Search
Search titles only
By:
Search titles only
By:
Home
Forums
New posts
Search forums
What's new
New posts
New profile posts
Latest activity
Members
Current visitors
New profile posts
Search profile posts
Log in
Register
Search
Search titles only
By:
Search titles only
By:
New posts
Search forums
Menu
Install the app
Install
Reply to Thread
Guest, we'd love to know what you think about the forum! Take the
Diabetes Forum Survey 2024 »
Home
Forums
Diabetes Discussion
Type 1 Diabetes
Had a read of the NICE Guidelines - it's quite revealing...
JavaScript is disabled. For a better experience, please enable JavaScript in your browser before proceeding.
You are using an out of date browser. It may not display this or other websites correctly.
You should upgrade or use an
alternative browser
.
Message
<blockquote data-quote="tim2000s" data-source="post: 887895" data-attributes="member: 30007"><p>Further - the update paper discusses the following questions with regard to CGMs and makes the following recommendations:</p><p></p><p></p><p>56.Do not offer real-time continuous glucose monitoring routinely to adults with type 1 diabetes. [new 2015] </p><p></p><p>57.Consider real-time continuous glucose monitoring for adults with type 1 diabetes who are willing to commit to using it at least 70% of the time and to calibrate it as needed, and who have any of the following that persist despite optimised use of insulin therapy and conventional blood glucose monitoring: </p><ul> <li data-xf-list-type="ul">more than 1 episode a year of severe hypoglycaemia with no obviously preventable precipitating cause </li> <li data-xf-list-type="ul">complete loss of awareness of hypoglycaemia </li> <li data-xf-list-type="ul">frequent (more than 2 episodes a week) asymptomatic hypoglycaemia that is causing problems with daily activities </li> <li data-xf-list-type="ul">extreme fear of hypoglycaemia. [new 2015] </li> </ul><p></p><p>58.For people who are having continuous glucose monitoring, use the principles of flexible insulin therapy with either a multiple daily injection insulin regimen or continuous subcutaneous insulin infusion (CSII or insulin pump) therapy. [new 2015] </p><p></p><p>59.Continuous glucose monitoring should be provided by a centre with expertise in its use, as part of strategies to optimise a person’s HbA1c levels and reduce the frequency of hypoglycaemic episodes. [new 2015]</p><p></p><p>The cost basis for CGM is wholly based on existing CGMs and not the Libre cost model, so the average cost of CGM is calculated at £3593 rather than the £1269 of the Libre. This compares to £1059 for fingerpricking when ten tests are done per day. </p><p></p><p>The studies cited by the document do show an improvement in Hba1C for CGM users, of 0.3%, only when used intensively. This is considered "Just significant", or in other words, if the cost was appropriate, then the use of the CGM technology has enough of an impact to make a difference. </p><p></p><p>In terms of quality of life measurement, the paper states that use of CGM is equivalent value to fingerpricking ten times daily. What it doesn't take into account is the quality of life impact of fingerpricking ten times daily. A fabulous circular miss in my book!</p><p></p><p><em>An original economic analysis compared SMBG with different frequencies to CGM; this analysis showed that CGM is more effective (increases QALYs) compared with SMBG up to 4 times but it is not more effective than SMBG 8 or 10 times a day; CGM is also more costly than any selected frequencies of SMBG (up to 10 times daily). SMBG 8 times daily was the most cost-effective strategy in the probabilistic analysis while SMBG 10 times daily was the most cost effective strategy in the deterministic analysis; in both analyses CGM was more costly and less effective than these strategies. In the base case analysis, the decrease in HbA1c level obtained with CGM in the meta-analysis of studies comparing CGM with SMBG was assumed to have been estimated compared with SMBG 4 times daily. In order to test whether CGM could be cost effective in some circumstances, a series of sensitivity analyses were conducted where the effectiveness of CGM at reducing HbA1c level was assumed to be estimated compared with SMBG 10. In these analyses CGM was not dominated anymore but Type 1 diabetes in adults Blood glucose control 254 Update 2015 its high cost was not offset by its increase in effectiveness. A subgroup analysis on people with hypo unawareness who have a risk of hypoglycaemic events 6 times higher than in the other type 1 diabetes population was conducted; in this analysis, the baseline risk of hypo events was increased and the effectiveness of CGM at reducing hypo events was 100% (no events occurred in the CGM arm of the model) and the cost of CGM was decreased by 30%. The results showed that the ICER of CGM versus SMBG 10 times daily was £30,203 per QALY, which is still above the NICE threshold. This analysis had some important limitations in terms of uncertainty in key parameters (quality of life associated with hypo events) and missing links between model outcomes (achieved HbA1c level and hypo events). Also the clinical effectiveness data on different frequencies of SMBG was obtained from a cross-sectional study; a higher frequency of testing could lead to a decrease in hypoglycaemic events but these data could not be obtained from the available study. The population in this analysis may not be representative of people with type 1 diabetes who have problems at controlling their HbA1c level with SMBG and self-injection only. The cost effectiveness of CGM in combination with insulin pumps was not assessed and it may be that this combination is cost effective in people with glycaemic control issues, , also because the prices of CGM equipment is lower when used in conjuction with insulin pumps.</em></p><p></p><p>I'll leave it to the evidence in the paper itself to describe the conclusions about CGM as it shows what is required:</p><p></p><p><strong>It was clear to the GDG that current data do not support the routine use of CGM. There is some evidence of clinical benefit but this is not compelling, and it is not currently a cost-effective intervention.</strong></p></blockquote><p></p>
[QUOTE="tim2000s, post: 887895, member: 30007"] Further - the update paper discusses the following questions with regard to CGMs and makes the following recommendations: 56.Do not offer real-time continuous glucose monitoring routinely to adults with type 1 diabetes. [new 2015] 57.Consider real-time continuous glucose monitoring for adults with type 1 diabetes who are willing to commit to using it at least 70% of the time and to calibrate it as needed, and who have any of the following that persist despite optimised use of insulin therapy and conventional blood glucose monitoring: [LIST] [*]more than 1 episode a year of severe hypoglycaemia with no obviously preventable precipitating cause [*]complete loss of awareness of hypoglycaemia [*]frequent (more than 2 episodes a week) asymptomatic hypoglycaemia that is causing problems with daily activities [*]extreme fear of hypoglycaemia. [new 2015] [/LIST] 58.For people who are having continuous glucose monitoring, use the principles of flexible insulin therapy with either a multiple daily injection insulin regimen or continuous subcutaneous insulin infusion (CSII or insulin pump) therapy. [new 2015] 59.Continuous glucose monitoring should be provided by a centre with expertise in its use, as part of strategies to optimise a person’s HbA1c levels and reduce the frequency of hypoglycaemic episodes. [new 2015] The cost basis for CGM is wholly based on existing CGMs and not the Libre cost model, so the average cost of CGM is calculated at £3593 rather than the £1269 of the Libre. This compares to £1059 for fingerpricking when ten tests are done per day. The studies cited by the document do show an improvement in Hba1C for CGM users, of 0.3%, only when used intensively. This is considered "Just significant", or in other words, if the cost was appropriate, then the use of the CGM technology has enough of an impact to make a difference. In terms of quality of life measurement, the paper states that use of CGM is equivalent value to fingerpricking ten times daily. What it doesn't take into account is the quality of life impact of fingerpricking ten times daily. A fabulous circular miss in my book! [I]An original economic analysis compared SMBG with different frequencies to CGM; this analysis showed that CGM is more effective (increases QALYs) compared with SMBG up to 4 times but it is not more effective than SMBG 8 or 10 times a day; CGM is also more costly than any selected frequencies of SMBG (up to 10 times daily). SMBG 8 times daily was the most cost-effective strategy in the probabilistic analysis while SMBG 10 times daily was the most cost effective strategy in the deterministic analysis; in both analyses CGM was more costly and less effective than these strategies. In the base case analysis, the decrease in HbA1c level obtained with CGM in the meta-analysis of studies comparing CGM with SMBG was assumed to have been estimated compared with SMBG 4 times daily. In order to test whether CGM could be cost effective in some circumstances, a series of sensitivity analyses were conducted where the effectiveness of CGM at reducing HbA1c level was assumed to be estimated compared with SMBG 10. In these analyses CGM was not dominated anymore but Type 1 diabetes in adults Blood glucose control 254 Update 2015 its high cost was not offset by its increase in effectiveness. A subgroup analysis on people with hypo unawareness who have a risk of hypoglycaemic events 6 times higher than in the other type 1 diabetes population was conducted; in this analysis, the baseline risk of hypo events was increased and the effectiveness of CGM at reducing hypo events was 100% (no events occurred in the CGM arm of the model) and the cost of CGM was decreased by 30%. The results showed that the ICER of CGM versus SMBG 10 times daily was £30,203 per QALY, which is still above the NICE threshold. This analysis had some important limitations in terms of uncertainty in key parameters (quality of life associated with hypo events) and missing links between model outcomes (achieved HbA1c level and hypo events). Also the clinical effectiveness data on different frequencies of SMBG was obtained from a cross-sectional study; a higher frequency of testing could lead to a decrease in hypoglycaemic events but these data could not be obtained from the available study. The population in this analysis may not be representative of people with type 1 diabetes who have problems at controlling their HbA1c level with SMBG and self-injection only. The cost effectiveness of CGM in combination with insulin pumps was not assessed and it may be that this combination is cost effective in people with glycaemic control issues, , also because the prices of CGM equipment is lower when used in conjuction with insulin pumps.[/I] I'll leave it to the evidence in the paper itself to describe the conclusions about CGM as it shows what is required: [B]It was clear to the GDG that current data do not support the routine use of CGM. There is some evidence of clinical benefit but this is not compelling, and it is not currently a cost-effective intervention.[/B] [/QUOTE]
Verification
Post Reply
Home
Forums
Diabetes Discussion
Type 1 Diabetes
Had a read of the NICE Guidelines - it's quite revealing...
Top
Bottom
Find support, ask questions and share your experiences. Ad free.
Join the community »
This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies.
Accept
Learn More.…