For anyone who lives in Greater London, on 5 October 2022 the NHS London Clinical Network for Diabetes (a group consisting of clinicians, patients and system partners) issued guidance ("A pan-London implementation document for continuous glucose sensors for adults with T1 diabetes: written pathway") to all integrated care boards and secondary care to indicate how the new NICE guidelines NG17, issued on 1st April 2022, ought to be implemented in London.
As far as the Libre 3, Dexcom G7, Dexcom G6 are concerned, the guidance issued says that if a diabetic patient demonstrates (a) problematic hypoglycaemia, or (b) is pregnant and has problematic hypoglycaemia, or (c) is using or will in the future use an automated insulin delivery system/closed loop/insulin pump where the cgm is (or will be) compatible with the insulin delivery system, etc and/or (d) there is a clinical need to have a family member, friend or other carer have access to their glucose data, then clinicians should consider offering patients access to the appropriate cgm.
"Problematic hypoglycaemia" is defined in the guidance as either:
1. One or more episodes of severe hypoglycaemia in the preceding 12 months; and/or
2. Impaired hypoglycaemia awareness (score ≥ 4 Gold score); and/or
3. More than one episode of asymptomatic hypoglycaemia per week;
4. Fear of hypoglycaemia
The guidance goes on to indicate that those who don't fall within the above criteria should be offered other continous glucose monitors or flash glucose monitors which are available on prescription.
They have included a very useful flowchart that suggests the decision -making process.
This guidance has apparently been rolled out to the various Greater London ICBs and secondary care.
It will be interesting to see to what extent this guidance is adopted outside Greater London.
As far as the Libre 3, Dexcom G7, Dexcom G6 are concerned, the guidance issued says that if a diabetic patient demonstrates (a) problematic hypoglycaemia, or (b) is pregnant and has problematic hypoglycaemia, or (c) is using or will in the future use an automated insulin delivery system/closed loop/insulin pump where the cgm is (or will be) compatible with the insulin delivery system, etc and/or (d) there is a clinical need to have a family member, friend or other carer have access to their glucose data, then clinicians should consider offering patients access to the appropriate cgm.
"Problematic hypoglycaemia" is defined in the guidance as either:
1. One or more episodes of severe hypoglycaemia in the preceding 12 months; and/or
2. Impaired hypoglycaemia awareness (score ≥ 4 Gold score); and/or
3. More than one episode of asymptomatic hypoglycaemia per week;
4. Fear of hypoglycaemia
The guidance goes on to indicate that those who don't fall within the above criteria should be offered other continous glucose monitors or flash glucose monitors which are available on prescription.
They have included a very useful flowchart that suggests the decision -making process.
This guidance has apparently been rolled out to the various Greater London ICBs and secondary care.
It will be interesting to see to what extent this guidance is adopted outside Greater London.
