Levelling up: should all continuous glucose monitoring systems be available on prescription in the NHS?

Abstract

Dear Editor, the launch of the FreeStyle Libre intermittently scanned continuous glucose monitoring system (also known as Flash or isGCM) on prescription in November 2017 and subsequently Libre 2 has brought about a paradigm shift in the widespread availability of CGM for people living with type 1 diabetes (T1D) in the UK.1 Libre has been available for self-funding since 2014 and real-time (rt) CGM has been around commercially for a decade or so before this.2 Strong clinical leadership from Professor Partha Kar and colleagues from the Diabetes Technology Network along with campaigning from patient organisations have undoubtedly accelerated and catalysed this change with over 69% of the English population of people living with T1D being prescribed a Libre, and – with the exception of two (out of 42) integrated care systems – all other systems have at least half of their population of people living with T1D on Libre from almost zero five years earlier.3 This growth occurred prior to the publication of 2022 NICE guidance (NG17)4 recommending all forms of CGM be offered to all people living with T1D. Previous NHS England guidelines suggested about 20% of the T1D population would be eligible for FreeStyle Libre and funding for sensors up to this number of patients was available centrally for a limited time. National Diabetes Audit data for rtCGM from 2020–215 (until recently rtCGM was not available on prescription at all) show that the majority of specialist adult diabetes care providers in England had none or a miniscule percentage of their patients using rtCGM; many of these same units had large numbers of people using FreeStyle Libre. (See Figure 1.) These data would suggest that there were (and still may be) large parts of the country where, for adults with T1D, rtCGM was (or still may be) either not available or difficult to access. The data would further suggest that there is an even greater variation in the use of rtCGM than there is with FreeStyle Libre. The recent update to NG174 on the use of all forms of CGM has undoubtedly encouraged companies to include some of their rtCGM products on prescription, but not all. At present there appears to be inconsistent, non-transparent and often complicated local schemes for providing access to many rtCGM systems. This makes delivery on the promise of NG17 unnecessarily difficult -- especially in terms of giving people with T1D a genuine choice in the device they use to monitor their glucose levels. If we are to fully meet the glucose monitoring needs of our adult population of people with T1D, surely the time has come for all CGM systems to be available on prescription. This would create a level playing field for people living with diabetes and those who provide their care, thereby affording access based on NICE 2022 criteria in keeping with the founding principles of the NHS. There are no conflicts of interest declared.