Is Continuous Glucose Monitoring Underappreciated in the UK?

Abstract

Introduction: Information about continuous glucose monitoring (CGM) use in the UK is limited. We conducted an online survey of a representative sample of current CGM users in England, Scotland and Wales to address this deficit. Methods: The 29-item online survey was conducted between 29 December 2016 and 25 January 2017. Persons with type 1 diabetes (T1D) and caregivers of T1D children/adolescents were recruited from mailing lists, using Nielsen and Harris Polling databases. Results: 315 patients and caregivers responded to the survey — 170 adult patients and 145 caregivers. Among respondents, 144 received full funding for CGM use, 72 received partial funding and 83 received no funding. Most reported improvements in glycated haemoglobin (HbA1c) (67.0%), fewer hypoglycaemia episodes (70.2%), improved hypoglycaemia awareness (77.5%) and better diabetes management (92.4%). Self-funders reported significantly higher CGM use (76.1%) than those who were fully funded (58.9%) and/or partially funded (65.9%), p=0.0008. Fewer than 50% of all respondents reported receiving guidance in interpreting CGM data from their diabetes care team; 30.1% of self-funders reported receiving no CGM support from their diabetes team compared with fully funded (2.8%) and partially funded (1.4%) respondents, p<0.0001. Conclusions: Patients with T1D and their caregivers are realising benefits from CGM use but are largely unsupported by the UK healthcare system.

Long-term Cost-Effectiveness of Dexcom G6 Real-time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K.

“…However, despite the guidance issued by the National Institute for Health and Care Excellence (NICE), funding for RT-CGM is limited, meaning that inequality exists around the availability of RT-CGM in the U.K. Indeed, in one recent study in patients and caregivers, 26% were wholly selffunded (9). Evidence from long-term costeffectiveness analyses that balance the acquisition cost of RT-CGM against its clinical and economic benefits are needed to assist U.K.-based policy makers and payers in making informed reimbursement decisions.…”

Diabetes Healthcare Professionals Use Multiple Continuous Glucose Monitoring Data Indicators to Assess Glucose Management

“…16,27,28 However, trends in pricing and reimbursement policies and the scope of CGM prescription continue to expand the use of CGM. 9,29-32…”

Development of an artificial intelligence system to identify hypoglycaemia via ECG in adults with type 1 diabetes: protocol for data collection under controlled and free-living conditions

“…However, despite being shown to be a beneficial tool for SMBG, national clinical guidelines for the UK do not recommend routine use of CGM devices for the management of T1DM due to insufficient evidence demonstrating their efficacy and cost-effectiveness. 14 It has been demonstrated, by this group 15 16 and others, [17][18][19] that glycaemic events can affect certain cardiac characteristics, which can be extracted from readings of the electrical activity of the heart, the ECG. With increasing availability of wearable devices for tracking physiological signals, studies have been undertaken to investigate prediction of blood glucose concentration or glycaemic event detection using artificial intelligence (AI), by combining data or features extracted from the ECG with blood glucose measurements.…”

“…However, despite being shown to be a beneficial tool for SMBG, national clinical guidelines for the UK do not recommend routine use of CGM devices for the management of T1DM due to insufficient evidence demonstrating their efficacy and cost-effectiveness. 14 …”