Everyone with type 1 diabetes will be offered flash or CGM technology free on the NHS in England and Wales: new NICE guidelines published

People with type 1 diabetes will be offered continuous glucose monitoring (CGM), shown here, or flash glucose monitoring. Image: Dexcom.

New guidance for the NHS in England published today has recommended that people with type 1 diabetes be offered a choice of intermittently scanned glucose monitoring (otherwise known as ‘flash’) or real-time continuous glucose monitoring (CGM) on the NHS.

In summary:

• Everyone with type 1 diabetes should be offered a choice of flash glucose monitoring or continuous glucose monitoring.
• Children and young people should be offered CGM, or flash for those aged four years and over who are unable to use CGM, or who express a clear preference for flash.

JDRF is delighted that the National Institute for Health and Care Excellence (NICE) is recommending that glucose monitoring devices can now be chosen based first and foremost on a person’s preferences and needs and how well the devices available will meet those needs, such as predictive alerts, uploading to the cloud, pump or smart pen integration and sharing with parents or carers.

Further guidance for children and young people with diabetes also recommends that those with type 1 diabetes be offered CGM, alongside education to support themselves and their families in using it.

The guidelines apply to England and Wales. Scotland and Northern Ireland have their own processes and JDRF is urging equivalent access across all four nations of the UK.

Life-changing technology

Hilary Nathan, JDRF’s Policy Director said: “This new guidance offers potentially life-changing technologies to everyone living with type 1 in perhaps the most significant change to treatment since home blood glucose monitoring was introduced more than forty years ago. Most importantly, comprehensive NHS access to flash and CGM treatments will substantially reduce health inequalities and improve long term health outcomes for people with type 1 diabetes.”

Dr Sufyan Hussain, Consultant Physician in Diabetes & Endocrinology at St Thomas’ NHS Foundation Trust & King’s College London, and a member of JDRF’s Scientific Advisory Council said: “This is really positive news for people living with and caring for type 1 diabetes. The work ahead needs to ensure we can continue to address the implementation gaps, disparities in care and support people with and carers for type 1 diabetes with the opportunities highlighted in the guidance. We look forward to continuing this journey with all our stakeholders.”

JDRF recommendations included

The new guideline has incorporated JDRF’s recommendations to NICE to widen access to type 1 technology. In 2019, JDRF submitted comments to the NICE stakeholder consultation calling for a change in wording that would require healthcare professionals to ‘offer’ rather than ‘consider’ CGM for people with type 1 diabetes who meet the criteria. This amendment has been incorporated into the new guidance.

This guidance has been shaped by the lived experience of the type 1 community, by charities such as JDRF, and by the leadership of Professor Partha Kar and the leading diabetes healthcare professional groups.

Local implementation

Major changes such as those announced today can take time to come into force, and will be implemented at different rates across the country. Previous NICE guidance updates have often been implemented differently across areas of England, meaning the same technologies and treatments are not available in each area. This creates a potential postcode lottery. JDRF will be scrutinising the local implementation of the new guidance to ensure geographical inequality is avoided.

In summary:

• Everyone with type 1 diabetes should be offered a choice of flash glucose monitoring or continuous glucose monitoring.
• Children and young people should be offered CGM, or flash for those aged four years and over who are unable to use CGM, or who express a clear preference for flash.
• Several factors will be considered when making the choice, including how the device impacts someone’s work or school life, potential fears of hypoglycaemia, and how it integrates with someone’s insulin pump, if applicable.
• If both flash and CGM are deemed to be suitable, then the guidance recommends they are offered the device with the lowest cost.
• But if a person cannot use or does not want these wearable glucose monitoring technologies, they should continue to be offered capillary blood glucose monitoring or ‘finger prick’ measures.
• CGM will be included in structured education, so that everyone is trained in how to use it.
• In addition to these announcements on glucose technology, the new guidelines include updates to diagnosis procedures, including a recommendation not to use age or BMI alone to exclude or diagnose type 1 diabetes in adults.