An investigation by The BMJ has concluded that tens of thousands of UK-based type 1 diabetes patients are missing out on the potential benefits of flash glucose monitoring devices because of where they live in the country.
Currently, Abbott’s Freestyle Libre is the only glucose monitoring device available in the UK. The investigation has shown that a year after this device became available, around 25% of clinical commissioning groups (CCGs) in England are not recommending it for patients even if they meet all of the NHS England criteria.
Data disclosed by CCGs to the BMJ shows that some CCGs have made the glucose monitoring devices available to hundreds of patients via GPs and spent thousands on prescriptions, while some say that the devices are only prescribed by secondary care clinicians. Some CCGs are also imposing stricter access criteria than those suggested by NHS England.
Around 400,000 people in the UK have type 1 diabetes, including Prime Minister Theresa May. She uses the Freestyle Libre device and recently spoke to parliament about its apparent availability on the NHS.
However, NHS England’s associate national clinical director for diabetes Partha Kar has estimated that only 3-5% of type 1 diabetes patients will currently have access to the sensor through the NHS. He believes that the figure should be around 20-25% or above if CCGs had followed guidance correctly.
NHS Clinical Commissioners chief executive Julie Wood said: “Unfortunately the NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face.”
Kar thinks some CCGs are merely paying “lip service” when offering access to the devices, and that variation in how the criteria is being applied has led to a postcode lottery.
Consultant diabetologist Emma Wilmot has found that some patients are considering moving to a different GP practice a few miles down the road so they can meet the criteria, while others are making “huge sacrifices” to fund Libre themselves.
She said: “By preventing people having access to the Libre you are compromising their quality of life compared to what it could be.”
Official prescribing data collated by diabetes campaigner Nick Cahm and shared with the BMJ states that only 2% of type 1 diabetes patients in England can access Libre on GP prescription, compared to 11% in Scotland, 16% in Wales, and 35% in Northern Ireland.
The BMJ also learned that some GPs in areas where CCGs have not recommended flash monitoring are prescribing the glucose monitoring device against their CCG’s advice.