How Flash is this?

In September, Abbott announced that the NHS Business Services Authority had approved the listing of the FreeStyle Libre system on the Drug Tariff. This means, subject to local health economy approval, it will be available for reimbursement via the NHS across England and Wales, NHS Scotland and Health and Social Care in Northern Ireland from November, 2017.
 
The FreeStyle Libre flash glucose monitoring system is designed to change
how people with diabetes measure their glucose levels and ultimately help them to achieve better health outcomes. The system automatically reads glucose levels through a sensor, approximately the size of a £2 coin, that is worn on the back of the upper arm for up to 14 days. This eliminates the need for routine finger pricks and user calibration. The ease, convenience and discretion of the product have won praise from healthcare professionals, key opinion leaders and most importantly, people with diabetes.
 
I was involved in the Medical Technologies Evaluation Programme carried out by Birmingham University on behalf on NICE for this device and I firmly supported the submission for inclusion on the Drug Tariff. However, in doing so, I realise that this is going to be a nightmare for all the Clinical Commissioning Groups, Health Boards and Health and Social Care organisations across the UK, as they will now have to decide who can access this glucose monitoring system on the NHS or who will still need to pay. As far as I am aware there are many patient organisations and professional bodies within diabetes care who are trying to come up with a sensible rationale for this.  
 
Chris Askew, Chief Executive of Diabetes UK, said: “Today’s announcement is fantastic news: Not since the transition from urine testing to finger-prick testing has there been such potential to transform the lives of people living with type 1 and type 2 diabetes through technology”.  Diabetes UK have also published a helpful consensus document, which can be found at https://is.gd/flashDUK (accessed 10.10.17)
 
Two clinical trials (Bolinder et al, 2016; Haak et al, 2017) and real-world evidence from more than 50 000 users (Dunn et al, 2017) showed that people who use the FreeStyle Libre system scan their glucose levels an average of at least 15 times per day. In real-world use, higher rates of scanning to self-monitor glucose were found to be strongly associated with improved glucose measures, including decreased time in hypoglycaemia and hyperglycaemia and reduced estimated HbA_1c.
 
In some instances, this could be a cheaper option for the NHS. For example, in those people who test via the capillary method more than 12 times per day.
 
With the data from the FreeStyle Libre system, people can have a better understanding of their glucose levels through the Ambulatory Glucose Profile, a chart generated by the system that provides a visual snapshot of glucose levels, trends and patterns over time. It also provides healthcare professionals with deeper insights to help make more informed treatment decisions.
 
We can only wait to see what the healthcare providers agree should be fair access to this system. What is your organisation saying?
 
References
Bolinder J, Antuna R, Geelhoed-Duijvestijn P et al (2016) Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet 388: 2254–63  
Dunn T, Xu Y, Hayter G (2017) Evidence of a strong association between frequency of flash glucose monitoring and glucose control measures during real-world usage. Diabetes Technol Ther 19 (Suppl 1)
Haak T, Hanaire H, Ajjan R et al (2017) Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther 8: 55–73