Volume 24, Number 2 - August 2021

Are your patients missing out on fully subsidised Flash Glucose Monitoring?

Introduction

It’s been over 12 months since FreeStyle Libre, the only available Flash Glucose Monitoring system, has been fully subsidised under the NDSS for some patients living with Type 1 diabetes (T1D) – yet many eligible patients are missing out.

“There are definitely some patients that are unaware of the subsidy and often these are the patients that have not seen an endocrinologist or diabetes educator since the subsidy was introduced,” says Marlene Payk, a Diabetes Nurse Practitioner at Blacktown and Mount Druitt Hospital in Western Sydney.

So what’s the problem? Ms Payk says: “Some people are not aware that the requirements for subsidy changed and they no longer need to meet the criteria that was introduced with the first round of subsidy.”

For example, prior to March 2020, people aged 21 years or older with T1D with valid concessional status had to demonstrate “high clinical need” to access subsidised products from the NDSS’ continuous glucose monitoring (CGM) initiative, which initially did not cover FreeStyle Libre. However, the process has been streamlined and the scheme expanded as a result for over a year, so patients may now be eligible and simply not know it.

How many of your patients know they are eligible?

The NDSS subsidy for FreeStyle Libre was introduced in March 2020 for people in the following categories:

  • adults with T1D who are 21 years and over and have concessional status
  • children and young people aged under 21 years living with T1D
  • children and young people under 21 years with conditions very similar to T1D who require insulin
  • women with T1D who are actively planning pregnancy, are already pregnant or immediately post-pregnancy.

The streamlined eligibility applies to some CGM devices as well as Flash Glucose Monitoring with FreeStyle Libre, although not all patients will be suitable for all devices.

According to Ms Payk, among her patients, NDSS subsidised FreeStyle Libre has been taken up mostly by pregnant women and women planning pregnancy, along with concession card holders over the age of 21.

“The under 21-year-olds has been a group that we have encouraged to use the technology,” she says.

As a result of this focus on the under 21-year-olds, many older patients are likely to be unaware they can access subsidised FreeStyle Libre.

What are the benefits of FreeStyle Libre?

FreeStyle Libre – the Flash Glucose Monitoring system that provides continuous glucose data with freedom from routine finger pricking*†‡1 – is easy for healthcare professionals, as well as patients.2–6

Patients find it easy as it’s simple to apply and set up. A painless, one-second scan of the small sensor on the upper arm with the FreeStyle Libre reader, or via the FreeStyle LibreLink app on a mobile phone,§ provides useful insights with simple reports that patients can share with their healthcare professionals.4–6 Patients like the fact that they can see where their glucose levels are heading, so they can adjust lifestyle factors, like diet and exercise, accordingly.4–6

Healthcare professionals like the easy-to-interpret data that provide a complete glucose picture to help them make treatment decisions and have more meaningful conversations with their patients through data-driven, targeted consultations.1,2-4

Ms Payk says: “The benefits are life-changing for many of my patients. Patients report not having to finger prick as a major advantage but knowing where a glucose level is heading, with the benefit of the trend arrow, gives them the opportunity to make informed decisions and reduce glucose excursions. Fear of hypoglycaemia is reduced and knowing that their diabetes self-management is not impacted by their financial situation provides additional benefits to their mental health.”

Patients being unaware of their eligibility for NDSS subsidised FreeStyle Libre could impact their diabetes management, Ms Payk says.

“Patients are missing the benefits of the technology in reducing hypoglycaemia, increasing time in range and making informed decisions about their diabetes self-management,” she says.

“The decisions are longer term, based on the ambulatory glucose profile, as well as short term. For example, deciding on how to manage exercise based on a sensor glucose reading and arrows that indicate if the glucose may be decreasing.”

Three top tips to ensure your patients get access

Ms Payk says: “Diabetes educators are well aware of the significant benefits of using CGM and Flash Glucose Monitoring in diabetes self-management. Informing patients about the benefits is part of the role, along with how patients may access the technology.”

1. Routinely have the discussion with all patients on the benefits of accessing the technology to aid in their diabetes self-management.

Ms Payk says: “I routinely ask my patients if they are using the CGM or Flash technology, regardless of age. I discuss the benefits it will provide them, and I have the discussion about access.”

2.  Don’t forget about the retired type 1 patients who can access the NDSS subsidy with the Commonwealth Seniors Health Card

“I recently had a newly diagnosed type 1 patient aged 70 years. When I suggested the Freestyle Libre through NDSS subsidy, he didn’t realise he would qualify. He knew about the subsidy but thought he would need complications before he could access it, which is no longer a requirement. We had the discussion about utilising the technology to help with his diabetes self-management.”

3.  Encourage patients that don’t have a healthcare/concession card to check with Centrelink

– they may be eligible

“Some people don’t realise they may be eligible for a healthcare/concession card and I encourage them to check on their eligibility,” says Ms Payk. “I don’t make assumptions about my patients’ concessional status, you never know who could be eligible and people’s circumstances can change.”

This product is indicated for measuring interstitial fluid glucose levels in people (age 4 and older) with insulin-requiring diabetes.

 

*In people with insulin-requiring diabetes.

† The sensor must be scanned a minimum of every 8 hours to continuously record glucose readings.

‡ Scanning the sensor to obtain glucose values does not require lancets. A finger prick test using a blood glucose meter is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels or if hypoglycaemia or impending hypoglycaemia is reported by the System or when symptoms do not match the System readings.

  • The FreeStyle LibreLink app is compatible with NFC enabled phones running Android 5.0 or higher, or with iPhone 7 or higher, running iOS 11 or higher.

FreeStyle, Libre, and related brand marks are marks of Abbott. Information contained herein is for distribution outside of the USA only. Abbott Australasia Pty. Ltd., Abbott Diabetes Care, 666 Doncaster Road, Doncaster, Victoria 3108, Australia. ABN 95 000 180 389 ADC-38085 v1.0

Conclusion

For everything you need to know about starting your subsidised patients on FreeStyle Libre, go to www.freestyleconnect.com.au

Acknowledgements

This article is commissioned by Abbott Australasia.

References

1.

Leelarathna L, Wilmot Diabet Med 2018; 35(4): 472–82.

2.

Saboo B et J Assoc Physicians India 2018; 66(7): 69–71.

3.

Consensus Position Statement on: Utilising the Ambulatory Glucose Profile (AGP) combined with the Glucose Pattern Summary to Support Clinical Decision Making in Diabetes Available at: https://diabetessociety.com.au/downloads/20200626%20ADS%20 AGP%20 Consensus%20Statement%2024062020%20-%20FINAL.pdf.

4.

Gibb FW, et Br J Diabetes 2020; 20(1): 32–40.

5.

Overend L et al. Practical Diabetes 2019; 36: 45-50.

6.

Ólafsdóttir AF et Diab Technol Ther 2017; 19(3): 164–72.

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