Continuous subcutaneous infusion

• Indications
• Diabetes Type 1 (adults & children)in line with NICE TA151
• for children and young people with a non-autoimmune cause for deficiency of beta cells (who do not have type 1 diabetes) TA151
  
  Prescribing of the pump and consumables would be by hospital specialists only (RED), in line with NICE, using the Blueteq initiation and continuation forms.

Insulin for use in the pump would continue to be prescribed by the individual patient’s GP

• Diabetes Type 2

The selected preferred cost-effective needles are those < £3 for 100 ;

• Microdot Max 4mm / 32G, 6mm / 31G

• CareFine 4mm / 32G, 5mm / 31G, 6mm / 31G, 8mm / 31G

• GlucoRx CarePoint 4mm / 31G, 5mm / 31G, 6mm / 31G, 8mm / 31G, 10mm / 29G, 12mm / 29G

• GlucoRx CarePoint Ultra 4mm / 32G

   Safety Needles e.g. BD Auto-shield NOT TO BE Prescribed on FP10. Not to be prescribed for use by SCFT staff -

Tablets

Tablets

• Rapid onset of action and short duration of activity
• Consider a rapid-acting insulin secretagogue as an alternative to sulfonylurea if the person has an erratic lifestyle or meal pattern
• Licensed as monotherapy
• Licensed as dual therapy in combination with metformin
   
   
  

Tablets

Tablets

• For renal impairment only

Tablets

• Indication - Diabetes (type 2) - in accordance with NICE criteria for both initiation and continuation of therapy

Indication Treatment option for type 2 diabetes in line with NICE (NG28)

• See PCN 194-2016

Injection 6mg/ml

• Indication - Type 2 Diabetes

Injection

• Indication - Diabetes (type 2)
• Consider adding a GLP-1 mimetic 3rd line therapy when control of blood glucose remains or becomes inadequate. Only continue if beneficial metabolic response.

Injection 0.25mg/0.19ml, 0.5mg/0.37ml, 1mg/0.74ml pre-filled pen

• Indication - Diabetes (type 2)

Not Approved for use in type 2 diabetic patients with inadequate glucose control despite lifestyle intervention and metformin if they have 9 of 9 established cardiovascular disease in accordance with joint ADA/EASD clinical practice guidelines

Surrey Area Precribing Committee (SAPC) have recommended this as BLACK on their formulary. APC 456-2019

Tablets

• Indication - Diabetes (type 2)
• Canagliflozin - an option for dual or triple therapy in type 2 diabetes.
• Monotherapy as per NICE TA390 Only if:
  •a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
  •a sulfonylurea or pioglitazone is not appropriate.

Tablets

Indication 

• Type 2 diabetes (combination therapy, in line with NICE criteria for initiation and continuation)
• Monotherapy as per NICE TA390 Only if:
  •a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
  •a sulfonylurea or pioglitazone is not appropriate.
• Triple therapy regimen is recommended as an option for
  treating type 2 diabetes in adults, only in combination with metformin and a sulfonylurea.TA418

• Indication - With insulin for treating type 1 diabetes (TA597)

Tablets

Indication - Type 2 diabetes in adults as per NICE TA572

Monotherapy when metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if:

• a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed and
• a sulfonylurea or pioglitazone is not appropriate.

Dual-therapy in combination with metformin, only if:

• a sulfonylurea is contraindicated or not tolerated or
• the person is at significant risk of hypoglycaemia or its consequences

Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes TA583

• the disease is uncontrolled with metformin and a DPP‑4 inhibitor, and a sulfonylurea or pioglitazone is not appropriate.

200mg Tablet

Indications

• Sotagliflozin with insulin for treating type 1 diabetes (TA622)

Funded by NHS England via specialist centres

CCGs commission ongoing prescription of drugs suitable for shared care

Suspension 250mg / 5ml

• Indication To treat Infants and Children with Congenital Hyperinsulinaemia, in combination with Chlorothiazide
  unlicensed
  
• CPMAP agreed RED June 2017

• A preferred list of cost-effective blood glucose meters and the associated test strips have been added onto the formulary. However, there is an exception criteria for certain patients (See excluded group below).
• The selected meters (which meet ISO 15197:2013 requirements) to be included on the preferred list are:
  o GlucoMen Areo Sensor
  o Contour/ Contour Plus (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)
• Exclusion group- 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.
• 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).
• 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)

• 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

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.

• A preferred list of cost-effective blood ketone meters and the associated test strips have been added onto the formulary.
• GlucoMen areo Ketone sensors (Menarini)
• KetoSens ketone test strips (Spirit)

Both test strips are £9.95 per 10 strips and have shelf life of 18mths

• Freestyle Optium Ketone Test Strips - providing a dual meter (blood glucose and ketones) to patients is sufficient regardless of if the patient uses the Freestyle Libre system.
• Prescribers are advised that they may continue to prescribe only to paediatric patients who are currently using this product so that the  specialist providers at Royal Alexandra Children’s Hospital have time to  transition them onto a new product in line with formulary choices.

Indication-

• Following thyroidectomy where a patient requires liothyronine until radioactive iodine is no longer indicated (PCN 186-2016)
• Treatment of coma of myxoedema (APC 408-2019)
• Severe chronic thyroid deficiency and hypothyroid states occurring in the treatment of thyrotoxicosis (APC 409-2019)
• Treatment of resistant depression (APC 410-2019)
• Liothyronine monotherapy in oncology - thyroid and parathyroid disease (APC 421-2019)
• Liothyronine sodium (monotherapy) - Hypothyroidism in adults with an intolerance to levothyroxine. Please note the Crawley, Horsham and Mid-Sussex CCG decision is RED and differs from the Surrey APC decision of AMBER. (APC 412-2019)
• Liothyronine sodium (combination) - Hypothyroidism in adults with an inadequate response to levothyroxine. Please note the Crawley, Horsham and Mid-Sussex CCG decision is RED and differs from the Surrey APC decision of AMBER. (APC 411-2019)