Glucose monitoring for patients living with diabetes

The NHS Long Term Plan made a commitment to ensure that “in line with clinical guidelines, patients with Type 1 diabetes benefit from life changing flash glucose monitors from April 2019, ending the variation patients in some parts of the country are facing”.

It also commits to offering “all pregnant women with Type 1 diabetes a continuous glucose monitor, helping to improve neonatal outcomes by 2020/21”.

Flash glucose monitoring

A flash glucose monitor, or flash for short, uses a sensor that is placed on the back of the upper arm and worn externally by the user, allowing glucose information to be monitored using a mobile app. 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.

All of the information the flash monitor collects can be shared with a patient’s healthcare professionals and reviewed easily during virtual appointments, which is particularly important during the COVID-19 pandemic.

National arrangements were published in March 2019 which set out how flash glucose monitoring devices are to be funded and prescribed to patients who meet a certain clinical criteria and who would benefit most from these devices.

The original roll out of flash applied to select patients with Type 1 diabetes only. However, many people with diabetes and a learning disability have Type 2 diabetes. The NHS is now offering Flash to all people with Type 1 diabetes or insulin treated Type 2 diabetes who are living with a learning disability and are recorded on their GP learning disability register.

Prior to 1 April 2019, it was estimated that around 3-5% of people living with Type 1 diabetes in England had access to flash. The life-changing monitors are now prescribed in primary care in every region across England and 34% of the Type 1 population have received one.

Learn more about flash

For a copy of the latest flash FAQs, please email england.digitaldiabetes@nhs.net.

Further information for patients

The eligibility criteria has been developed to guide clinicians, and eligibility is normally determined in your annual diabetes review when you have the opportunity to speak to your clinician about your care. Depending on local arrangements this review may be with either your specialist diabetes team or your GP.

If you have further queries or experience any problems these can be directed to your local clinical commissioning group who are responsible for local implementation of the guidance and for providing flash glucose monitoring.

In addition, the Diabetes UK website contains lots of valuable information about living with Type 1 diabetes which you may find helpful.

Continuous glucose monitoring

Type 1 diabetes increases the risk of adverse outcomes in pregnancy. Research shows that that use of continuous glucose monitoring, or CGM for short, throughout pregnancy improves glucose control and neonatal outcomes associated with Type 1 diabetes in pregnancy.

A CGM is a small device that sticks to the skin. It measures glucose levels continuously throughout the day and night and can show trends in glucose levels over time. The information is available instantly when a patient looks at the reader. Importantly, it can alert the user if the glucose goes too high or too low.

Information collected by the CGM is also shared with a patient’s maternity and diabetes care team so that they can review and adjust care appropriately. It also means that the information can be shared easily during virtual appointments, which is particularly important during the COVID-19 pandemic.

By March 2021, all joint maternity and diabetes services are required to identify and offer all women with Type 1 diabetes CGM as part of their care plan.

Learn more about CGM

Access training resources on how to use CGM at abcd.care/dtn/CGM and https://abcd.care/dtn-uk-top-tips.

For a copy of the latest CGM FAQs, please email england.digitaldiabetes@nhs.net.