Who Qualifies for a CGM?
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Do I Qualify for a Continuous Glucose Monitor on the NHS?
ContinuousContinuous glucose monitoring (CGM) can be a game-changer for people living with diabetes. With CGM, you can automatically track your blood sugar levels 24-hours a day, gaining valuable insight for insulin management. However, CGM can be expensive and there are strict criteria for eligibility on the NHS. This guide will help you determine if you might be eligible and what options you have for funding a CGM.
What are the Funding Criteria for Getting a CGM on the NHS?
The NICE NG17 guidelines recommend that CGM should be considered for adults with type 1 diabetes who meet any of the following conditions:
- More than 1 severe hypo per year with no explainable cause
- Complete loss of hypoglycaemia awareness
- More than 2 hypos per week with no symptoms which affect day-to-day life
- An extreme fear of hypos
- An HbA1c level of 75mmol/mol despite testing 10 times per day
The guidelines also state that any individuals receiving CGM must be committed to using it more than 70% of the time. Furthermore, the centre providing the CGM must have the expertise to provide you with the guidance and support to use it to reduce your HbA1c level and prevent hypos.
Guidelines for CGM for children
The NICE NG18 guidelines recommend that CGM should be offered to children who have:
- frequent, severe hypos
- hypo unawareness with serious consequences (e.g., seizures or anxiety)
- inability to recognise or communicate about hypos because of developmental or neurological disabilities.
CGM should also be considered for children who:
- are under school age
- play sport competitively (at regional, national or international level)
- have other health conditions that make treatment more difficult (e.g., children who suffer from anorexia or who need steroid treatment)
- have blood sugar levels despite insulin treatment and support.
Guidelines for CGM for pregnant women
The NICE NG3 guidelines have been updated to recommend that all pregnant women with type 1 diabetes should be offered real-time CGM on the NHS.
If you are pregnant and have type 2 or gestational diabetes, CGM should be considered if you have severe hypos or unstable blood sugar levels.
What is the Eligibility for Getting Flash Monitoring on the NHS?
The current NICE guidelines do not mention or recommend the use of flash glucose monitoring (Flash). It is possible to get Flash on prescription on the NHS, although the criteria differ throughout the UK. England, Northern Ireland and Wales all have national criteria that you must meet to be eligible. In Scotland, you’ll need to meet the criteria published by your local health board. Since 2019, Flash has slowly become more available to people with diabetes. You can check out the links on the Diabetes UK website to learn more about criteria in England, Northern Ireland, Wales and Scotland.
What if I Don't Qualify for CGM on the NHS?
Due to current guidelines which recommend limited use of CGM for type 1 diabetics, many people have been denied their request to get diabetes technology on the NHS. The good news is that NICE has recently released new draft guidelines which recommend the wider use of CGM and Flash for all people with type 1 diabetes. The new updates will be published on 31 March 2022.
If you don’t meet the criteria for getting CGM on prescription, but you think you can make a strong case for why this technology could better help you manage your diabetes, you can try to apply for individual funding through your local commissioning group (CCG) or health board.
Can I Self-Fund a CGM?
Even with the push for wider usage of CGM outlined in the soon-to-be-published NICE guidelines, change can take time. The reality is that even if you meet the criteria for CGM, there is no national requirement that funding must be made available to you. For this reason, a vast majority of patients using CGM are self-funded.
Estimated prices vary greatly but you should expect that a standalone CGM (one that is not part of an integrated insulin pump solution) costs approximately £1,000. Monitors that work with an insulin pump cost approximately £500. Sensors are priced from £40 to £60.
If you do decide to privately fund your CGM solution, it’s critical that you work with your healthcare team to make sure they can support you effectively. For continuous glucose monitoring to be truly effective, you’ll need to work with your healthcare team on strategies to reduce hypos and improve your HbA1c level.
Speak to our CGM Experts
Despite the evidence supporting the benefits of continuous glucose monitoring, getting a prescription for CGM is not easy for many people with diabetes.
At the London Diabetes Centre, we can help you decide if CGM is the right choice for you. We’ll provide an assessment, selection guidance and ongoing training and support to help you get the most from your CGM.
Give us a call today to get started with CGM.
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Carol Willis - Diabetes Clinic Facilitator
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