The Leading Peer-Reviewed Journal for the Primary Care Nursing Team
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November 2018

Patients with type 1 diabetes missing out on glucose devices



Tens of thousands of UK patients with type 1 diabetes are being denied the potential benefits of ‘flash’ glucose monitoring devices because of a postcode lottery, an investigation by the BMJ has found.

The device, which works via a sensor attached to the skin, has been available on prescription since November 2017. Users can access glucose readings by scanning the sensor with a portable reader or a smartphone app. The reading comes with an arrow that indicates whether glucose is rising or falling.

Abbott’s Freestyle Libre is currently the only device available in the UK.

But the investigation shows that a year after the device became available, around a quarter of clinical commissioning groups (CCGs) in England are not recommending it for patients even if they meet NHS England criteria.

There are roughly 400,000 people in the UK with type 1 diabetes, including the UK prime minister Theresa May, who uses Freestyle Libre and recently told parliament that it is available on the NHS.

But Dr Partha Kar, NHS England’s associate national clinical director for diabetes, estimates that only around 3-5% of patients with type 1 diabetes in England currently have access to the sensor on the NHS. If CCGs were following guidance correctly, he believes this figure should be closer to 20-25%.

He said some CCGs were merely paying ‘lip service’ to offering access to the devices, and that variation in how the criteria were being applied had led to an unacceptable postcode lottery.

As of July 2018, GP prescribing data showed that only only two out of 195 CCGs in England had prescribed Freestyle Libre to more than 20% of patients with type 1 diabetes, only 15 CCGs had prescribed it to over 10% of type 1 patients, and 25 CCGs had issued no prescriptions at all.

The BMJ has also learnt that some practices in areas where CCGs have not recommended flash monitoring are prescribing Freestyle Libre against their CCG’s advice.

Iacobucci G. Glucose device for type 1 diabetes is rationed BMJ 2018; https://www.bmj.com/content/363/bmj.k4675