***Following today’s announcement by NICE recommending CGM and Flash should be offered to all people with type 1 diabetes, we are working to update the content on this page***
For latest information about access to CGM and Flash please see our Q&A guidance.
Whilst the National Institute for Health and Care Excellence (NICE) has issued statements describing when CGM might help someone with type 1 diabetes, it hasn’t yet performed a Technology Appraisal (TA) of CGM. So unlike insulin pump therapy, which is covered by TA151, there is no statutory obligation on your CCG, Health Board or NHS England to provide funding for CGM, even if you meet the criteria.
Note:
- Retrospective CGM lets your clinic look back at results by downloading them to a computer – you might not see the readings while they are being recorded. This is sometimes called ‘diagnostic use’.
- Real-time CGM allows you to see your glucose levels at any time and alrms can be set to let you know when your glucose levels go too high or too low, or when it predicts they will.
- Flash glucose monitoring has different funding arrangements from CGM so please see our separate page Can I get Libre on the NHS
NHS funding criteria for CGM
Current NICE guidelines (published in 2015) recommend that CGM is NOT OFFERED ROUTINELY to all people with type 1 diabetes. However whilst there is no statutory obligation on your CCG or NHS England to provide funding for CGM, there are some criteria suggested by NICE when CGM might be offered.
CHILDREN AND YOUNG PEOPLE – NICE NG18
“Offer ongoing real-time CGM with alarms to children and young people with type 1 diabetes who have:
- Frequent severe hypoglycaemia (see notes below)
- OR impaired awareness of hypoglycaemia associated with adverse consequences (for example, seizures or anxiety)
- OR inability to recognise, or communicate about, symptoms of hypoglycaemia (for example, because of cognitive or neurological disabilities).”
Also: “Consider ongoing real-time CGM for:
- Neonates, infants and pre-school children
- Children & young people who undertake high levels of physical activity (for example, sports at a regional, national or international level)
- Children & young people who have comorbidities (for example anorexia nervosa) or who are receiving treatments (for example corticosteroids) that can make blood glucose control difficult.”
And: “Consider intermittent (real-time or retrospective) CGM to help improve blood glucose control in children & young people who continue to have hyperglycaemia despite insulin adjustment and additional support.”
ADULTS WITH TYPE 1 DIABETES – NICE NG17
“Consider real-time CGM for adults with type 1 diabetes who…despite optimised use of insulin and conventional blood glucose monitoring have:
- More than 1 episode a year of severe hypoglycaemia with no obviously preventable precipitating cause
- Complete loss of awareness of hypoglycaemia
- Frequent (more than 2 episodes a week) asymptomatic hypoglycaemia that is causing problems with daily activities
- Extreme fear of hypoglycaemia
- Hyperglycaemia (HbA1c of 75mmol/mol [9%] or higher) that persists despite testing at least 10 times a day. Continue real-time CGM only if HbA1c can be sustained at or below 53 mmol/mol [7%] and/or there has been a fall in HbA1c of 27 mmol/mol [2.5%] or more).”
“Real-time CGM should be provided by a centre with expertise in its use, as part of strategies to optimise a person’s HbA1c levels and reduce the frequency of hypoglycaemic episodes.”
Also: “Review insulin regimens and doses and prioritise strategies to avoid hypoglycaemia in adults with type 1 diabetes with impaired awareness of hypoglycaemia including offering real-time CGM.”
Please note:
- ‘Offer’ is a stronger recommendation than ‘consider’.
- Impaired awareness of hypoglycaemia means the person cannot recognise that they are having a hypo until it becomes severe.
A severe hypo is one where the person needs help from another person or an ambulance or hospital to treat it. Be aware that accepting help is not the same as needing help. - These criteria apply to people who treat their type 1 diabetes with injections or an insulin pump.
The above recommendations mean the NHS can provide funding for CGM if you meet the criteria, but there is no obligation for funding to be granted. CGM users will need to commit to using it at least 70% of the time (3 weeks every month). However, these guidelines make a strong recommendation for CGM to be used with adults who have impaired awareness of hypoglycaemia, and with children who are unable to recognise or communicate about hypo symptoms – this includes very young children who cannot tell you they are having a hypo even if they recognise it.
PREGNANCY – NICE NG3
NHS England announced in its Long Term Plan (2019) that by 2020/21 all pregnant women living in England with type 1 diabetes will be offered CGM.
NICE updated its guidelines to reflect this, and in light of new evidence. Since December 2020 NG3 has stated:
- Offer continuous glucose monitoring (CGM) to all pregnant women with type 1 diabetes to help them meet their pregnancy blood glucose targets and improve neonatal outcomes.
- Offer intermittently scanned CGM (isCGM, commonly referred to as flash) to pregnant women with type 1 diabetes who are unable to use continuous glucose monitoring or express a clear preference for it.
(For pregnant women who are using isCGM or continuous glucose monitoring, a member of the joint diabetes and antenatal care team with expertise in these systems should provide education and support (including advising women about sources of out-of-hours support).
You can see from the above that real time CGM (rtCGM) is the priority, with flash only being offered if you cannot get on with rtCGM or would prefer to use flash. You should not be offered flash as a cheaper option unless you have declined rtCGM.
Local funding arrangements
Whilst there is no requirement to provide CGM, several areas in England have published policies on funding it. If your area doesn’t have a policy on CGM, ask your diabetes clinic team to contact ABCD DTN-UK for support with building a business case to present to local NHS commissioners.
If your local CCG has a policy not to fund any CGM, ask your clinic team to report the policy to Professor Partha Kar, National Specialty Advisor, Diabetes with NHS England.
Future prospects for CGM funding
We anticipate that the UK will face challenges in expanding access to CGM, as will the US and our neighbours in Europe. 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 type 1 diabetes.
Need more help/have further questions? Contact us
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