Updated NICE T1 guidelines published

[donnellysdogs]

I have cheap needles and only use one a day with no issues.

I use one needle for anout 5 -7 days with the bd fine ones and multiple injections each day. Only because I'm lazy... Not actually to save costs to NHS.

When I went back to MDI from
Pump (went on it 2010) I got out my needles for my pen that I used up until 2010. The needles were out of date in 2009 and only a few had gone from the box.

Not good practice I know!!

 

[TooMuchGlucose]

I use one needle for anout 5 -7 days with the bd fine ones and multiple injections each day. Only because I'm lazy... Not actually to save costs to NHS.

When I went back to MDI from
Pump (went on it 2010) I got out my needles for my pen that I used up until 2010. The needles were out of date in 2009 and only a few had gone from the box.

Not good practice I know!!

Wow, I'm really surprised how many people re-use needles, I just always thought it would cause infection or be painful.

 

[tim2000s]

When you couldn't get pen needles on prescription, you made them last longer... Once in the habit...

 

[Mrs Vimes]

Ask your DSN about the circadian profile.

I used to use the Vibe, but changed to the Accu Chek Insight this year - the circadian profile algorithms have eradicated night time hypos and dawn phenomenon for me... you should be able to set 24 hourly basal rates on the Vibe if I recall correctly. (You will need to see your DSN to calculate the profile.)

Hi Conrad, I've done that already with the pump that why I think I won't qualify for funding for cgm because the cgm is already proof I'm in control of it. (Mostly!!!!!)

 

[Mrs Vimes]

When you couldn't get pen needles on prescription, you made them last longer... Once in the habit...

OMG yes!

 

[Angusc]

CGM/s may well be for every one as there's a non-invasive test coming in the near future which should be a one off cosr with no consumables and there's a few other in the pipeline atm
http://www.leeds.ac.uk/news/article...aily_finger_pricking_for_people_with_diabetes

 

[Spiker]

Gotta love that pipeline... ^_^

 

[Matt J]

I know the NICE statement says something along the lines of the benefits of using CGM's are not proven. However, it's the apparent prohibitive cost of CGM's which makes it unlikely at the moment and the foreseeable future for the NHS to prescribe to all T1's. I know someone on here produced a cost comparison of all CGM's based on 2 years use. From memory I think it averaged about £1250 a year.

With these new NICE guidelines on testing stating T1's can test up to 10 times a day i.e. up to 300 strips a month or 6 x 50 packs). Well with say an average price per packet of 50 strips of £15 then yearly cost in strips alone is over £1k never mind the lancets. I realise some strips can be had for less but also for a lot more, not everyone will test 10 times a day and people with CGM's also use some strips but at the end of the day it's not a huge difference in cost. (If the strips used are £20 for 50 then the cost per year based on the above scenario is heading towards £1.5k). If the cost of CGM's reduced in price then it makes it even more of an attractive option.

 

[ConradJ]

I know the NICE statement says something along the lines of the benefits of using CGM's are not proven. However, it's the apparent prohibitive cost of CGM's which makes it unlikely at the moment and the foreseeable future for the NHS to prescribe to all T1's. I know someone on here produced a cost comparison of all CGM's based on 2 years use. From memory I think it averaged about £1250 a year.

With these new NICE guidelines on testing stating T1's can test up to 10 times a day i.e. up to 300 strips a month or 6 x 50 packs). Well with say an average price per packet of 50 strips of £15 then yearly cost in strips alone is over £1k never mind the lancets. I realise some strips can be had for less but also for a lot more, not everyone will test 10 times a day and people with CGM's also use some strips but at the end of the day it's not a huge difference in cost. (If the strips used are £20 for 50 then the cost per year based on the above scenario is heading towards £1.5k). If the cost of CGM's reduced in price then it makes it even more of an attractive option.

If the technology discussed in the link from @Angusc is proven then I suspect that we could see the end of invasive blood testing / cgms within 5 years... It could easily be released to market for about £2,500 but with a lifespan of 5+ years, thereby costing less than £500 pa all-inclusive.

 

[Spiker]

CGM is not an alternative to fingertip testing, it requires fingertip testing. The valid comparison isn't CGM vs fingertip testing, it's CGM vs pump. The costs are similar.

This NICE statement as far as I know does not say that the benefits of using CGMs aren't proven. They have greatly expanded the scenarios where they now recommend CGM use, and say only that it's not recommended for use by everyone.

And of course NICE is silent on questions of funding. That's not their job really.

 

[ButtterflyLady]

When comparing costs of different options, the amounts should also include the cost of staff to initiate and maintain the technology/treatment. There are similar debates in the sleep apnoea/CPAP users community. The big costs there are sleep studies (about GBP1k), staff time, and the CPAP (airflow) devices (GBP500-1000s) and consumables. Like with T1, technologies/devices/drugs are what keep people alive and well, so the questions of what is affordable and who should get the treatments are very important.

 

[Spiker]

Good point. I suspect there is no data on support costs for CGMs because almost no one is getting a supported CGM. However from my own experience I think a pump requires masses more HCP support than a CGM. But maybe that's just because the support was made available for the pump and none was made available for the CGM, so I had to sink or swim.

 

[Spiker]

CGM/s may well be for every one as there's a non-invasive test coming in the near future which should be a one off cosr with no consumables and there's a few other in the pipeline atm
http://www.leeds.ac.uk/news/article...aily_finger_pricking_for_people_with_diabetes

Well call me skeptical (do I look skeptical?) but people have been investigating light based non invasive reading of BG for about 20 years and no one has produced a usable product yet. They always found there was too much variability in the signal to get any kind of consistency in the BG measurement. Prof Grant does not appear to have published his clinical pilot data anywhere I can find. His funding from BHF ran out in April so I guess that's why he published results in July... you can see that there might be a vested interest by some parties in bigging up the results. The description given in the Leeds Uni press release, quoted by all other sources I can find, doesn't even make any sense. Decay time of infrared laser induced flourescence in the glass film varies in relation to BG, just because the glass is in contact with the skin? I am not saying the device doesn't work on sound physical principles, just that Leeds Uni and the media in general have failed to coherently report what those physical principles are. Eg it would make a little more sense if it was the backscatter from a laser penetrating into the capillaries that was causing the film to flouresce.

If they publish some data on what reliability and accuracy they have achieved with their bench test setup, maybe I will buy shares in the company. For now I will just keep an open mind. But to say "this is coming in the near future" is without foundation and is really spreading false hope. We are constantly bombarded with talk of cures and revolutions in therapy. Yes, some of them actually happen. The great majority don't. So, while I hope this project is a success, I think it's a little premature at the moment to say the future just changed.

 

[Spiker]

CGM/s may well be for every one as there's a non-invasive test coming in the near future which should be a one off cosr with no consumables and there's a few other in the pipeline atm
http://www.leeds.ac.uk/news/article...aily_finger_pricking_for_people_with_diabetes

The website of the company developing the product has the same unhelpful description of 'how it works' that was cut and pasted into the press release. It's unhelpful FAQ says

Technical enquiries
Technical details and data will be presented and published in peer reviewed scientific literature as and when appropriate. GlucoSense Diagnostics Ltd is not able to respond to individual requests for further technical information.

Leaving us with just the bland and unreferenced claim

The results of a pilot clinical study, carried out at the Leeds Institute of Cardiovascular and Metabolic Medicine suggests that the device will perform as well as conventional technologies.

I am underwhelmed.

 

[tim2000s]

I've been looking at both of these. I don't really see the need for support in either.

 

[PaulinaB]

When it comes to the cgm cost for the nhs... Are you saying that if they made a deal for 1000s of sensors with the supplier they couldn't get the price down?
Exactly that happens with the test strips right now - just compare the price for the nhs with the retail price.
They could probably get the cost down, it's just no one is trying...

Edit: look at the price difference between Animas and AT - AT charges £250 per pack of 4, what's the price from Animas? Someone quoted £180. I'm sure Animas doesn't sell them with a loss - at least a minimal profit. So if they get a lower price, nhs with potentially so much more patients can't?

 

[Mrs Vimes]

Animas don't sell at a loss, I think there is some deal because their pump has a receiver for the dexcom. I dream of free sensors but until then I'll by them while I can afford.

 

[tim2000s]

Given the cost of sensors from Dexcom to researchers is around £33, someone is making a decent profit somewhere...

 

[Mrs Vimes]

Oooohhhh the @@@@@@@@. I'm on week three with the sensor I'm currently wearing.

 

[Spiker]

Given the cost of sensors from Dexcom to researchers is around £33, someone is making a decent profit somewhere...

That is almost certainly a below cost price. It's probably the cost of delivery and administration alone. Dexcom have a vested interest in providing them to researchers.