Policy Number: SRP 037
Policy Name: Continuous Glucose Monitoring
Status: Individual Prior Approval / Group Prior Approval:
Effective Date: 1 October 2024
Next Review Date: 1 October 2026
Mid and south Essex ICB funds Continuous Glucose Monitoring devices for 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.
A separate policy covers the commissioning of Hybrid closed loop systems (HCL) for managing blood glucose levels in type 1 diabetes in line with National Institute for Health and Care Excellence (NICE) Technology Appraisal (TA) 943.
Adult Type 1 Diabetes (T1DM)
All adults with T1DM are eligible for continuous glucose monitoring (CGM).
Adults with T1DM who have:
- 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
must be seen by a specialist diabetes team who will assess and initiate an appropriate device to meet their clinical need.
All other eligible patients may be initiated in primary care.
Where multiple CGM devices meet the clinical needs of the patient, the formulary approved device with the lowest acquisition cost will be funded.
Adults with non-type 1 Diabetes who have insulin deficiency should be managed as T1DM.
Children and Young People Type 1 Diabetes (T1DM)
All children and young people with T1DM are eligible for standalone continuous glucose monitoring (CGM) and must be initiated by a specialist diabetes team. Individual Prior Approval.
Where multiple CGM devices meet the clinical needs of the patient, the formulary approved device 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 reassessed in line with this policy.
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 continuous glucose monitoring (CGM) 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 continuous glucose monitoring 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 CGM 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 CGM devices meet the clinical needs of the patient, the formulary approved device with the lowest acquisition cost will be funded.
Patients with non-type 1 Diabetes who do not have insulin deficiency should be managed as T2DM.
Eligible patients, including children and young people, with T2DM should be initiated by specialist diabetes teams.
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.
Diabetes in Pregnancy
MSE-ICB funds standalone continuous glucose monitoring in pregnant women who meet criteria and choice of devices in accordance with this policy. They should be initiated and managed by specialist diabetes teams.
All pregnant women with T1DM are eligible for continuous glucose monitoring (CGM).
Pregnant women who are on insulin therapy but do not have T1DM (for example- T2DM, non-Type 1 or gestational diabetes) are eligible for CGM 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 CGM devices meet the clinical needs of the patient, the formulary approved device with the lowest acquisition cost will be funded.
Within 3 months postpartum, patients should be reviewed and choice of CGM device reassessed in line with this policy according to the applicable diabetes type for non-pregnant patient.
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 for devices not available on FP10, 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 CGM the quantities required will be lower.
Patients on CGM 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.
Find out more information on applying for funding in exceptional clinical circumstances.
- 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