INPUT hears from more and more people who are interested in obtaining funding for continuous glucose monitoring (CGM). The number of posts in online forums and blogs about CGM may give the impression that ‘everyone’ is using it. The fact that it took a long process to get insulin pump therapy funded by the NHS and uptake of pumps remains low may give the impression that the UK must be lagging behind in access to CGM too. The reality is most people around Europe who have CGM are self-funding it. At present, only a handful of European countries have clear guidelines on CGM funding and their policies differ considerably. Some policies are quite restrictive: for example, if someone in Belgium meets the criteria to have a trial of CGM, funding is dependent on them using the CGM at least 70% of the time. If the patient uses CGM for less than 70% of the time, the funding is withdrawn and the patient can never again apply for CGM.
Recent estimates from JDRF US suggest that about 20% of Americans with type 1 diabetes are using CGM, while industry estimates from a few years ago suggest that around 35% of Americans with type 1 diabetes use a pump. Coverage for CGM by American health insurers has increased significantly in the past few years, but even Americans with diabetes who have excellent health insurance cover regularly pay 20%-30% of the cost of their care (medical appointments, tests and supplies alike) ‘out-of-pocket.’ Insurance coverage in the US works very differently from the NHS principle of ‘free of charge at the point of service’. Not all CGM users have a pump and certainly not all pump users have CGM (see diagram below).
Note: this drawing is not proportional, it’s to illustrate that CGM users may be on either multiple daily injections (MDI) or a pump – it’s not necessary to have a pump to use CGM.
While it may seem like lots of people commenting on the Internet have both a pump and a CGM, people using both CGM and a pump represent a very, very tiny percentage of the global population of people with type 1 diabetes. People in developing nations, and Americans with poor health insurance coverage, still struggle to get access to insulin, syringes and fingerstick blood glucose testing.
Funding for CGM in the UK: current situation and the history of insulin pump funding
At present, the funding situation for CGM is similar to what we faced in 2000-2002 with insulin pump therapy in that there is no requirement for funding to be provided even if people meet criteria set in clinical guidelines. The current diabetes guidelines were set by NICE in August 2015. Here is a link to a summary of current NICE guidance on technology for children/young people with diabetes and for adults with type 1 diabetes (link to follow).
Change takes time; like pumps, CGM will take time to become widely used in the UK.
November 2016 news: 8 North West London CCGs commission CGM for adults in line with NICE NG17. A great example for other CCGs.
For more on the current funding situation, and how you can influence it, click here.
The future of diabetes technology
INPUT is very excited by the pace at which CGM systems, insulin pumps and algorithms are being developed into artificial pancreas (AP) technologies. Some researchers predict that their AP systems could gain United States Food and Drug Administration approval as early as 2017. Many people think that the US always gets new technology before the UK, but the Medtronic Paradigm Veo pump with low-glucose suspend was available here 5 years before the very similar Medtronic MiniMed 530G was approved in the US. The Animas Vibe was available earlier here in the UK too. So maybe we will see AP technologies sooner as well.
Thinking bigger-picture: less than 100 years after the discovery of insulin, here we are talking about systems that can automatically manage type 1 diabetes! Taking the long view, we anticipate that the UK will face challenges in increasing the availability of CGM and eventually AP systems, but we will not be alone in this. Other countries around the world, including the US and our neighbours in Europe, will be examining the evidence from trials and trying to evaluate the cost-effectiveness of new technologies. Along with diabetes technology companies (who have a financial interest), charities like JDRF and INPUT are working to raise the profile of CGM as a valuable tool for managing diabetes. While we wait for broader access to emerging technologies in the UK, we are fortunate to have easy access to insulin and blood glucose test strips, which are sadly out of reach for many people with diabetes around the world.