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Page last updated:
16 November 2021
NICE NG17 and NICE NG18 recommend that all adults, children and young people with type 1 diabetes should be offered a real-time continuous glucose monitor (rtCGM) device to monitor their glucose levels.
For further information, including the local commissioning position, refer to section 6.1.7 Continuous Glucose Monitors (CGM)
NICE advises that people with type 1 diabetes who are using CGM will still need to take capillary blood glucose measurements (although they can do this less often), because:
Provide them with enough test strips to take capillary blood glucose measurements as needed.
If a person cannot use or does not want a real-time continuous glucose monitor (rtCGM) or intermittently scanned continuous glucose monitor (isCGM), offer capillary blood glucose monitoring.
NICE NG17: Type 1 diabetes in adults: diagnosis and management recommends supporting adults with type 1 diabetes to test blood glucose at least 4 times a day, and up to 10 times a day if any of the following apply:
Enable additional blood glucose testing (more than 10 times a day) for adults with type 1 diabetes if this is necessary because of the person's lifestyle (for example, driving for a long period of time, undertaking high‑risk activity or occupation, travel) or if the person has impaired awareness of hypoglycaemia.
NICE has issued a “Do not do” recommendation in relation to self-monitoring of blood glucose (SMBG) by people with type 2 diabetes. The exceptions to this recommendation are listed below.
NICE guidance recommends that SMBG should not be offered to people with type 2 diabetes unless:
A structured review of self-monitoring in type 2 diabetics should be carried out at least annually.
Short term monitoring should be considered when starting treatment with oral or intravenous steroids or to confirm suspected hypoglycaemia.
NICE NG28 recommends that a small defined group of adult patients with type 2 diabetes who are treated with insulin should be offered intermittently scanned CGM (isCGM). For further information including the local commissioning position, refer to section 6.1.7 Continuous Glucose Monitors (CGM)
All the following first line meters are suitable for use in type 1 and type 2 diabetes (where indicated).
These will be patients with Type 1 diabetes who have received structured education from the local Diabetes Specialist Team.
Primary Care will be advised by the Specialist Team regarding which blood glucose test strip to prescribe for these specific patients.
For patients who are carbohydrate counting, in most cases, a first line formulary choice meter and supporting app, will meet the needs of the patient.
For insulin pump users, some insulin pumps require specific meters, whereas others are not so prescriptive. Whenever possible, a first line formulary choice meter will be selected by the specialist.
However, there maybe be times when a first line formulary choice meter is not suitable. In these cases, primary care is asked to prescribe the corresponding strips as requested by the specialist to support ongoing patient testing. Specialists are expected to explain to the GP the reason that formulary recommended options are not suitable.
With the advancements in technology of strips, testing blood ketones with capillary blood is much more accurate than testing urine for ketones. Type 1 patients who have unstable diabetes control and have a significant risk of developing ketones (after specialist advice) may benefit from testing their blood for ketones once their glucose level reaches an agreed upper limit and/or in times of acute illness. It is also recommended by NICE for all pregnant women with type 1 diabetes and advised for all those on insulin pump therapy.
MHRA Drug Safety Update (March 2020): SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
Freestyle Optium Neo meter is for paediatric use only, where GlucoMen Areo 2K meter or GlucoRx HCT meter is considered not to meet the needs of the child
When transitioning to adulthood, the patient’s meter should be switched to GlucoMen Areo 2K meter or GlucoRx HCT meter for ketone testing