Barriers to implementation of FreeStyle Libre and the approaches taken to overcome these
| Barrier | Category | Approach |
| FSL lacked some of the function of an rtCGM. | Specialists/users | Despite NICE guidance from 2015, rtCGM access remains challenging. FSL2 now has alarms. |
| Education needed to fully implement FSL and optimise management. | Specialists/users | Education provided to services from national organisations, for example, DTN-UK. Educational opportunities provided to users via organisations, trickle down of knowledge from specialist teams. FSL relatively intuitive for users. |
| FSL uptake lower in harder-to-reach groups. | Systems/users | Criteria expanded to include access for all people with learning disabilities and psychosocial indications. |
| Awareness of technology and fear of stigma. | Users | FSL seen in use in public by increasing numbers, including UK prime minister. Campaigns from Diabetes UK. |
| Limited data on outcomes in the long term. | Systems | ABCD audit programme, access to quality of data and real-world outcomes showing reductions in DKA and hospitalisation and improved HbA1c.7 |
| Varied access nationally and inconsistent application of RMOC criteria. | Systems/specialists | Introduction of ring-fenced funding and a standard platform of criteria by NHS England for 20% of those with type 1 diabetes. |
ABCD, Association of British Clinical Diabetologists; DKA, Diabetic Ketoacidosis; DTN, Diabetes Technology Network; FSL, FreeStyle Libre; HbA1c, haemoglobin A1c; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; RMOC, Regional Medicines Optimisation Committee; rtCGM, real-time continuous glucose monitoring.