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December 2021

NICE to recommend wider use of CGM for adults

Draft guidelines from NICE on the management of type 1 diabetes recommend that all adults with the condition should be offered Flash glucose monitoring or continuous glucose monitoring (CGM) to improve blood glucose control.

CGM should also be offered to children with either type 1 or type 2 diabetes.

People with type 2 diabetes who are treated with insulin intensive therapy (four or more injections a day) and who experience regular hypoglycaemic episodes should also be given access to Flash monitoring.

NICE’s guideline development committee agreed that there was sufficient evidence for key outcomes, such as HbA1c, time in range and nocturnal hypoglycaemia to demonstrate that both CGM and Flash provide clinical benefits over standard self-monitoring of blood glucose – but that there wasn’t enough evidence to recommend one technology over another.

In its recommendations for children, the GDC stated that there was evidence that CGM decreased HbA1c and increased time in range, and that the continuous nature of real-time CGM, and that it can be connected to a parent or carer’s phone were important considerations for children and young people. For Flash (only licensed for children aged 4 and over), no clinically meaning effect was found and the intermittent nature of the technology could affect adherence.

Diabetes UK has welcomed the recommendations as a ‘huge step towards more people having access to this life-changing technology, which we know improves blood sugar control and makes life easier for people living with type 1 diabetes and their parents and carers.

‘We’re [also] pleased to see NICE recognising that more people living with type 2 diabetes can benefit from Flash, something we’ve highlighted consistently, especially in our Cheque for Tech campaign last year and this year’s Diabetes is Serious campaign.’

The draft guideline states that clinicians need to ensure that CGM is included in the education provided to patients, and that their use of the devices should be monitored as part of routine review.

Currently, NICE only recommends access to CGM in very limited circumstances and the guidelines do not mention Flash at all.

The final guidelines are due in March 2022, and will update NG17 (adults) and NG18 (children), published in 2015.

Practice Nurse 2021;51(10):9