CGM vs Freestyle Libre

I’ve get several emails and direct messages from people who are asking for Freestyle Libres or CGMs from the diabetes care teams and it would seem that there is a HUGE, MASSIVE, GINORMOUS lack of information, on the part of healthcare professionals and people with diabetes, about what's available in Ireland and who it's available to.

So I thought I would go through some of my Tips for Starting The Glucose Sensor Conversation with your Team in a blog post.

Tips for The Glucose Sensor Conversation with your Team

  1. Know The Difference between CGM vs Freestyle Libre

Many people are not aware that a Freestyle Libre is NOT a CGM or a Continuous Glucose Monitor.

A CGM is also NOT an insulin pump. There are insulin pumps that have CGMs integrated but ALL the CGMs come without insulin pumps.

How are they different:

  • The Freestyle Libre is a Flash Glucose Monitor or sensor. This means that the sensor on your arm has to be scanned to get the readings. 

  • A flash glucose monitor does NOT currently include alarms for high or low reading. 

    • The Libre 2 which is not available in Ireland or UK yet will have this but for now this is the situation. 

  • A CGM or Continuous Glucose Monitor send the reading continuously to your phone (or receiver) all the time.

  • A CGM DOES alarm for high or low readings. Dexcom and the Medtronic Guardian are CGMs.

It would seem that it is because of these differences that CGMs and Flash Monitors are being classed as two separate devices with completely separate eligibility criteria. 

If you want to know more about how a glucose sensor works or more about the different devices currently available in Ireland go to this link here.

A CGM is NOT an Insulin Pump

A Freestyle Libre is NOT a CGM

2. Know The Eligibility Criteria for both the CGM and Flash

There is a clear set of guidelines on when a person with diabetes is suitable for a CGM or a Flash, with one exception: if you are over 21 years there is no point asking for a Flash, ask for a Dexcom or Medtronic Guardian CGM instead. Obviously, the diabetes team need to mention these criteria in the funding application. See the section below for the differences in the criteria for both devices.


3. Know The Right Person to Talk to

The best people to have this discussion with on your diabetes team is either the diabetes nurse specialist (not all nurses are DSNs) or your consultant. But a lot of times it can be down to finding the right time with the right person. So if at first you don’t succeed, please do ask again, especially if you do believe that you meet the clinical need.

 

4. Know How it will make a Difference to you

People with diabetes need to do their homework before they start this conversation about what it is specifically about a CGM that will help them with their diabetes. I know this is difficult if you haven’t had access to one but there are a lot of blogs by people with diabetes about how CGMs or Flash have made a difference in their diabetes management. If you can do use real life situations where you think a CGM would have prevented a diabetes related situation.


5. Other Types of Diabetes on Insulin

If you do not have type 1 diabetes but your diabetes is managed using multiple daily injections or an insulin pump then you can argue that you qualify on the basis of your diabetes management rather than your type of diabetes. If it walks like a duck, etc

This would be Diabetes type 3c (caused by pancreatitis), type 2 on MDI, MODY, Steroid induced Diabetes 


Eligibility Criteria For Libre

Eligibility Criteria for Flash (Freestyle Libre) For Children

The eligibility guidelines for a Flash glucose monitor for Children and young adults aged 4 - 21 years, as of the 3rd of April 2018, are:

  • Type 1 Diabetes

  • Patients using multiple daily injections of insulin or insulin pump therapy

  • Patients who have increased blood glucose testing requirements (≥8 times daily)

  • Frequent episodes of diabetic ketoacidosis (DKA) or hypoglycaemia which have included hospital admissions

  • Patient is not pregnant.

Eligibility Criteria for Flash (Freestyle Libre) For Adults

The eligibility guidelines for Flash for Anyone over aged 21 years, is:

  • you have to meet the "exceptional circumstances". 

*** Unfortunately, the HSE will not provide more detail as to what an “exceptional” circumstance might be. 

Eligibility Criteria for CGMs

There are clear guidelines which make a person eligible for a CGM, obviously the diabetes team need to mention these in the funding application, set out in Section 3.6.22 of the National Clinical Guidelines for Adults with T1. 

There is no set qualifying criteria for CGM’s for children with type 1 diabetes but most consultants look to the UK”s NICE Guidelines for guidance.

Hopefully this section is helpful to you and will get your conversation with your team on the right footing.