Mid and South Essex Medicines Optimisation Committee (MSEMOC)
Mid and South Essex Integrated Care Board (MSE-ICB) funds Continuous Glucose Monitoring devices in patients on insulin with Type 1 or Type 2 Diabetes, including children or young people on insulin, and patients on insulin with non-Type 1 Diabetes (as defined within this policy) who meet criteria and choice of devices in accordance with this policy.
Adult Type 1 Diabetes (T1DM)
All adults with T1DM are eligible for intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’).
Where multiple isCGM devices meet the clinical needs of the patient, the one with the lowest acquisition cost will be funded.
Adults with T1DM are eligible for real-time continuous glucose monitoring (rtCGM) only when despite optimised management the patient has:
- complete loss of awareness of hypoglycaemia OR
- frequent (more than 2 episodes a week) asymptomatic hypoglycaemia that is causing
- problems with activities of daily living OR
- requires a 3rd party to share glucose data and follow functions for clinical safety
OR
- the patient is pregnant-see Diabetes in Pregnancy
Where multiple rtCGM devices meet the clinical needs of the patient, the one with the lowest acquisition cost will be funded.
Adults with T1DM who do not meet the eligibility criteria for rtCGM as detailed above are eligible for rtCGM only where rtCGM is available at the same or lower cost as isCGM.
Adults with non-type 1 Diabetes who have insulin deficiency should be managed as T1DM.
See also section CGM and Insulin Pumps when initiating patients on insulin pump therapy at the same time.
Children and Young People Type 1 Diabetes (T1DM)
All children and young people with T1DM are eligible for real-time continuous glucose monitoring (rtCGM).
Intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) will be funded for all children and young people with T1DM who are unable to use rtCGM or who express a clear preference for isCGM.
Where multiple devices meet the clinical needs of the patient, the one with the lowest acquisition cost will be funded.
Children and young people with non-type 1 Diabetes who have insulin deficiency should be managed as T1DM.
Children and young people should be reviewed as they transition into adult services and choice of CGM device re-assessed in line with this policy according to the applicable diabetes type for adult patients.
Type 2 Diabetes (T2DM)
Patients, including children and young people, with T2DM on multiple daily insulin injections (i.e. two or more injections per day) are eligible for intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) 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 by their specialist diabetes team to self-measure at least 8 times a day
OR
- the patient is pregnant and meets criteria detailed below -Diabetes in Pregnancy.
Patients with T2DM on once daily insulin injections are only eligible for intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) if:
- 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 and use of isCGM would avoid or reduce the need a care worker or healthcare profession to visit solely for the purpose of blood glucose monitoring.
OR
- the patient is pregnant and meets criteria detailed below -Diabetes in Pregnancy.
Where multiple isCGM devices meet the clinical needs of the patient, the one with the lowest acquisition cost will be funded.
Patients with T2DM who meet the eligibility criteria for isCGM as detailed above are eligible for rtCGM only where rtCGM is available at the same or lower cost as isCGM.
Patients with non-type 1 Diabetes who do not have insulin deficiency should be managed as T2DM.
Diabetes in Pregnancy
MSE-ICB funds continuous glucose monitoring in pregnant women who meet criteria and choice of devices in accordance with this policy.
All pregnant women with T1DM are eligible for real-time continuous glucose monitoring (rtCGM).
Intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) is available for all pregnant women with T1DM who are unable to use rtCGM or express a clear preference for isCGM.
Pregnant women who are on insulin therapy but do not have T1DM (for example- T2DM, non-Type 1 or gestational diabetes) are eligible for rtCGM if:
- they have problematic severe hypoglycaemia (with or without impaired awareness of hypoglycaemia) OR
- they have unstable blood glucose levels that are causing concern despite efforts to optimise glycaemic control.
Where multiple devices meet the clinical needs of the patient, the one with the lowest acquisition cost will be funded.
Within 3 months postpartum, patients should be reviewed and choice of CGM device re-assessed in line with this policy according to the applicable diabetes type for non-pregnant patient.
CGM and Insulin Pumps
MSE-ICB commissions the provision of continuous subcutaneous insulin infusions (via insulin pumps) in line with our policy.
In accordance with NICE principles and the ethos of NICE clinical guideline Type 1 diabetes in adults: diagnosis and management (nice.org.uk/guidance/ng17) MSE-ICB will fund the package i.e. CGM device, Insulin Pump device and Blood Glucose Test Strips (estimated annual usage) with the lowest total annual cost that meets the clinical needs of the patient.
The choice of pump in very young children should take into account the ability to deliver a very low basal rate.
Initiation of CGM
Only CGM devices listed on the MSE Formulary are approved for NHS funding within MSE-ICB. Each device has been assigned a Traffic Light status-see Policy for Clinical and Prescribing Responsibility.
Consideration of whether a person is appropriate to use CGM may be undertaken at the patient’s next annual diabetes clinical review; this review could be in primary, community or secondary care. An earlier review at the discretion of the treating healthcare professional may be appropriate if there is clinical need. Individuals should be referred to specialist diabetes teams for initiation when primary care initiation is not clinically appropriate and/or for products which are not available for FP10 prescribing.
People who self-funded CGM prior to this commissioning policy approval may be assessed for NHS funding in accordance with the above. There will be no retrospective funding of any intervention or service costs incurred in advance of assessment of eligibility for NHS funding in accordance with this policy.
Individual/Group Prior Approval: Community/Secondary care providers must provide a patient specific request/notification to the ICB of use of CGM device on initiation and annually upon review using agreed process.
Capillary Blood Glucose Testing: All patients using CGM will still require a capillary blood glucose meter, testing strips and lancets although it is anticipated that when using isCGM or rtCGM the quantities required will be lower.
Patients on isCGM or rtCGM will have their capillary Blood Glucose Test Strips prescription changed to the least expensive strip which meets clinical needs, and quantity reduced to 1 box every 3 months OR on request in line with specialist diabetes teams’ advice. The MSE BGTS guidance should be followed to select an appropriate meter with cost effective testing strips.
Patients who do not meet criteria as defined in this policy will not be eligible for NHS funding of CGM or any other associated costs.
Funding for patients not meeting criteria will only be granted in clinically exceptional circumstances. Further information on applying for funding in exceptional clinical circumstances can be found on the MSE-ICB website.
References:
- NICE guideline [NG17] “Type 1 diabetes in adults: diagnosis and management” Published:26 August 2015 Last updated:17 August 2022
- NICE guideline [NG28] “Type 2 diabetes in adults: management” Published:2 December 2015 Last updated: 29 June 2022
- NICE guideline [NG18] “Diabetes (type 1 and type 2) in children and young people: diagnosis and management Published:1 August 2015 Last updated:29 June 2022
- NICE guideline [NG3] “Diabetes in pregnancy: management from preconception to the postnatal period” Published: 22 February 2015 Last updated:16 December 2020
Version: 1.0
Author: MSEMOC working group
Approved by: MSEMOC
Date approved: February 2023
Review date: February 2026