Following a decision by the HSE last year, Minister for Health Simon Harris refused to make Flash Glucose Monitoring technology available for all people with Type 1 diabetes making Ireland the only country worldwide to put an age restriction on access to the Freestyle Libre.
Instead, the HSE deferred its decision by 12 months to review whether it was cost effective to do so with no clear outline of how it was going to achieve this. It also highlighted the need for further Irish based clinical effectiveness data and quality of life data.
The diabetes community reacted by undertaking some further research on both these issues and today, Diabetes Ireland submitted a report to the Minister for Health and the HSE review team setting out the findings of a survey it completed in April 2019 to hear first-hand from current users of Freestyle Libre Users in Ireland on the impact it has had on their daily life experience and social interactions.
The “Users Experiences of Flash Glucose Monitoring on Daily Life Experiences” was an online survey that collected data on demographics, blood glucose strip usage and user’s life experiences. Over 300 people responded with equal representation of HSE funded users (i.e. under 21 year old users and self-payers (i.e. over 21 year old users) with the survey showing significant reduction in blood glucose strip usage, which provides cost savings for the HSE and offsets the monthly cost of the Libre sensors and information on individual daily experiences and life changing benefits of using Libre.
The primary findings from over 300 users (162 respondents were HSE funded with 142 self-funded)
- Usage levels in the over 22 years of age (self-funders) is almost as high as those under 22 years of age (HSE funded) which reflects the desire of people of all ages to use the technology.
- Over half of respondents (56%) are using the device for longer than 12 months.
- 86% of respondents scanned more than 8 times daily. (57% of respondents scanned 9-16 times daily. 29% scanned more than 17 times daily). It is proposed by the HSE that scanning more than 8 times daily would be cost effective when compared to blood glucose strip costs.
- There was an average reduction of 66% in blood glucose strip usage with 48% of respondents reducing their usage by more than 75%.
- Self-funders did not reduce their blood glucose strip usage as much as HSE funded respondents. Self-funders reduced on average by 62% compared to 69% for HSE funded respondents. This may reflect the need for adults to do a blood glucose meter check prior to driving and every 2 hours while driving as FGM/CGM checks are not recognised in this country by the Road Safety Authority as a legitimate blood glucose check whereas in the UK it is.
Respondents were asked if using the Freestyle Libre had benefitted their daily life as an open question. The report outlines a number of recurring themes which have being collated into 4 main topics which were “Makes Life Easier”, “Improved control”, Empowering individuals to be more proactive and confident in their diabetes management” and “privacy” with the latter being a surprise as the survey highlighted that many people with diabetes do not like testing blood glucose levels in public places via the traditional method of finger pricking and would rather not do so.
Respondents report Libre as being a major advancement in diabetes self-care and in their own words
It is more helpful than the pump. My control has improved dramatically. The trends are so useful. I know what different foods do to me. I know what happens while I am sleeping. It is invaluable. My HbA1c is now in the normal range. I have dreamed of such a device for years. I would sacrifice the pump before the libre. All I need now is for it to link to my phone and alarm. It’s the best thing ever and I am lost without it! (Susan Elliott, Galway).
“It is like going from watching the trailer for a film to actually reading the whole book, All the gaps in my knowledge have been addressed” (Judith Devine, Clare)
“Helped more that I could have ever thought. All the information is like turning on the light, you can actually see what’s going on” Parent of child 6-13 years.
The results of this survey reflects an equal number of self-funders and HSE funded users and reflects the views of over 10% of current Libre users in Ireland.
Dr Anna Clarke, Diabetes Ireland Health Promotion and Research Manager said “without doubt, this survey proved that using the Freestyle Libre results in increased frequency of checking glucose levels with respondents reporting decreases in acute high and low blood glucose levels, improvements in proactive diabetes management and results in improved glucose control and other side effects of fluctuating glucose levels such as eyesight disturbances. Using Libre also results in less sore fingers, greater security at night time resulting in peace of mind and less anxiety”.
The survey has also shown, although self-reported, that blood glucose strip usage declined in that cohort of responders by 66%. This highlights potential savings in strip usage for the HSE which in turn should help offset some of the perceived financial bottom line costs identified in the HSE’s Health Technology Assessment Group Advice Note 2017/001.
Diabetes Ireland recommends extension of the Freestyle Libre to all people with Type 1 diabetes based on quality of life improvement for the individual and cost savings resulting from the reduction in blood glucose strip usage which together will further aid prevention of costly diabetes complications.
“Libre may be the French for free but for people with Type 1 diabetes, Freestyle Libre means freedom from finger pricking, improved glycaemic control, removal of much of the anxiety about hypoglycaemia events and control over their life with diabetes. That is worth having” Dr Clarke concluded.