CGM – NHS funding

Whilst the National Institute for Health and Care Excellence (NICE) has issued statements describing when CGM might help someone with type 1 diabetes, it hasn’t yet performed a Technology Appraisal (TA) of CGM. So unlike insulin pump therapy, which is covered by TA151, there is no statutory obligation on your CCG or NHS England to provide funding for CGM, even if you meet the criteria. For more information on NICE and CGM funding, click here.

As of early 2017, several documents from NICE mention CGM:

Clinical Guidelines

  • NG17 (Aug 2015/July 2016) – Type 1 diabetes in adults: diagnosis and management
  • NG18 (Aug 2015/Nov 2016) – Diabetes (type 1 and type 2) in children and young people: diagnosis and management

Diagnostics Assessment

  • DG21 (Feb 2016) – Integrated sensor-augmented pump therapy systems for managing blood glucose levels in type 1 diabetes (the MiniMed Paradigm Veo system and the Animas Vibe with Dexcom G4 PLATINUM CGM system)

In addition, in July 2016 NICE published a Quality Standard on Diabetes in children and young people (QS125). Statement 4 of this QS refers to CGM.

Links to these documents can be found on this page.

To make it easier to find and understand the relevant statements on technology, INPUT, JDRF and Diabetes UK have worked together to produce two free Type 1 Technology Guides (one for adults, one for young people and families). The Guides cover other forms of technology too, including insulin pens, insulin pumps and blood glucose meters. You can view and download them here.

Current NHS funding for advanced glucose monitoring technologies

Short-term/diagnostic use:

Short-term or diagnostic use of either CGM or Flash Glucose Monitoring (Abbott FreeStyle Libre) can help you and your diabetes care team spot patterns or problems. Usually, a diabetes specialist nurse (DSN) will help you insert a sensor to wear for between 5 days and 2 weeks. You will have a clinic appointment at the end of your session to return reusable parts of the system and discuss your results. Many clinics own CGM or Libre systems for short-term use, and can provide you with a sensor to wear.

They may use a real-time (readings visible on a screen) or blinded (no readings visible but data is saved) CGM system. The Medtronic iPro2 is often used for this purpose.

CGM systems for short term diagnostic use are owned by the clinic, and no extra funding needs to be applied for in this instance. We believe all clinics supporting people with type 1 diabetes should have access to short term CGM systems for troubleshooting. If your clinic doesn’t have a system, contact INPUT for advice.

Note that research shows that using a CGM at least 70% of the time is more likely to improve your HbA1c than short-term use.

Long-term/therapeutic use:

NICE Guidelines NG17 (for adults with type 1 diabetes) and NG18 (for children and young people with diabetes) set out specific situations in which clinics should consider CGM for certain people with diabetes. Not everyone with type 1 diabetes will meet those criteria. To see the criteria have a look at the CGM section in the Type 1 Technology Guide for the relevant age group.

Note:

Access to long-term CGM varies across clinics and CCGs, with highly pro-active paediatric clinics being the most forthcoming
If you apply for individual funding through your consultant, your letter should explain how the NHS can save money if you use a CGM, for example, preventing ambulance call-outs or A&E admissions

Local and national funding arrangements

Whilst there is no requirement to provide CGM or Libre, several areas in England have developed policies on funding them. We have listed below the areas where we are aware of a policy. These policies might support the use of CGM in line with NICE guidance, or may rule it out altogether. If your area doesn’t have a policy on CGM, ask your diabetes clinic team to visit this page for examples of policies, and to contact IPN-UK for support in building a business case to present to local NHS commissioners.

Northern Treatment Advisory Group – relates to Abbott FreeStyle Libre only

North West London (8 CCGs) – adults only

Southampton, Hampshire, Isle of Wight and Portsmouth (SHIP) (8 CCGs) – adults only

Abbott are currently working with the NHS to try to have FreeStyle Libre available on prescription just like blood glucose testing strips. For updates on their progress, please check this page.

Future prospects for CGM funding

NICE will perform a Technology Appraisal of CGM when there is sufficient evidence for its effectiveness and cost-effectiveness.

This evidence base for CGM will include

  • Clinical trials published in medical journals showing that CGM improves HbA1c, increases the time spent in the target glucose range and reduces hypos
  • Patient data beyond HbA1c as a measure of optimal diabetes control – for example, hypo risk, diabetes distress, time in target glucose range
  • Accuracy, reliability and wearability of CGM devices

Thus CGM companies are supporting clinical trials; investing in research and development and running educational events for healthcare professionals working in diabetes.

We anticipate that the UK will face challenges in expanding access to CGM, as will the US and our neighbours in Europe. Along with diabetes technology companies (who have a financial interest), INPUT, Diabetes UK and JDRF are working to raise the profile of CGM as a valuable tool for managing type 1 diabetes.

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