NICE says its new recommendations for real-time continuous glucose monitoring (CGM) and intermittently scanned or 'flash' glucose monitoring will help people with diabetes manage their condition better and reduce the need for fingerprick testing by up to 50%.
Newly updated NICE guidelines on type I and type II diabetes recommend that:
- all adults with type I diabetes should have access to either real-time CGM or flash monitoring
- all children with type I diabetes should have access to real-time CGM, and
- some people with type II diabetes who use insulin intensive therapy (2 or more injections a day) should have access to flash monitoring (eg, if they experience recurrent or severe hypos, if they have a disability that means they cannot fingerprick test or if they would otherwise be advised to test 8 or more times a day).
NICE had previously only recommended CGM for adults with type I diabetes in certain circumstances.
The choice of real-time CGM or flash monitoring technology in adults with type I diabetes should be based on the patient's individual preferences, needs, characteristics, and the functionality of the devices available, says NICE.
A real-time CGM sensor is attached discreetly to the person’s body and transmits a continuous stream of real-time information about the user's current blood glucose level to their smartphone. The data provides current and previous glucose levels but also a prediction of where the levels are headed, allowing the patient to take action to stabilise their levels if necessary.
Real-time glucose monitoring systems also feature active alerts or alarms that warn users of immediate and/or impending high or low blood sugar.
Flash devices require users to consciously scan a sensor on their arm to obtain blood sugar data. Not all flash monitors provide optional alarms or alerts. Three flash devices are currently available on NHS prescription: FreeStyle Libre Sensor, FreeStyle Libre 2 Sensor and GlucoRx Aidex Sensor.
NICE says research has shown that both real-time and flash devices help people maintain optimal blood sugar control.
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.'
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.'