Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 3 clinical experts were familiar with the Dexcom G6 device and use it with patients. None felt it had been superseded.

Level of innovation

Three experts agreed that the Dexcom G6 is an innovative technology. One noted that providing a 24‑hour glucose profile with hypoglycaemia alerts without the need for calibration represented a unique and significant change. Another noted that while continuous glucose monitoring (CGM) itself is not new, it is significantly different to capillary glucose testing which is the current standard of care. One expert suggested the technology 'shifts the paradigm from invasive monitoring with finger sticks to non-invasive monitoring' with added benefits of alarms at low levels of blood glucose readings. All experts noted that there are alternative companies providing CGM within the UK. Other similar technologies mentioned were the Medtronic Guardian RT and the FreeStyle Libre. Experts noted that, unlike the Dexcom G6, the Medtronic Guardian RT requires finger-prick calibration and the FreeStyle Libre does not have alarms and provides intermittent flash-monitoring rather than continuous monitoring.

Potential patient impact

All 3 experts felt that this technology could offer benefits to people. Benefits included reducing the frequency and severity of hypoglycaemia and better glucose control. One expert highlighted that continuous monitoring of a person's glucose profile can support treatment decisions and enable appropriate adjustments to medication, which would improve clinical outcomes and quality-of-life indicators. Another expert noted that the device's ability to connect to insulin pumps to provide a closed-loop artificial pancreas system may significantly aid monitoring and management.

Two experts felt it was particularly beneficial for people with type 1 diabetes at risk of hypoglycaemia, with 1 expert suggesting children or people operating heavy machinery as specific examples of groups that may benefit. One noted that people who would benefit should include those who need carer support to manage their diabetes. A third expert highlighted that pregnant women and people who have been unable to achieve target glucose control (after structured education, multiple dose insulin or insulin pump therapy) may benefit.

All experts felt that the technology could change current pathways and clinical outcomes. All experts suggested that the technology could help prevent the need for clinical intervention. For example, 1 expert suggested that recognition and prevention of hypoglycaemia could prevent admission to hospital for severe hypoglycaemia. All experts noted that overall improvement in blood glucose levels could have a positive impact on the development of diabetes-related conditions needing hospital admission and intensive treatment (such as foot disease, diabetes-related eye disease, diabetes nephropathy and dialysis, and cardiovascular disease). One expert also highlighted the potential benefits to mental health.

Potential system impact

Three clinical experts felt that using Dexcom G6 could reduce costs and would benefit the healthcare system. This is because it could improve long-term outcomes, reducing the need for intensive treatment and, in the short term, reducing severe hypoglycaemic events leading to hospital admissions. Remote care may reduce the need for hospital visits.

One expert suggested that managing this technology (including patient support and potential data collection) would need an increase in number of clinicians. Two experts mentioned that training would be needed for staff working with the technology.

General comments

Two experts estimated that between 5% and 20% of people with type 1 diabetes would benefit from CGM.

One expert noted that clinicians working in specialist diabetes care will need training in data analysis and review to provide support to those using the technology. The competency of specialist diabetes centres to provide technologies such as CGM and insulin pump therapy should be standardised to ensure safety in delivering increasingly complex diabetes care.

More research into which subgroups of patients would benefit from this treatment would be valuable and this may allow greater access to the technology. All experts felt that NICE guidance on Dexcom G6 would be very relevant to support decision making and local implementation.