Updated NICE Guidance aims to improve CGM access for both T1 and T2

[everydayupsanddowns]

Published today for England and Wales

For adults with T1 diabetes

Recommendations | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE

www.nice.org.uk

Including the section we have already been discussing about widening the access for people with T1 to both Libre 1 & 2 (isCGM - intermittently scanned CGM), and Dexcom / Medtronic / Libre 3 / Medtrum (rtCGM - Realtime CGM)

Additionally guidance for T2 had also been updated:

For adults with type 2 diabetes:

Offer intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) to adults with type 2 diabetes on multiple daily insulin injections if any of the following apply:

• they have recurrent hypoglycaemia or severe hypoglycaemia
• they have impaired hypoglycaemia awareness
• they have a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them)
• they would otherwise be advised to self-measure at least 8 times a day.

Link: Type 2 diabetes in adults: management – glucose monitoring

Previous NICE guidelines only recommended CGM to people with type 1 diabetes in very limited circumstances and did not recommend Flash at all. Further, this is the first time NICE has ever recommended Flash use for anyone with type 2 diabetes. That’s why these new guidelines represent such a significant and exciting change.

It is expected that any rollout of recommendations in these guidelines for improved CGM access will take time, and access to varying tech will still be an individual clinical decision, and be subject to relevant criteria.

It’s gonna take some time!!

 

[helli]

It’s gonna take some time!!

But the way the Daily Mail reported it a few weeks back suggested we would all be running around with CGMs attached and never needing to do "painful" finger pricks again from the 1st April 😎

 

[everydayupsanddowns]

But the way the Daily Mail reported it a few weeks back suggested we would all be running around with CGMs attached and never needing to do "painful" finger pricks again from the 1st April 😎

Daily Fail strikes again 🙄

 

[SB2015]

Thanks for this Mike

I know that the provision of CGMs will be sporadic and still a long way off but when I first self funded Libre I never thought that would become available on NHS …..

 

[Totalwar]

So I typ 2 and on short and long acting insulins and should be taking a reading before and after meal do I stand a chance of getting one?

 

[SB2015]

So I typ 2 and on short and long acting insulins and should be taking a reading before and after meal do I stand a chance of getting one?

The new guidelines Mike has posted is specifically related to those with T1 and also focus on links to our insulin pumps.

I am aware of some people with T2 that have had Libre prescribed. I will let them respond.

 

[Lucyr]

So I typ 2 and on short and long acting insulins and should be taking a reading before and after meal do I stand a chance of getting one?

Before and after meals is only 6 times a day, if it’s recommended that you need to test a minimum of 8 times a day then potentially you qualify now, subject to getting your dr to agree it

 

[helli]

So I typ 2 and on short and long acting insulins and should be taking a reading before and after meal do I stand a chance of getting one?

Out of interest, why are you taking a reading after meals?
I know this is the advice for people with type 2 trying to understand which foods are suitable for them .
However, for those of us with Type 1, the advice is not to focus on this as it is dependent on the speed our injected insulin takes to work which we have no control over.

I am genuinely interested to learn your reasoning, not questioning whether it is right or not.

 

[Totalwar]

i Don’t do it but suppose to because of being on insulin ya I make it with 7 with before bed and when I wake in morning would be 8.I was advised to do this by Community Diabetes Team.

 

[rayray119]

Out of interest, why are you taking a reading after meals?
I know this is the advice for people with type 2 trying to understand which foods are suitable for them .
However, for those of us with Type 1, the advice is not to focus on this as it is dependent on the speed our injected insulin takes to work which we have no control over.

I am genuinely interested to learn your reasoning, not questioning whether it is right or not.

I do after meals to try and get a rough idea of parttens.

 

[trophywench]

Other thing is whether T1, 2 or anything else using insulin - you have to test before jumping in the car and driving - so even without loss of hypo symptoms or anything else untoward requiring more frequent testing, the number of blood tests soon mounts up!

 

[Proud to be erratic]

Before and after meals is only 6 times a day, if it’s recommended that you need to test a minimum of 8 times a day then potentially you qualify now, subject to getting your dr to agree it

But, this Guideline is for T1s.

Also, section 1.6 and following clauses refer to capillary bg testing at least 4x daily (before meals and at bedtime) followed by up to 10x daily; 7 specified criteria are listed, including reference to the DVLA remit. The advice to test immediately before a meal and 2 hrs later is frequently recommended in this forum (for T2s) and presumably in the Diabetes UK main site, but does not seem to be endorsed by NICE for T1s. But perhaps someone knows if/where this is formally supported by NICE for T2s?

 

[Proud to be erratic]

But, this Guideline is for T1s.

Perhaps someone knows if/where this is formally supported by NICE for T2s?

Slight apologies, I see that @everydayupsanddowns refers to self-measuring up to 8 times daily. I couldn't find that in NG17, nor in a speed-read of the draft guideline for T2s NG28. But I could well be missing things in NG 28.

 

[Bruce Stephens]

But perhaps someone knows if/where this is formally supported by NICE for T2s?

I don't see it, but the guidance on SMBG seems a bit vague for T2s whereas it seems not to encourage testing after meals for T1s.

I couldn't find that in NG17, nor in a speed-read of the draft guideline for T2s NG28.

Agreed, it recommends to support testing "at least 4 times a day, and up to 10 times a day" for T1, and T2 specifically mentions DVLA requirements (leaving other things dependent on avoiding hypos and maintaining BG control in a more vague way).

https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#continuous-glucose-monitoring seems clear enough that if someone with T2 were testing 8 times a day for good reason they'd qualify for CGM. (The requirements looks rather similar to those for T1 before the update.)

 

[Proud to be erratic]

Slight apologies, I see that @everydayupsanddowns refers to self-measuring up to 8 times daily. I couldn't find that in NG17, nor in a speed-read of the draft guideline for T2s NG28. But I could well be missing things in NG 28.

Apologies again, now found it! Clause 1.6.17 refers in NG28, for T2s.

 

[Catsymoo]

I really hope I can get a Dexcom from this, I am currently using finger tests with the FreeStyle Freedom Lite and my blood sugar control is horrendous. I have such bad hypo anxiety I purposely run my sugars 15-20 for peace of mind.

I feel that a CGM could get rid of this anxiety as I will be able to clearly see the trends of my blood sugars overnight and what they are doing.

 

[helli]

I really hope I can get a Dexcom from this, I am currently using finger tests with the FreeStyle Freedom Lite and my blood sugar control is horrendous. I have such bad hypo anxiety I purposely run my sugars 15-20 for peace of mind.

I feel that a CGM could get rid of this anxiety as I will be able to clearly see the trends of my blood sugars overnight and what they are doing.

Have you asked about Libre? Libre 2 gives you the hypo alerts, is available for 50% of people with Type 1 today and is a lot cheaper than Dexcom.

 

[Catsymoo]

Have you asked about Libre? Libre 2 gives you the hypo alerts, is available for 50% of people with Type 1 today and is a lot cheaper than Dexcom.

Yes, I was declined it. I was told I have to do the DAFNE course first then never heard anything.

Just an example of how volatile my type 1 is. I woke up at 14 mmol. I took 2 units to correct, waited 2 hours. Ate 30g carbs, took 3 units, blood sugar was 20.1. I waited another 2 hours to let the 3 units of Novo work - I am now at 20.8. How?

 

[rayray119]

For me I therogity like the idea of the dropping fast and predictive,

Yes, I was declined it. I was told I have to do the DAFNE course first then never heard anything.

Just an example of how volatile my type 1 is. I woke up at 14 mmol. I took 2 units to correct, waited 2 hours. Ate 30g carbs, took 3 units, blood sugar was 20.1. I waited another 2 hours to let the 3 units of Novo work - I am now at 20.8. How?

What surlly that's not right I was given libre a few weeks in. It didn't seem to suit me for some reason but requireung dafanw doesn't sound right

 

[everydayupsanddowns]

For adults with type 2 diabetes:

Offer intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) to adults with type 2 diabetes on multiple daily insulin injections if any of the following apply:

• they have recurrent hypoglycaemia or severe hypoglycaemia
• they have impaired hypoglycaemia awareness
• they have a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them)
• they would otherwise be advised to self-measure at least 8 times a day.

Link: Type 2 diabetes in adults: management – glucose monitoring

Previous NICE guidelines only recommended CGM to people with type 1 diabetes in very limited circumstances and did not recommend Flash at all. Further, this is the first time NICE has ever recommended Flash use for anyone with type 2 diabetes. That’s why these new guidelines represent such a significant and exciting change

Sorry for the confusion, @SB2015 @Lucyr @Totalwar @Proud to be erratic

I‘ve quoted the bit that talks about the changes to T2 guidance. See section 1.6.17 in the updated guidance linked in the quote.

Edit: I see @Proud to be erratic beat me to it!