What is FreeStyle Libre?
The Abbott FreeStyle Libre (FSL) flash glucose monitoring system is a factory-calibrated glucose sensor that measures interstitial fluid (not blood) glucose levels in individuals with diabetes mellitus. It is worn on the back of the arm and sensors last 14 days. Interstitial glucose readings are taken using an associated reader device or a compatible smartphone which is held over the sensor and downloads the last eight hours-worth of data, providing a graphical display of interstitial glucose levels. This reduces the need to perform fingerprick glucose measurements. However, glucose monitoring is still required to confirm hypoglycaemia or suspected spurious results, and to enable accurate calculation of insulin correction doses.
Who can prescribe the Freestyle Libre?
GPs can prescribe FSL, and should do so, only for individuals identified by the secondary care diabetes team as being eligible based on clinical need and criteria as proposed by the Scottish diabetes Group/MCN Leads and endorsed by a Scottish Health Technology Group Assessment on the cost effectiveness of FSL.
Who is eligible to receive prescriptions for FSL?
- Individuals with diabetes who are attending diabetes specialist services and treated with intensive insulin therapy, with multiple daily insulin injections, or insulin pump therapy, who are already performing multiple (5 or more) fingerprick blood glucose tests per day.
- Individuals with recently developed impaired awareness of hypoglycaemia who are not yet candidates for (more costly) continuous glucose monitoring systems.
- Women planning pregnancy (this would be switched to Dexcom continuous glucose monitoring during pregnancy).
- Those who required a third party to perform monitoring, or where dexterity or disability denote that conventional testing is difficult or impossible.
What other criteria must be met for the FSL to be prescribed?
- Deemed by the team to have the required knowledge and skills to effectively self-manage their diabetes. This may include having undertaken a recognised diabetes structured education programme (eg HEIDI), and/or 1 to 1 carbohydrate counting.
- Completion of the on-line Libre Academy modules at: https://freestylediabetes.co.uk/freestyle-libre/academy. Agreement to attend a locally provided flash glucose monitoring education session, or an on-line equivalent, if appropriate.
- To agree to measure/“swipe” a minimum of six times per day.
- To use sensors as recommended.
- To agree to share glucose monitoring data with the diabetes clinic and complete any associated clinical questionnaires.
How will ongoing effectiveness of the device be assessed?
Ongoing prescription of FSL will require effective use of the technology to improve self management as determined by the specialist diabetes team at their review appointments, eg reduction in hypoglycaemia, improvement in HbA1c, reduction in hospital admissions.
What are the associated costs?
FSL was added to the NHS prescribing tariff in November 2017 at a reduced acquisition cost compared to when purchased privately. The annual prescribing cost for FSL and associated sensors is £910 per patient, roughly equivalent to 8 or more glucose test strips per day. This is a significant saving compared to private purchase by patients. However, prescription should be limited to those identified by the specialist team as being suitable.
What if an individual is already self-funding Freestyle Libre?
If an individual with Type 1 diabetes is already self-funding FSL then it is likely that prescription of FSL will be recommended by the specialist team provided that they are satisfied that it has led to improvements in the management of the individual’s diabetes, ie improved HbA1c, reduced hypos, less hospital admissions with DKA (if applicable). However, as above, please do not prescribe FSL unless on the advice of the secondary care diabetes team.
What if an individual is having technical problems with the sensors?
Individuals should contact Abbott directly rather than contacting their GP or the diabetes team.
Abbott UK General Customer Service telephone number: 0800 1701177
8am to 8pm, Monday to Friday; excluding bank holidays
- Freestyle Libre® flash glucose monitoring (shtg.scot) (Accessed on 18th Aug 2021)