Flash Glucose Sensing (Libre)

Flash Glucose Sensing(FGS) is located under “CGM” simply because it uses a sensor and displays trends. It has its own page because it is not CGM but is more than blood glucose testing. Abbott describe their FreeStyle Libre as a replacement for routine fingerstick blood glucose measurements but in the diabetes community Libre is being talked about as a potentially cheaper alternative to CGM. Both measure the glucose in interstitial fluid but the Libre sensor cannot transmit and therefore will not alert you to low or high glucose levels until you ‘flash’ the sensor.

Libre reader following a 'flash'

Libre reader following a ‘flash’

The Libre system includes a sensor which is worn for up to 14 days, and a handset which the user scans over the sensor to obtain a reading. The reading also shows a trace for the last 8 hours and usually a direction arrow showing whether the glucose reading is stable, rising, rising fast, falling or falling fast. The handset includes a smart FreeStyle Optium blood glucose meter and blood ketone meter.

Abbott markets Libre as a replacement for fingerstick blood glucose monitoring, but note that the Abbott FreeStyle Libre UK website says:

“A finger prick test using a blood glucose meter is required

  • during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels or
  • if hypoglycaemia or impending hypoglycaemia is reported by the System or
  • when symptoms do not match the System readings.”
    (INPUT’s highlighting)

Please note: you will still need to do fingerstick blood tests prior to and during driving to meet DVLA requirements. 

Emma, 20’s, said “It has reignited my interest in my blood sugars. I’ve always been frustrated by finger prick tests because you don’t actually know what the reading means. Am I stable? Going up? Plummeting down? Now I know 😀 I already can’t imagine life without it.”

The Edinburgh Centre for Endocrinology & Diabetes has produced a helpful guide to using Libre data to improve glucose control in type 1 diabetes – click here

NICE Medtech Innovation Briefing (MIB) published July 2017 – link

MIBs are Objective information on device and diagnostic technologies to aid local decision-making by clinicians, managers and procurement professionals. The information provided includes a description of the technology, how it’s used and its potential role in the treatment pathway. This is not the same as NICE guidance, and does not have to be acted on by clinicians, managers or commissioners.

Diabetes UK consensus guideline to Flash glucose monitoring – published August 2017
“We have developed these recommendations for the use of Flash GM in the NHS, jointly with other diabetes organisations representing people with diabetes and clinicians. We recognise that there is need for further research and audit to determine a full picture of the benefits and limitations of the technology to the NHS and people with diabetes. These recommendations are based on the best currently available clinical and scientific evidence as well as experiences from people living with diabetes using this technology.”

See our Research page for research and articles about Libre.

NHS funding of Libre

Abbott announced in September 2017 that the NHS Business Services Authority had approved the listing of the FreeStyle Libre system, on the Drug Tariff. This means, subject to local health economy approval, it will be available on GP prescription in England and Wales, Scotland and Northern Ireland from 1st November 2017.

To see if your CCG has published a policy, check Diabetes UK’s map of Libre access

Points to note: 

  1. FreeStyle Libre will not be available on prescription to everyone straightaway. It will take some months for CCGs to develop their policy. As with any new product which goes on tariff, local clinicians and managers will need to agree pathways and monitoring of use of Libre
  2. The countries covered by the national formulary include England, Wales, Northern Ireland and Scotland.
  3. The target cohort by Abbott is anyone with diabetes (any type) who uses intensive insulin management needing multiple blood sugar measurements (4 or more per day)
  4. Your GP will not be able to prescribe Libre unless the local CCG has agreed to put it in their formulary.
  5. If your CCG will not put Libre on their formulary, a letter from your clinic to your GP WILL NOT make any difference. The local system needs to agree first.
  6. There are no NICE guidelines on the use of Libre, only a Medical Innovation Briefing, which does not make recommendations.
  7. NICE is not working on any further guidances, advice or publications about Libre. 
  8. The RMOC (North) Position Statement provides advice and makes recommendations to local decision-makers across England. The status of RMOC recommendations and all other outputs are advisory. 
  9. If your GP cannot prescribe Libre you may wish to write to your CCG (ask your GP practice for the address) to ask if they have published a policy, and if they have given due regard to the RMOC advice.

Two reactions of particular interest:

Dr Partha Kar, Consultant Endocrinologist, Associate National Clinical Director for Diabetes (dated 17 September 2017)

Dr Emma Wilmot, Consultant Diabetelogist (dated 13 September 2017)

People who do not get Libre on prescription will still be able to buy direct from Abbott. Some local pharmacies are selling Libre at a discounted price – ask the diabetes online community on social media for locations of those pharmacies.

Libre website & webshop (be sure to tick the VAT exemption box)

To join the chat about Libre, have a look at the Facebook group

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