About Freestyle Libre and Flash Glucose Monitoring in Type 1 Diabetes
Freestyle Libre® is recommended for people with Type 1 diabetes, aged 4 and above.
Patients must have:
- Type 1 diabetes
- OR any form of diabetes on haemodialysis and on insulin treatment
- AND clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months
- OR diabetes associated with cystic fibrosis on insulin treatment
- Pregnancy with Type 1 Diabetes (12 months in total inclusive of post-delivery period)
- Unable to routinely self-monitor blood glucose due to disability requiring carers to support glucose monitoring and insulin management
- Specialist diabetes MDT determines occupational circumstances (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support
- Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where their clinical history suggests that they would have satisfied one or more of these criteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self-funding
For those with Type 1 diabetes and recurrent severe hypoglycaemia or impaired awareness of hypoglycaemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation. However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered.
- Education on Flash Glucose Monitoring has been provided (online or in person)
- Agree to scan glucose levels no less than 8 times per day and use the sensor >70% of the time
- Agree, as a minimum, to attend their 6 month review with the clinical team who initiated Libre, to review continued use based upon the criteria below
- Previous attendance, or due consideration given to future attendance, at a Type 1 diabetes structured education programme (DAFNE or equivalent if available locally)
6 months review
Primary and Secondary care initiated patients will require the following clinical coding recorded in their electronic records, as evidence to continue to prescribe Freestyle Libre®, 6 months following initiation:
- Reductions in severe/non-severe hypoglycaemia
- Reversal of impaired awareness of hypoglycaemia
- Episodes of diabetic ketoacidosis
- Admissions to hospital for hypoglycaemia
- Admissions to hospital for diabetic ketoacidosis
- Improvements in HbA1c
- Scanning no less than 8 times per day and are using their sensor >70% of the time
- Reductions in testing strip usage and prescription quantities
- Quality of Life changes using validated rating scales
- Commitment to regular scans and their use in self-management
If no improvement is demonstrated in one or more of these areas above over a 6 month trial then the use of Freestyle Libre® should be discontinued and an alternative method of monitoring should be used.
Ensure all patient records demonstrate clear documentation with details reasoning for discontinuation.