Dr Emma Wilmot describes an innovative project to improve the uptake of flash glucose monitoring.
The Flash Glucose Collaboration, an alliance between the Association of British Clinical Diabetologists (ABCD), the Diabetes Technology Network UK (DTN-UK) and NHS England, were delighted to receive the Royal College of Physicians' Excellence in Patient Care Digital Award 2020. This award recognises the work which was undertaken to ensure people living with type 1 diabetes mellitus (T1DM) gained access to innovative flash glucose monitoring technology.
Type 1 diabetes is the most challenging long-term condition to self-manage. It requires 4–10+ daily painful finger prick blood checks as well as multiple decisions on carbohydrate and insulin administration throughout the day. We desperately need ways to improve the quality of life of people living with this relentless condition.
'Type 1 diabetes is the most challenging long-term condition to self-manage […] We desperately need ways to improve the quality of life of people living with this relentless condition.'
As a group of diabetologists we were inspired by our early clinical experience with flash glucose monitoring technology, a device which allows the users to scan an arm-worn sensor to gain insight into their glucose levels and the impact of therapy, replacing the need for frequent painful finger prick measurements. As highlighted by the charity Diabetes UK, this device is life-changing for many. However, despite its availability on the NHS from 2017, uptake remained low reflecting the lack of evidence demonstrating benefit, low healthcare professional (HCP) knowledge of the system and a postcode lottery in funding access. As a group of senior clinicians, we worked together to develop a strategy to address these issues and ensure more widespread uptake of flash glucose monitoring. Key priorities for the group were:
- collecting high-quality real-world evidence to make sustainable changes in T1DM care
- education and support for HCPs and people with diabetes (PWD)
- ensuring national reimbursement to overcome the postcode lottery in access.
To explore the benefits of the system, ABCD set up a national online audit platform, led by Professor Sathypalan, Dr Harshal Deshmukh and team, to collate real-world evidence of outcomes in FreeStyle Libre (FSL) flash glucose monitor users. The audit, presented at national and international conferences, has now collated outcomes from >10,000 users and has demonstrated a significant improvement in glucose control, reduced hypoglycaemia, improved diabetes-related distress and a reduction in admissions.
A further barrier to uptake was education. This technology was not only new to people living with diabetes but also to the healthcare professionals supporting their care. To facilitate rapid upskilling of both groups, DTN-UK, led by Dr Emma Wilmot, Dr Pratik Choudhary and the team, developed an online education platform for people with diabetes and healthcare professionals. Working in partnership with people living with diabetes, the modules were co-produced, edited, filmed and launched during webinars in 2019 . This option for online education reduced the pressure on local services to deliver face-to-face education and supported wider uptake.
Finally, to address inequitable access to the FSL, Professor Partha Kar from NHS England launched central funding in April 2019 to address inequitable FSL access. Online education, as described above, was incorporated into the NHS England guidance.
Overall, through the provision of a national audit platform to demonstrate the benefits of the device, the development of online education resources and a national funding stream to improve access, the Flash Glucose Collaboration has successfully supported the rollout of flash glucose monitoring. The number of users more than doubled over a 7-month period (from 11% in April 2019 to 22% in November 2019) and continues to grow. In 2020 more than one-third of people living with T1DM in the UK now have access to the device. The FSL has been successfully embedded in routine clinical care, improving the lives of people living with T1DM.
We thank the RCP for recognising the work of the many in ABCD, DTN-UK and NHS England who worked collaboratively to bring this innovative technology into the hands of people living with diabetes.
Excellence in Patient Care Awards 2021
The EPCA 2021 will be opening in autumn 2020 and we’ll be introducing an additional category for work linked to COVID-19.
