netFormulary NHS Crawley and NHS Horsham and Mid Sussex CCG NHS
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 Formulary Chapter 6: Endocrine system - Full Chapter
06.01.06  Expand sub section  Diagnostic and monitoring agents for diabetes mellitus
06.01.06  Expand sub section  Blood glucose monitoring
 note  Formulary recommendations are based on cost effectiveness. Other brands of test strips are considered non-formulary although may be continued if appropriate for existing patients.
Accu-check Performa Test Strips
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Formulary
Green
  • Test strips for use with Performa Nano blood glucose meter.
     
  • Link  Medical Device Alerts issued in April 2018; recent alert about Accu-Chek blood glucose test strips
       
    Blood Glucose Test Strips & associated meters
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    • A preferred list of cost-effective blood glucose meters and the associated test strips have been added onto the formulary.
    • The selected meters (which meet ISO 15197:2013 requirements) to be included on the preferred list are:
      o GlucoMen Areo Sensor
      o Contour (Bayer)
      o Wavesense Jazz
      o Wavesense Jazz Duo
      o Omnitest 3 (Braun)
      o MyLife Pura
      o MyLife Unio
      o GlucoRx Nexus now the preferred speaking meter - suitable for patients with visual impairment
    • CareSens Pro Blood Glucose strips added to the formulary to enable the patient to have one meter to test both glucose and ketones (CareSens dual meter)
    • Or any meter that meets the above requirements with a test strip cost <£10 for 50
    • (Supercheck2 test strips and meter have been discontinued)
    • It is recommended that new patients should be started on meters on the preferred list and an informed switch programme should be initiated at routine review of existing patients (who are currently prescribed test strips costing >£10 and where a cost effective formulary meter would be clinically appropriate).
    • Patients remaining outside the scope of this work are specialist patient groups with specific clinical needs that are not met with the meters on the proposed formulary including:
       Patients with gestational diabetes
       Unstable type 1 diabetic patients who require ketone testing
       Patients who are carbohydrate counting
       Patients on insulin pumps
       Patients with severe manual dexterity problems who cannot use the meters on the preferred list.
    • Where a specialist has recommended a meter not on the preferred list, the specialist should communicate to the GP the clinical reasons why the preferred meters are not suitable. In these cases prescribing of other meters should be supported.
    • Meters are not prescribable on the NHS
    • Company representative contacts for obtaining meters free of charge are included in the link below (Preferred blood glucose meters and strips)

    Black

    • Freestyle Optium Blood Glucose test strip - Providing a dual meter (blood glucose and ketones) to patients is sufficient, regardless of if the patient uses the Freestyle Libre system
     
    Link  Brighton APC Blood Glucose Meters & Test Strips
    Link  Preferred blood glucose meters and strips Crawley CCG, Horsham and Mid-Sussex CCG
       
    Flash Glucose Monitoring (FreeStyle Libre)
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    Approved for prescribing from 1 April 2019 in line with NHS England criteria only.

    Commencement must be within diabetes specialist led clinic.

    Patients should not be referred specifically for the initiation of flash glucose monitoring. Eligibility is expected to be assessed during routine consultations with specialist as part of the patient's annual diabetes review or a review that takes place as a result of other changes in their diabetic needs.

    Indications

    • People with Type 1 diabetes

    OR with any form of diabetes on hemodialysis and on insulin treatment

    who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months

    OR with diabetes associated with cystic fibrosis on insulin treatment

    • Pregnant women with Type 1 Diabetes - 12 months in total inclusive of post-delivery period.
    • People with Type 1 diabetes unable to routinely self-monitor blood glucose due to disability who require carers to support glucose monitoring and insulin management.
    • People with Type 1 diabetes for whom the specialist diabetes MDT determines have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support.
    • Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of these criteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since self-funding. 
    • For those with Type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of hypoglycemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation. However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered.

    Other requirements:

    1. Education on Flash Glucose Monitoring has been provided (online or in person)

    2. Agree to scan glucose levels no less than 8 times per day and use the sensor >70% of the time.

    3. Agree to regular reviews with the local clinical team.

    4. Previous attendance, or due consideration given to future attendance, at a Type 1 diabetes structured education programme (DAFNE or equivalent if available locally)

    Note: Continuing prescription for long-term use of Flash Glucose Monitoring-post initial 6 months- would be contingent upon evidence of agreeing with the above conditions and that on-going use of the Flash Glucose Monitoring is demonstrably improving an individual’s diabetes self-management- for example improvement of HbA1c or Time In Range; improvement in symptoms such as DKA or hypoglycaemia; or improvement in psycho-social wellbeing.

     
    Link  APC 404-2019 (replaces PCN 281 2017)Flash Glucose Monitoring System (FGS) for patients (over 4 years of age)
    Link  Flash Glucose Monitoring Frequently Asked Questions for Commissioners
    Link  Flash Glucose Monitoring (FGM): Continuation Agreement for Adults
    Link  Flash Glucose Monitoring (FGM): Initiation and Transfer Agreement for Adults
    Link  Flash Glucose Monitoring (FGM): Initiation and Transfer Agreement for Paediatrics
    Link  Flash Glucose Monitoring (FGM): Continuation Agreement for Paediatrics
       
    06.01.06  Expand sub section  Urinalysis
    06.01.06  Expand sub section  Blood Ketones Testing Strips
     ....
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
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    Link to adult BNF
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    Link to children's BNF
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    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Black

    Comment : Not to be routinely commissioned (prescribed) in any care setting (primary or secondary care). This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. As such, drugs classified as Black should be considered as non-formulary.   

    Red

    Initiation : Specialist only
    Repeat Prescribing : Specialist
    Monitoring : Specialist
    Comment : Prescribing must be in line with any specific treatment criteria outlined. In exceptional circumstances a GP may be asked to prescribe the specialist must provide adequate information and support.   

    Amber

    Initiation : Specialist only
    Repeat Prescribing : Primary care OR specialist
    Monitoring : Primary care OR specialist
    Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis.   

    Blue

    Initiation/Recommendation : Specialist only
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Should be initiated or recommended by a specialist. Monitoring of either medicine or disease does not require specialist skills or equipment   

    Green

    Initiation : Primary care or specialist
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Suitable for non specialist initiation   

    OTC

    Patients should be advised to purchase if approriate.  

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