Type 2 diabetes in adults

Quality statement

Adults with type 2 diabetes who have multiple daily insulin injections and a condition or disability that means they cannot use capillary blood glucose monitoring are offered continuous glucose monitoring (CGM) to support self-monitoring. [new 2023]

Rationale

CGM can help to improve glycaemic control in adults with type 2 diabetes who use insulin. It helps to improve glycaemic control by providing sufficient, reliable recordings of glucose against which insulin dose and schedules can be adjusted. The quality statement focuses on the use of CGM by adults with type 2 diabetes who have multiple daily insulin injections and a condition or disability, including a learning disability or cognitive impairment, that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring. This will potentially increase their independence when compared with monitoring by finger-prick capillary methods.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly. The quality measures focus on use of CGM by adults with a condition or disability that means they cannot use capillary blood glucose monitoring. The measures aim to reduce health inequalities in this group. Local services may want to identify groups for which there are specific concerns about health inequalities to focus measures on. For example, by reporting data for people with a learning disability or cognitive impairment, by age or indices of deprivation.

What the quality statement means for different audiences

Service providers (such as primary care networks, community providers and secondary care services) ensure that services are in place to offer CGM to adults with type 2 diabetes who have multiple daily insulin injections and a condition or disability, including a learning disability or cognitive impairment, that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring. They should ensure education is provided alongside CGM to support adults to use it. They should also address inequalities in CGM access and uptake by monitoring who is using CGM, identifying groups who are eligible but who have a lower uptake and making plans to engage with these groups to encourage them to consider CGM.

Healthcare professionals (such as GPs, diabetes specialist nurses and consultant diabetologists) are aware of CGM availability and offer it to adults with type 2 diabetes who have multiple daily insulin injections and a condition or disability, including a learning disability or cognitive impairment, that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring. They also provide education to support them to use the CGM device and review their use of CGM as part of their diabetes care plan. In addition, they should help to address inequalities in CGM access and uptake by monitoring who is using CGM, identifying groups who are eligible but who have a lower uptake and making plans to engage with these groups to encourage them to consider CGM.

Integrated care systems ensure that services address inequalities in CGM access and uptake by monitoring who is using CGM, identifying groups who are eligible but who have a lower uptake and making plans to engage with these groups to encourage them to consider CGM.

Adults with type 2 diabetes on multiple daily insulin injections and with a condition or disability, including a learning disability or cognitive impairment, that means they cannot monitor their blood glucose themselves using a finger-prick are offered a CGM system to help them manage their diabetes and education on how to use it if they can scan it themselves. Their use of CGM is reviewed as part of their diabetes care plan.

Source guidance

Type 2 diabetes in adults: management. NICE guideline NG28 (2015, updated 2022), recommendations 1.6.17 and 1.6.19

Definitions of terms used in this quality statement

Equality and diversity considerations

Integrated care systems, providers and healthcare professionals should address inequalities in CGM access and uptake by monitoring who is using it, identifying groups who are eligible but have lower uptake and making plans to engage with these groups and encourage them to consider CGM, for example, older adults (aged 65 and over), adults with frailty and adults with physical, mental health related or learning disabilities. Data suggests that adults with diabetes from lower socioeconomic groups are less likely to access CGM.

Adults with type 2 diabetes who are offered CGM should be given information about using the technology that they can easily read and understand themselves, or with support, so they can communicate effectively with health and social care services. Information should be in a format that suits their needs and preferences. It should be accessible to adults who do not speak or read English, and it should be culturally appropriate and age appropriate. Adults should have access to an interpreter or advocate if needed.

For adults with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.