Flash Glucose Monitor (Freestyle Libre®)

Flash Glucose Monitor (Freestyle Libre®) has been approved by Wirral CCG, following Pan Mersey recommendation. It has been granted an Amber Initiated RAG status for the indication of interstitial fluid glucose monitoring in Type 1 diabetes only. Freestyle Libre® should not be prescribed on the NHS for patients with Type 2 diabetes.

The statement outlines the initiation criteria and review by the specialist diabetes service, and continuation criteria (under Flash Glucose Meter). 

Please note:

  • Freestyle Libre can only be initiated in specialist diabetes clinics where initial sensor and reader supply will be made. The reader is not available on FP10 prescription. GPs can prescribe ongoing sensors (one sensor should last for 2 weeks) for 6 months then the patient will need to return to the specialist for review. Blood Glucose Testing Strips will still need to be prescribed, at a reduced quantity. Where appropriate a low cost meter should be used – please refer to Wirral Blood Glucose Monitoring at Home Guidelines.
  • GPs should only be asked to prescribe sensors by a specialist, and should only agree to prescribe if the specialist supplies an initiation criteria confirmation form and confirms that they continue to meet the criteria at 6 months by supplying a continuation criteria confirmation form. Ongoing use should be assessed at 6 months and annually thereafter.
  • Patients should be informed by the specialist that if they do not continue to meet the criteria then prescribing will be stopped. This is through the Patient Contract.
  • Patients should have completed a structured diabetes education programme and been educated to ensure that they can best use the information that the Freestyle Libre® system provides.
  • Freestyle Libre® should not be prescribed on the NHS for patients who have previously been purchasing it themselves unless they have been assessed as fulfilling the criteria as detailed in the statement.

Further information

Freestyle Libre® should only be used for people with type 1 diabetes, >4 years of age, attending specialist care using multiple daily injections or insulin pump therapy, who have been assessed by the specialist clinician (including specialist diabetes nurses in hospital or community specialist diabetes service) and deemed to meet one or more of the following: 

1. Patients / carers who undertake intensive blood glucose monitoring ≥ 8 times daily including those on insulin pump. 

2. Those who meet the current NICE criteria for insulin pump therapy (and this would be considered a viable option for them) where a successful trial of FreeStyle Libre® may avoid the need for pump therapy. 

3. Those who have recently developed impaired awareness of hypoglycaemia (potentially short-term use). However, it is noted that for persistent hypoglycaemia unawareness, NICE recommend continuous glucose monitoring with alarms and Freestyle Libre® does not currently have that function. 

4. Frequent hospital admissions (>2 per year) with diabetic ketoacidosis (DKA) or hypoglycaemia but only where use of Freestyle Libre® would be likely to prevent this in future. 

5. Those who require third parties to carry out monitoring and where conventional blood testing is not possible. 

Template documents have been prepared giving background information, and information to be included in communication from specialist diabetes services to primary care prescribers regarding initiation, patient information/contract, and review and continuation when initiating Freestyle Libre® in individual patients.

It is anticipated that this will be cost-neutral or cost-saving if Freestyle Libre® is used in patients fitting the initiation and response criteria, with cost-savings from reduced blood glucose monitoring and reduced insulin pump requirement.

Please note: Community Pharmacists need to order through Abbott’s Freestyle Libre pharmacy portal. Please take into account that stock availability will take at least 48 hours from ordering.