The number of posts in online forums and blogs about CGM may give the impression that ‘everyone’ is using it. The fact that it took a long process to get insulin pump therapy funded by the NHS and overall uptake of pumps is increasing slowly (currently around 15% of all people with type 1 diabetes in the UK) may give the impression that the UK must be lagging behind in access to CGM too. The reality is most people around Europe who have CGM are self-funding it. At present, only a handful of European countries have clear guidelines on CGM funding and their policies differ considerably. Some policies are quite restrictive: for example, if someone in Belgium meets the criteria to have a trial of CGM, funding is dependent on them using the CGM at least 70% of the time. If the patient uses CGM for less than 70% of the time, the funding is withdrawn.
Recent estimates from JDRF in the US suggest that about 20% of Americans with type 1 diabetes are using CGM, while industry estimates from a few years ago suggest that around 35% of Americans with type 1 diabetes use a pump. Coverage for CGM by American health insurers has increased significantly in the past few years, but even Americans with diabetes who have excellent health insurance cover regularly pay 20%-30% of the cost of their care (medical appointments, tests and supplies alike) ‘out-of-pocket.’ Insurance coverage in the US works very differently from the NHS principle of ‘free of charge at the point of service’. Not all CGM users have a pump and certainly not all pump users have CGM (see the diagram below).
Note: this drawing is not proportional, it’s to illustrate that CGM users may be on either multiple daily injections (MDI) or a pump – it’s not necessary to have a pump to use CGM.
While it may seem like lots of people commenting on the internet have both a pump and a CGM, people using both CGM and a pump represent a very, very tiny percentage of the global population of people with type 1 diabetes. People in developing nations, and Americans with poor health insurance coverage, still struggle to get access to insulin, syringes and fingerstick blood glucose testing.
Funding for CGM in the UK: the current situation and the history of insulin pump funding
At present, the funding situation for CGM is similar to what we faced in 2000-2002 with insulin pump therapy in that there is no national rule that funding must be provided even if people meet criteria set in clinical guidelines. The current diabetes guidelines were set by NICE in August 2015. For a summary of current NICE guidance on diabetes technology have a look at our Type 1 Technology Guides under e-downloads.
Change takes time; like pumps, CGM will take time to become widely used in the UK.
The future of diabetes technology
INPUT:JDRF is very excited by the pace at which CGM systems, insulin pumps and algorithms are being developed into artificial pancreas (AP) technologies. Many people think that the US always gets new technology before the UK, but the Medtronic Paradigm Veo pump with low-glucose suspend was available here five years before the very similar Medtronic MiniMed 530G was approved in the US. The Medtronic 670G hybrid closed-loop system was launched later here, but now that a precedent has been set for hybrid closed-loop systems others may come along more quickly.
Thinking bigger-picture: less than 100 years after the discovery of insulin, here we are talking about systems that can automatically manage type 1 diabetes! Taking the long view, we anticipate that the UK will face challenges in increasing the availability of CGM and eventually AP systems, but we will not be alone in this. Other countries around the world, including the US and our neighbours in Europe, will be examining the evidence from trials and trying to evaluate the cost-effectiveness of new technologies. Along with diabetes technology companies (who have a financial interest), we are working to raise the profile of CGM as a valuable tool for managing diabetes. While we wait for broader access to emerging technologies in the UK, we are fortunate to have easy access to insulin and blood glucose test strips, which are sadly out of reach for many people with diabetes around the world.