good base to work from, but this is just the beginning and he expects the rules to be loosened as time goes by and more evidence comes in.

I'm lucky enough to live in Edinburgh which has one of the most liberal policies anywhere - if you're T1 and want it, you get it.

Because so many of us have been using it for a while now, the area has been pushing out some numbers. They're going to be doing a fuller paper, but initial results are showing some amazing figures, numbers coming in below 48 a1c have almost doubled, numbers above 75 have almost halved, and reductions across the entire range - see pic below.

ABCD is also inviting data submissions from across the country for a national audit, dealing not only with a1c, but also dka and hypo admissions and call-outs. I'd be surprised if that audit didn't show similsr results to the Edinburgh one.

It's taking time, but I think it will reach a point where the evidence is so overwhelming about how libre engages patients, makes them more interested in their levels, and lets them safely reduce a1c, and generally be more content, that prescribers will be asking why they didn't loosen up the rules earlier.

What about insulin dependent t2?

Scott. Thanks for the reply and mention of the Scottish success. Also hear good reports coming from Europe as well on use. I was however referring to being a self-funded user of Libre and so NOT finger-pricking 8+ times per day. If, as Tim is suggesting, the CCGs (or however it is come April that will say “yes” or “no” to my receiving sensors on prescription) is expecting me to do finger prick blood tests of 8+ per day then this seems ridiculous given the only reason I am ‘not’ is because I am using the Libre sensor.
Do I stop using the sensor now and increase finger prick testing just to show that I can? Mad.

The criteria is simple having now been taken onto a 6 month freestyle Libre trial.
1 reduce your HBA1C by using the Libre
2 Finger pricking currently more than 8 times a day

You still need to finger prick if you have low reading from the Libre but you get a new monitor to use as the trade off is you use less blood sticks hence saving money i.e. self funding by using a les expensive blood monitor I am now restricted to 2 boxes of blood sticks a month prior to this I could use 2 a week.

It’s certainly working for me after 3 sensors I’ve reduced my hba1c from 52 to 46 on average.

It is not 100% accurate but the mid range readings are pretty good.

TonyBlue said:

The criteria is simple having now been taken onto a 6 month freestyle Libre trial.
1 reduce your HBA1C by using the Libre
2 Finger pricking currently more than 8 times a day

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Do you have to satisfy one or both of these criteria?
At the moment, the criteria differ around the country: in my CCG, currently both of these criteria need to be satisfied.
In April, the criteria should become unified across England (sorry, I do not know about Scotland, Wales and Northern Ireland) and, from then on, I understand satisfying one of these criteria should be sufficient.

I self fund my Libra sensor I have had one since they were approved I wouldn’t be without it my average over a90 day period is 39 It was 52 when first diagnosed in September 2017 I have had 2 that didn’t adhere to my arm but a quick phone call to Abbott laboratories soon had them replaced I have never taken any medication but rely on a low carb diet which I didn’t find easy at first but it becomes a way of life.

I’m fairly certain you only need to satisfy one of the criteria , you have to sign a contract and adhere to the rules which for me was fine...

One note I would add it is like big brother watching your BG 24/7 which is slightly weird as I’ve been so used to blood testing as and when needed as I also carb count but now I can check as many times as I like and it gives you full visibility of your BG it can be very startling to say the least.

I can now see my BG rising during the night and lowering just before I wake up....which is very interesting but also worrying.. it’s taking some time for me to get used to big brother but with the team of DSN,s behind me I’m confident this will work out in the long term much better for me even though my BG levels have always been pretty good...

AndyGW said:

Why would I finger prick more than 8 times a day when scanning with my sensor provides more useful information on trends? Is the expectation that we should be doing both just to show what would be obvious that we ‘would’ likely be using that number of strips if we were not using sensors?
It is the wrong approach when looking at cost savings to just compare what I assume would be a comparable costs of 8+ strips per day versus the cost of sensors and not consider the long term savings from the better control achieved by use of the sensors. There is such a saving by those that get better control so why wouldn’t they issue them to all that wish to have them on CONDITION that they show they are regularly scanning their levels and, in addition, they could also stipulate that HbA1c levels improve*. Very easy to assess after say 3 or 6 months.

*Not sure reduced HbA1c reduction is necessarily a good measure given that it could be a result of significant number of low readings but prefer the ‘daily patterns’ or other logs like ‘time in target’ when looking at assessing improvements.

tim2000s - as you are showing as an ‘expert’ on this forum do you know if is still the local CCG and/or our local consultants that have the say on how these RMOC rules/guidance are applied as it sounds from the threads that there are differing opinions.

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This is the problem that those of us who have self funded face. Because we don't need to fingerprick 8 times a day and because our diabetic control has improved so much, we don't qualify to get the Libre on the NHS. If we let our selves go to pot and start fingerpricking again, the we will qualify. It's absolute madness and a typical catch 22 situation.

Copernicus said:

This is the problem that those of us who have self funded face. Because we don't need to fingerprick 8 times a day and because our diabetic control has improved so much, we don't qualify to get the Libre on the NHS. If we let our selves go to pot and start fingerpricking again, the we will qualify. It's absolute madness and a typical catch 22 situation.

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It reminds of the fact that I was told I was not heavy enough to qualify for an NHS funded visit to an NHS dietician.

As I’ve said before it is still only going to be available to a target of 25% of Type 1s. There is still going to be a high % of the 75% remaining who would like it but are not going to get it even if they do prick 8+ times a day.

Whilst talking about the Libre, just been to my local Asda to pick up a couple and they have increased the price from £44 to £46.26. Not a lot I know but I wonder if this is a price increase from Abbott or just Asda wanting to make more money from us.