New guidance from NICE has recommended the use of real-time continuous glucose monitoring (rtCGM) for adults and children living with type 1 diabetes for the first time. It will give them a continuous stream of real-time information on a smartphone about their current blood glucose level.
Alongside new rtCGM technology, the use of intermittently scanned glucose monitoring (isCGM) devices – also known as flash monitoring – has been expanded to the whole of the type 1 patient population. Patients will now have a choice in picking the technology which is right for them in discussion with their diabetes team.
A rtCGM sensor is attached discreetly to the person’s body and collects the data which is transmitted to their smartphone. The data provides current and previous glucose levels but also a prediction of where the levels are headed meaning they can take action to stabilise their levels if necessary.
The real-time systems also feature active alerts or alarms that warn users of immediate and/or impending high or low blood sugar. Research has found both real-time and flash devices help a person in maintaining optimal blood sugar control.
Until now NICE had only recommended technology for continuous glucose monitoring for adults with type 1 diabetes in certain circumstances and capillary blood glucose monitoring (finger-prick testing) for people who weren’t eligible for the technology. With the introduction of new technology for everyone with type 1 diabetes, people will no longer have to monitor their condition with finger-prick testing as regularly as before. Instead the technology, calibrated using the person’s blood, will do that work for them. Experts predict this will reduce by half the need for finger-prick testing.
NHS England has rolled out NICE recommended flash devices to around 50% of those with type 1 diabetes.
The flash devices require users to consciously scan a sensor on their arm to obtain blood sugar data and not all flash monitors provide optional alarms or alerts.
In other new recommendations:
- NICE has recommended extending the use of flash monitoring to certain adults with type 2 diabetes on insulin therapy as outlined in recommendations 1.6.17 and 1.6.18. This recommendation makes the technology available to around 193,000 people.
Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “By recommending the use of either real-time or flash monitoring, our independent committee has made recommendations that will be a step forward in helping all people with type 1 diabetes manage their condition.
“Many people find finger-prick testing to be painful and time consuming and the introduction of technology for all people living with type 1 diabetes will reduce this considerably. This group of people also live with the constant worry of suffering from an attack brought on by dangerously low blood sugar while they sleep. Having an alarm which will alert them if this happens will give them the peace of mind knowing they will wake up in the morning.”
Eligible patients should speak to their diabetes team to access real-time or flash monitors on prescription.
Chris Askew OBE, chief executive at Diabetes UK, said: “These landmark guidelines promise to be transformational for people living with diabetes. Having campaigned for many years for wider access to Flash and continuous glucose monitoring, and contributed to NICE’s consultation, we are delighted that the voice of people with diabetes has been heard, and that our calls have been listened to.
“What we are seeing today is a key shift in thinking – a move to recognising that technology is an integral part of diabetes management, not simply an added luxury.
“There is still work to do, and we welcome NICE's commitment to addressing the inequalities which currently exist in access to Flash and CGM. Local health systems will need to support healthcare professionals to deliver these guidelines equitably and we will play our part too, in helping the NHS to get this right. But today is about celebrating a clear step towards ensuring many more people living with all types of diabetes will have access to the appropriate technology that can help them live happier and healthier lives.”