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The routine commissioning of continuous glucose monitors (CGMs) is accepted in Devon only in line with specific criteria; CGMs are not routinely commissioned for use outside these patient groups (refer to Commissioning Policy for initiation and continuation criteria).
A range of rtCGM devices are available, it is expected that a clinically appropriate device with the lowest cost is chosen (taking into account acquisition and ongoing running costs).
NICE advises that people who are using CGM (and their families or carers) will still need to take capillary blood glucose measurements to check the accuracy of their CGM device and as a back-up (for example when their blood glucose levels are changing quickly or if the device stops working), although they can do this less often. GPs should consider reducing the number of testing strips and lancets the patient requires in combination with a continuous glucose monitor.
Please refer to DVLA guidance regarding the use of real-time CGM (rtCGM) and intermittently scanned CGM (isCGM, also referred to as “flash” glucose monitors) when driving.
GP prescribable rtCGM is routinely commissioned for ALL patients with type 1 diabetes (or type 3c diabetes who are treated with insulin).
GP prescribable rtCGM is also routinely commissioned as an alternative to intermittently scanned continuous glucose monitoring (isCGM) for patients who meet the isCGM eligibility criteria in the policy if it is available for the same or lower cost.
Diabetes specialists* will provide appropriate patient training (and a route for ongoing support), supply the initial sensor and transmitter and ensure that this is linked with the patient’s smartphone or reader device, and ensure that the patient has sufficient sensors to last until the GP is able to provide ongoing prescriptions.
Following initial supply by the specialist*, the GP may be asked to prescribe rtCGM sensors on an ongoing basis.
* This includes primary care diabetes professionals with suitable knowledge and experience of rtCGM.
Notes
A 6-month trial of intermittently scanned continuous glucose monitoring (isCGM) is routinely commissioned for patients with type 1 diabetes (or type 3c diabetes who are treated with insulin), and patients with type 2 diabetes who are treated with multiple daily insulin injections and who meet one or more of the criteria specified in the Commissioning Policy (updated December 2022)
The commissioning policy also details specific continuation criteria which must be met in order for continued use of an isCGM device. On completion of the trial, the initiating clinician should undertake a review to assess suitability for continuation against the specified criteria.
Diabetes specialists* will provide appropriate patient training (and a route for and ongoing support), supply the initial sensor and ensure that this is linked with the patient’s smartphone or reader device, and ensure that the patient has sufficient sensors to last until the GP is able to provide ongoing prescriptions.
Following initial supply by the specialist*, the GP may be asked to prescribe isCGM sensors on an ongoing basis (including during the 6-month trial period).
* This includes primary care diabetes professionals with suitable knowledge and experience of isCGM.
Notes
A range of rtCGM devices are available, it is expected that a clinically appropriate device with the lowest cost is chosen (taking into account acquisition and ongoing running costs).
A 6-month trial of a secondary care procured rtCGM is routinely commissioned only for patients with type 1 diabetes (or type 3c diabetes who are treated with insulin) who meet one or more of the criteria specified in the Commissioning Policy.
The commissioning policy also details specific continuation criteria which must be met in order for continued use of a secondary care procured (non GP prescribable) rtCGM device.
It is expected that at each review consideration is given to stepping down to lower cost (e.g GP prescribable) forms of glucose monitoring wherever clinically appropriate or where the ability to recognise and/or communicate about symptoms of hypoglycaemia has significantly improved.
These devices (including Dexcom G6 & G7, Medtrum TouchCare, Medtronic Guardian, and Freestyle Libre 3) are only available via the secondary care NHS supply chain; GPs are unable to prescribe these devices.
MHRA Device Safety Information (May 2021): Dexcom G6 Sensor: Untested barrier methods to reduce skin reactions:
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