Diabetes monitoring method is available

We would like to clarify the situation with regard to so-called ‘flash glucose monitoring’ as alluded to in his article. This is the system whereby an electrode is inserted by the client, under the skin, which allows constant measurement of interstitial fluid blood glucose (not quite blood glucose, but directly related to this). This can then be monitored using an application on a smart phone. There is currently only one commercial supplier of this system. There is a more complex (and expensive) system (CGMS), produced by a different manufacturer, which allows an alarm to be raised in the presence of rapidly altering levels of blood glucose. This particular system can also be interfaced with insulin delivery via an insulin pump.

The problem faced by all health authorities is that of the cost of these new systems. They can be used to replace ‘finger pricking’ which clearly would be appreciated by most clients, but potentially deeply damaging to the health care budget. I quote from literature provided by the Association of British Clinical Diabetologists (UK):

‘The decision about who will be eligible for prescriptions has been devolved to local purchasers of health services, all of which are trying to find huge savings from their budgets. No new money has been made available to pay for this. There is an understandable demand for universal access to this technology on prescription; it is a more convenient method for glucose monitoring than capillary blood glucose monitoring for people with insulin-treated diabetes. Wholesale switching from capillary blood glucose monitoring would place an unaffordable burden on budgets at current prices, although the anticipated introduction of similar technologies should drive prices down and eventually consign inconvenient and painful finger-prick glucose testing to history.’

Currently the National Institute for Health and Clinical Excellence (NICE), which makes recommendations about the introduction of new technologies and agents, advocates CGMS in only very specific circumstances, and is not supportive of the widespread introduction of flash glucose monitoring, pending the results from further studies to define its clinical use and cost effectiveness. However, Andrew is wrong in saying that the system of ‘flash glucose monitoring’ is not available on prescription on the islands. It is, but only in the same very specific circumstances as in the UK.

As with the consideration for the introduction of other new technologies and drugs in association with the provision of diabetes care, we have had fruitful discussions with the local prescribing panels. Such mutual co-operation and prioritisation in the face of limited resources has allowed us in the past to introduce, for example, both a comprehensive insulin pump service, and an insulin matching/carbohydrate counting programme, at an earlier stage than in the UK, or indeed on our neighbouring island of Jersey.

States funding for flash glucose monitoring has been secured for all children with Type 1 diabetes on-island, and for those adults who conform to criteria laid down (and adapted pretty universally in the UK as a guide) by the Regional Medicines Optimisation Committee (North). These guidelines have been developed to identify those individuals who may most benefit from the introduction of this system. We estimate that currently about 70 clients with Type 1 diabetes use flash glucose monitoring locally, of whom approximately 20% are States funded.

G Oswald, consultant physician, diabetes, C/O MSG;

A Place, clinical nurse specialist, diabetes, C/O PEH;

R Pattimore, clinical nurse specialist, diabetes, C/O PEH;

A Kinch, consultant nurse, diabetes (retired), C/O PEH.

(Issued by) ARMINA TERRISS

Executive Support and Clinical Governance Assistant

Medical Specialist Group