Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 4 clinical experts stated that they regularly use FreeStyle Libre with patients and 1 is also a self-user.

Level of innovation

All 4 of the clinical experts agreed that FreeStyle Libre is an innovative technology, 1 of them describing it as a 'huge leap forward', another as a minor variation of continuous glucose monitoring. Although easy to use, the experts all felt that some basic training or information would need to be provided for patients and healthcare professionals using FreeStyle Libre.

Potential patient impact

All 4 experts felt that this technology could offer benefits to patients. One stated that the constant monitoring of glucose levels with FreeStyle Libre would improve patient outcomes because it allows for quicker interventions, would aid self-management and would improve insulin titration. Two experts reported that a number of their patients with type 1 diabetes showed improvements in Hb1A1c when using FreeStyle Libre. Three clinical experts felt it was particularly beneficial for people who are deterred from self-monitoring by finger pricks, and for pregnant women. One expert felt that people who need to test multiple times would also benefit. Another felt people with learning difficulties, people with mental health problems and people with hypoglycaemia unawareness would benefit most.

One clinical expert felt that FreeStyle Libre helped people who were disengaged from their treatment to monitor their glucose levels non-invasively, and that this could lead to fewer hospital admissions. In their clinical experience, people using this technology, with the right support, had improved HbA1c levels, indicating benefits in longer-term health outcomes. Another expert found it best suited for those who had already attended a structured education programme enabling them to self-manage intensive insulin therapy and under the care of a diabetes service experienced in intensive insulin therapy.

Patients with type 2 diabetes taking fixed doses of insulin may derive less benefit from the technology.

Potential system impact

Three clinical experts felt that using FreeStyle Libre would be cost effective because of improved diabetes management and reduced complications such as hospital admissions. One expert noted that managing complications accounts for 80% of diabetes spending, and so any reduction in the rate of complications would be meaningful. Another felt that it could be cost effective but only in a subset of patients, such as people who were testing their blood glucose excessively. In these people, FreeStyle Libre might be suitable for a fixed period of time and may not need to be used long term.

All 4 experts agreed that no significant changes in NHS infrastructure would be needed. Two noted that diabetes clinics need to have the appropriate software to download and analyse results installed on their computers. Another noted that diabetes education programmes would need to be updated to include the use of flash glucose monitoring.

General comments

One expert felt that FreeStyle Libre was a part of modernising care in diabetes and that it offered a less invasive form of monitoring. They noted that it is supported by healthcare professionals in the type 1 diabetes community and by diabetes charities. Another stated that in their experience, FreeStyle Libre had been a powerful tool but a number of their patients had not used it as much as they thought they would, had been allergic to the adhesive, or found that it made them 'paranoid' about their glucose values leading to them over-testing. The expert felt that suitable people could be offered FreeStyle Libre for a trial period before reviewing its use and only providing it in the longer term to people who showed a benefit.