NICE guidelines for CGM and pumps?

[Cate]

Hi,

My pump is due for replacement and I was looking at the new Medtronic one. On the website it says there are new NICE guidelines recommending that pump with CGM for all T1s. I'm pretty sure it's not that simple, but can anyone clarify?

I'd love CGM, but I'm pretty sure I won't get it just for asking!

 

[Radders]

My understanding is that it's not a full CGM, but I am open to correction. My DSN told me that it just stops the pump if it detects low glucose levels, which I have never, ever done and would not want to start!

 

[Pumper_Sue]

Hi,

My pump is due for replacement and I was looking at the new Medtronic one. On the website it says there are new NICE guidelines recommending that pump with CGM for all T1s. I'm pretty sure it's not that simple, but can anyone clarify?

I'd love CGM, but I'm pretty sure I won't get it just for asking!

Yep it's recommended as long as you pay for CGM 🙂 CCG's do not have any money to provide CGM's unless you for the NICE criteria and even then the answer is mostly no.

 

[Cate]

Can you point me to the recommendations? I googled earlier but only found a reference to them, not the actual guidelines.

 

[everydayupsanddowns]

Hi,

On the website it says there are new NICE guidelines recommending that pump with CGM for all T1s. I'm pretty sure it's not that simple, but can anyone clarify?

I'd love CGM, but I'm pretty sure I won't get it just for asking!

No that's not right I'm afraid. Where did you read it?

The latest clinical guideline was NG17 (https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendations)

1.6.21 Do not offer real‑time continuous glucose monitoring routinely to adults with type 1 diabetes. [new 2015]

1.6.22 Consider real‑time continuous glucose monitoring for adults with type 1 diabetes who are willing to commit to using it at least 70% of the time and to calibrate it as needed, and who have any of the following despite optimised use of insulin therapy and conventional blood glucose monitoring:

• 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 level of 75 mmol/mol [9%] or higher) that persists despite testing at least 10 times a day (see recommendations 1.6.11 and 1.6.12). Continue real‑time continuous glucose monitoring 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. [new 2015]

So the first says 'NO' and the second is only a 'consider' which is much weaker in NICE speak than 'offer'.

Additionally this guideline just sets out evidence-based best practice and is not binding in the way that the Technology Appraisal TA151 is for pumps (if you meet the criteria for a pump they have to find the money to give it to you)

You should certainly ask, and ask what they need from you to make the case to the CCG (or whatever they are called this week). But it is quite rare for adults with T1 to get full time CGM coverage so you'd probably need to go for an Exceptional/Individual Funding Request (see http://www.inputdiabetes.org.uk/nice-and-diabetes-technology-funding/)

 

[Cate]

Thanks, that's really helpful. I have issues around hypos, and have been having counselling arranged through the diabetes centre to deal with it, so that might help the cause. I'll definitely follow it up.