For the first time new guidance from NICE recommends the use of real-time continuous glucose monitoring (rtCGM) or intermittently scanned glucose monitoring (isCGM) devices for some children living with type 2 diabetes who are currently using finger prick testing and insulin therapy.
Our committee was told that children being offered the technology would be subjected to the ‘burdensome’, ‘tiring’, and ‘stressful’ task of finger prick testing several times a day, and instead technology could automate this process.
The devices have already been recommended for children with type 1 diabetes.
The technologies give a continuous stream of real-time information on a smartphone allowing better/quicker management of the condition.
A sensor is attached discreetly to the body to monitor current and previous glucose levels. It also shows a prediction of where the glucose levels are headed meaning they can inject themselves with insulin to stabilise their levels if necessary.
If a patient or their family has a preference for which technology they wish to use, they could opt for an intermittently scanned glucose monitoring (isCGM) device – also known as flash monitoring – as an alternative to real-time devices, picking the technology that will work best for them.
Research has found both real-time and flash devices help a person in maintaining optimal blood sugar control.
The recommendation comes following changes to NICE’s guideline on the diagnosis and management of type 1 and type 2 diabetes in children and young people published today (Thursday 11 May, 2023).
Dr Judith Richardson, programme director in the Clinical Directorate at NICE, said: “Type 2 diabetes in children is the most aggressive form of the disease and recommending new technology is a clear step towards giving children on insulin therapy the ability to manage their own condition in a less invasive way, and to live happier and healthier lives.
“We’re focused on bringing the best care to people fast, while at the same time ensuring value for money for the taxpayer. This technology can take away the burdensome task of several finger prick tests a day, which can be tiring, stressful and have a negative psychological impact on the child.
“Improvements made in managing a child’s diabetes at an early stage can reduce the health impact of the condition later in their lives, and the potential impact on the health service.”
Health Minister Helen Whately said: “Type 2 diabetes is increasingly being diagnosed in children, many of whom face the constant stress of needing to monitor their blood glucose levels by finger prick testing – often multiple times a day – just to stay healthy and avoid complications.
“Offering children glucose monitoring devices will relieve some of this burden on hundreds of children and empower them to manage their condition more easily.”
Professor Partha Kar OBE, national specialty advisor for diabetes at NHS England, said: "Some of the children and young people with type 2 diabetes often have the most complex needs with a high proportion of them having either a learning disability, special educational need or mental health issue.
"Asking these children to carry out finger prick testing when non-invasive sensors are progressing to become standard care in diabetes is not right, so I am pleased these evidence-based recommendations have been made to offer this life-changing technology to them."
Nikki Joule, policy manager at Diabetes UK, said: “We are pleased to see the new NICE guidelines recommending that continuous glucose monitoring devices are made available for some children with type 2 diabetes.
“Diabetes is a relentless condition, requiring constant, careful management, which can be really challenging for children and young people. It’s important that these devices are now rapidly offered to affected families to help them manage their child’s condition well. That will require healthcare systems to swiftly make plans to equitably roll out these devices to children who are eligible.”
The guideline committee has also recommended the technology is offered to children and young people with type 2 diabetes, if they:
- have a need, condition or disability (including a mental health need, learning disability or cognitive impairment) that means they cannot monitor their blood glucose by finger prick testing
- would otherwise be advised to self-measure at least 8 times a day
- have recurrent or severe low blood sugar levels
- have impaired blood sugar awareness.
Those eligible should speak to their diabetes team to access real-time or flash monitors on prescription.