London NHS Trust successfully rolls out continuous glucose monitoring (CGM)

Pregnant womanType 1 diabetes increases the risk of adverse outcomes during in pregnancy. However, tight control of maternal blood glucose levels during pregnancy is thought to minimise these risks to mother and baby.

Continuous glucose monitoring, or CGM for short, is an alternative means of measuring glucose levels in the tissues just below the skin – it uses a sensor that is placed on the upper arm and worn externally by the user, allowing glucose information to be monitored continuously. This information helps the user and their clinical team to identify what changes are needed to insulin administration to achieve optimal glucose control, and therefore reducing the risk of adverse outcomes in pregnancy.

The NHS Long Term Plan made a commitment to “offer continuous glucose monitoring to all pregnant women with Type 1 diabetes, helping to improve neonatal outcomes” and, by March 2021, all joint maternity and diabetes services are required to have a pathway in place, ensuring that all pregnant women with Type 1 diabetes are identified and offered CGM.

Rochan Agha-Jaffar is a Consultant Endocrinologist and lead for the antenatal and diabetes service at Imperial College Healthcare NHS Trust where they provide a range of treatments and specialist support for people across north west London with Type 1 and Type 2 diabetes. They have been offering CGM to pregnant women with Type 1 diabetes since July 2018. Rochan told us:

“Our multidisciplinary diabetes team includes consultant diabetologists, specialist diabetes nurses, dietitians, podiatry specialists and psychologists and we have a large diabetes technology service.

“I was a new consultant at the Trust and I identified that offering CGM to all pregnant women with Type 1 diabetes was one of the ways that I was very keen to develop the service. My manager at the time was super proactive and we were able to set up the new offering very quickly.

“Our diabetes technology service is closely linked with a research programme actually developing and researching CGM and the findingsfrom those studies – for example that CGM is very accurate – influenced our decision to go ahead and offer CGM to improve neonatal outcomes.

“Applying the CGM sensor is so easy – the latest technology is amazing and they have introduced a ‘click’ sound so you know when it’s attached properly. As well as myself and another endocrinology consultant colleague, one of the Diabetes Specialist Nurses in our multidisciplinary team was already competent in applying a CGM sensor and analysing the data and they trained up our Specialist Dietician to do the same.

“CGM gives women much more control over their condition. Readings are communicated to women in real time, every five minutes and the patient is notified if her glucose levels are too high or low. One of the challenges, particularly in early pregnancy, is the risk of hypoglycaemia which can be particularly difficult at night – the CGM helps to manage this by tracking glucose levels and notifying the patient.

“CGM also gives healthcare professionals a wealth of information and helps us to provide better care. We now have so much more digestible data and patterns at our disposal which helps so much with things like insulin adjustment which is really challenging for pregnant women with Type 1 diabetes. However, with the data from the CGM, we are able to guide patients much more quickly and much more effectively. It has also given us the ability to provide valuable remote support where that would have been challenging before which is particularly important during the COVID-19 pandemic.

“We see around 40 pregnant women with Type 1 diabetes each year and, from the word go, we’ve had fantastic uptake – approximately 95 per cent across the Trust.

“The feedback that we have received from patients about CGM has been incredible and moving – they have said that it has improved their quality and life and whole pregnancy experience and that they have really appreciated the remote support that we’ve been able to provide as we’re able to check the data. It’s extremely rewarding for us to be able to guide them thoroughly during what can often be a super challenging time.”