Flash glucose monitoring: how to access ‘life-changing’ diabetes technology
Sensor removes need for regular finger-prick testing, but is not available universally on NHS
The sensor removes the need for regular finger-prick testing, but it's not yet available universally on the NHS
According to Dan Howarth, flash glucose monitoring is the biggest development in diabetes testing in a quarter of a century.
The technology, which allows people to monitor their blood glucose via a sensor on their arm, greatly reducing the need for finger-prick testing, has been credited with transforming the lives of people with diabetes, helping them to manage their condition and potentially improve their health.
This brings many benefits to people with diabetes and to the health service more widely, says Mr Howarth, Diabetes UK’s head of care. Despite this, there are still large swathes of the UK where people with diabetes are unable to access the technology unless they pay for it themselves.
‘There’s a realisation that this is life-changing, and that it can make a real difference to people with diabetes’
Danny Beales, Diabetes UK
‘There’s a real postcode lottery,’ says Mr Howarth, a clinical nurse specialist in diabetes. ‘We believe that every area should be providing this new technology free on prescription for those who need it, but at the moment it depends on where you live. We don’t believe this is right.’
Bringing together benefits
Flash glucose monitoring uses a sensor placed under the skin to record blood glucose levels. The wearer uses a reader to scan it, obtaining their blood glucose level either at a single point in time or over a longer period, and can decide whether they need to take action such as adjusting their insulin.
This brings together the benefits of finger-prick testing, which became widespread in the early 1990s, and the more recently introduced continuous glucose monitoring, Mr Howarth says. ‘It’s the biggest development in accessible home blood sugar testing since finger-prick testing came along in the late 1980s. To say that we are excited about it is very much an understatement.
‘Every area should be providing this new technology free on prescription for those who need it, but at the moment it depends on where you live’
Dan Howarth, Diabetes UK
‘It’s improving the quality of life for people with diabetes, not least because it means they can reduce the number of finger-prick tests, which can be painful and stressful, but it also helps them manage their condition.
How flash glucose monitoring works
- Flash glucose monitoring uses a small sensor worn just under the skin that continuously stores readings of blood glucose levels. Patients can see their levels by scanning the sensor with a reader
- Because it continuously takes readings, flash glucose monitoring gives a fuller picture than a finger-prick test, which only shows a reading for a particular moment
- It can show whether glucose levels are rising or falling, and how quickly
- If the reading indicates that the person should take action to control their blood glucose level, they should still use a finger-prick test to confirm the reading
- A National Institute for Health and Care Excellence Medtech innovation briefing, designed to support commissioners and staff considering using new medical devices and technologies, summarises evidence showing that the technology improves time in target glucose range, reduces hypoglycaemia and improves HbA1c levels (glycated haemoglobin)
- Diabetes UK advises a minority of users may experience skin discomfort
‘It’s accurate, quick and effective, and gives people the information they need to know and when they should take action. It also gives the user the ability to see trends, to see what’s happening at different times of day, and helps them to recognise where they could make changes to improve control.’
Diabetes UK started campaigning on the issue about a year ago, and in November there was a big step forward when the NHS said it could be prescribed. But local commissioners do not have to agree to fund it, and even those who do so set varying criteria for eligibility.
In May, the charity reported that while patients across Wales and Northern Ireland could access the device, only about a third of health boards in Scotland and two out of five in England were making it available. Since then the figure has risen to around 50% in Scotland and England.
A game changer
NHS Forth Valley is one of the Scottish health boards that has decided to make flash glucose monitoring available to patients.
Diabetes specialist nurse Lynn Ryan says it’s a game changer. ‘When we knew it was coming, the whole team was very excited. It’s a positive new development in diabetes care with the potential to make a real difference,’ she says. ‘And as soon as patients read it was available we had people ringing up asking for it.’
Ms Ryan, who is based at the Forth Valley Royal Hospital in Larbert, near Stirling, says clinicians made the case for adopting the technology on the basis that it would be good for patients, but also that ultimately it would save money.
‘Yes, it’s reducing the number of finger-prick tests that patients have to do, but it’s also improving their control, and helping to educate them to self-manage. We hope down the line that we’ll see fewer of the complications of diabetes.
‘Our colleagues in paediatrics are introducing it too, so we’ll be getting people coming through the system with better control, which is great.’
At Forth Valley, patients have to meet strict criteria before they are deemed eligible. To access the therapy, patients must be using multiple daily injections and be carbohydrate counting. Some patients have chosen to begin carb counting so that they can qualify for flash glucose monitoring, and the health board has been running education courses to support them.
In addition, every patient who moves to the new technology has a 90-minute training session in how to use it and how to interpret the results.
Telephone support is available from the nursing team if required, although patients have rarely felt the need to use it, Ms Ryan says.
Advocating for patients
Diabetes UK campaigns and public affairs manager Danny Beales says the response to the campaign had been unprecedented. ‘There’s been a real momentum behind this – it’s fantastic to see where we’ve come in six months.
‘I think there’s a realisation that this is life-changing, and that it can make a real difference to people with diabetes.
‘Nurses and other healthcare professionals have a vital role in supporting people to realise the benefits – it’s really a partnership between the person and the healthcare professional.
‘We’ve also got healthcare professionals making the case for flash glucose monitoring in areas where it was not available, advocating for their patients with commissioners, which has been great.’
Self-funding isn’t an option for everyone, with the cost as much as £1,200 per year. Mr Beales says there have been some heart-rending cases, such as a mother with twins who both have type 1 diabetes. ‘She could only afford to pay for one of them. It’s terrible that so many people have been shut out.’
‘It’s a lot of work initially, but it’s definitely worth it’
Lynn Ryan, diabetes specialist nurse
Mr Howarth believes that all nurses, not only those who specialise in diabetes, should be aware of the technology. ‘All nurses have a valuable role to play in supporting people with diabetes, and I think they should engage with the technology and ensure they have an understanding of what it is and how it is benefiting people with diabetes.’
Although it is too early to say that the technology will reduce complications of diabetes such as blindness, amputations and strokes, there is evidence that it improves control of the condition, which should in time improve wider health outcomes.
Introducing flash glucose monitoring has also had an unexpected benefit, according to Ms Ryan. ‘Some of our patients with type 1 diabetes who had dropped out of contact with services through choice, have heard about it and got back in touch. So we’re able to check them out and update their treatment, which is brilliant.’
She urges nurses to back the campaign and encourage health providers to make flash glucose monitoring available. ‘It’s a lot of work initially, but it’s definitely worth it.’
‘I decided to self-fund – but everyone should have access’
For teacher Rebecca Williams, using flash glucose monitoring has been life-changing.
Diagnosed with type 1 diabetes at the age of 19, she had done her best to get to grips with managing the condition over the next few years, but she couldn’t help but feel it was putting limitations on her life.
After hearing about flash glucose monitoring, she took the decision to fund it herself at a cost of between £70 and £100 per month.
Her local clinical commissioning group, South Worcestershire, refused to pay for it, saying after an assessment that there was not enough evidence on the benefits. It is due to reconsider the decision in 2020, or sooner if more evidence becomes available, but Ms Williams did not want to wait.
‘I made the decision to self-fund and I’ve had it for two years – I think it’s brilliant,’ she says.
‘It makes such a difference’
‘It’s such a help for me at home, at school, when I’m driving. It’s so convenient and quick to use. I really don’t understand how commissioners can refuse to fund it when it makes such a difference.’
Ms Williams found that finger-prick testing was particularly inconvenient at work, as she did not feel it was appropriate to do it in front of her class of children aged nine and ten. But it also affected her social life.
‘I felt I couldn’t do anything spontaneous, and I always had to carry a bulky bag with all the testing equipment,’ she says. ‘Now I can go for a good night out with my friends, and if I fall asleep my boyfriend can run the scanner over my arm to make sure I’m not having a hypo (when the blood glucose level is too low). It’s really incredible and everyone should have access to it.’
Finding the money to pay for it every month hasn’t been easy, but she feels it is worth it. ‘For me it means freedom – and the chance to have an exciting life.’
Jennifer Trueland is a freelance health journalist