Continuous glucose monitoring
- Offer real-time continuous glucose monitoring (rtCGM) to children and young people with type 2 diabetes if any of the following apply. They:
• have a need, condition or disability (including a mental health need, learning disability or cognitive impairment) that means they cannot engage in monitoring their glucose levels by capillary blood glucose monitoring
• would otherwise be advised to self-monitor at least 8 times a day
• have recurrent or severe hypoglycaemia. - Consider rtCGM for children and young people with type 2 diabetes who are on insulin therapy.
- Consider intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as ‘flash’) for children and young people with type 2 diabetes aged 4 years and over who are on insulin therapy if:
• rtCGM is contraindicated for them or
• they express a clear preference for is CGM.
(use of is CGM for children aged 3 years is off label).
| Measurement of HbA1c > In adults with type 2 diabetes, measure HbA1c levels at: 3–6-monthly intervals (tailored to individual needs), until the HbA1c is stable on unchanging therapy > 6-monthly intervals once the HbA1c level and blood glucose lowering therapy are stable |
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| Self-monitoring of blood glucose Take the Driver and Vehicle Licensing Agency (DVLA) At a glance guide to the current medical standards of fitness to drive into account when offering self‑monitoring of blood glucose levels for adults with type 2 diabetes. Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless: the person is on insulin or >there is evidence of hypoglycaemic episodes or >the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or >the person is pregnant, or is planning to become pregnant. For more information, see the NICE guideline on diabetes in pregnancy. [new 2015] Consider short-term self-monitoring of blood glucose levels in adults with type 2 diabetes (and review treatment as necessary): >when starting treatment with oral or intravenous corticosteroids or >to confirm suspected hypoglycaemia. Be aware that adults with type 2 diabetes who have acute intercurrent illness are at risk of worsening hyperglycaemia. Review treatment as necessary. If adults with type 2 diabetes are self‑monitoring their blood glucose levels, carry out a structured assessment at least annually. The assessment should include: >the person's self-monitoring skills >the quality and frequency of testing >checking that the person knows how to interpret the blood glucose results and what action to take >the impact on the person's quality of life >the continued benefit to the person >the equipment used. |
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| CHOICE OF COST EFFECTIVE STRIPS NHS Somerset recommends the use of devices which use strips not exceeding £9.25 per 50 strips. There are over 15 to choose from, all offering similar ranges and accuracy to more expensive strips. Blood glucose meters are not available at NHS expense, and prescribers are not obliged to supply expensive strips just because a manufacturer has supplied a certain meter. This applies both to type 1 and type 2 diabetics. Some type 1 diabetics may require more specialised meters, but many will only require basic testing capability. | Click here for a list of approved strips | |||
| GlucoRx Aidex, Dexcom one, Freestyle libre 2 and GlucoMen Day are approved in Somerset for All Type 1 patients and Type 2 patients on multiple daily insulin injections fitting any of the below criteria: - 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 is CGM device (or have it scanned for them) - they would otherwise be advised to self-measure at least 8 times a day. - They are an adult with insulin-treated type 2 diabetes who would otherwise need help from a care worker or healthcare professional to monitor their blood glucose |
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| GlucoRx Aidex® | 14 day sensor | £29.95 (1) | For persons over the age of 14 years | |
| Dexcom One® | 10 day sensor | £23 (1) | For persons over the age of 2 years | |
| Transmitter | £18 (1) | |||
| Dexcom ONE+® | 10 day sensor | £24.97 (1) | ||
| Freestyle libre 2® | 14 day sensor | £35 (1) | For persons over the age of 4 years | |
| FreeStyle Libre 2 Plus® | 15 day sensor | £37.50 (1) | For persons over the age of 2 years | |
| GlucoMen Day® | 14 day sensor | £67 (2) | For persons over the age of 6 years | |
| The DVLA issued new guidance in February 2019 on flash and continuous glucose monitoring for driving. Click New guidelines will make testing requirements simpler for drivers with insulin treated diabetes and A guide to insulin treated diabetes and driving for details. | ||||