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Updated NICE T1 guidelines published

tim2000s

Expert
Retired Moderator
As the title says:

https://www.nice.org.uk/guidance/NG17

Interestingly, Hba1c is recommended to be below 6.5 and all Type 1s are recommended to use at least MDI.

To achieve the 6.5 Hba1c many of us have had to invest in some form of CGM. Pity this is still not recommended under the NICE guidelines. Once again, they are disjointed and don't really reflect what is needed to manage diabetes long term.
 
And dietary advice. I was achieving 6.5% on mdi without cgm using lchf. Now I'm in the 5% club with a pump and self funding cgm, still lchf.
 
Pleased to see the MDI recommendation although patients should still be given a choice.

This is good news for those that have trouble with obtaining sufficient test strips to manage their diabetes:

  • Support adults with type 1 diabetes to test at least 4 times a day, and up to 10 times a day if any of the following apply:



  • the desired target for blood glucose control, measured by HbA1c level (see recommendation 1.6.6), is not achieved

  • the frequency of hypoglycaemic episodes increases

  • there is a legal requirement to do so (such as before driving, in line with the Driver and Vehicle Licensing Agency [DVLA] At a glance guide to the current medical standards of fitness to drive)

  • during periods of illness

  • before, during and after sport

  • when planning pregnancy, during pregnancy and while breastfeeding (see the NICE guideline on diabetes in pregnancy)

  • if there is a need to know blood glucose levels more than 4 times a day for other reasons (for example, impaired awareness of hypoglycaemia, high‑risk activities). [new 2015]
 
Wow, how timely/coincidental l that I was ranting about the guidelines and the fact they hadn't been updated in 5 yrs just 2 days ago...and magically we have new, improved guidelines!!

Do you mind divulging what the cost of the CGM is, and whether you find it intrusive uncomfortable to carry around day to day?

I definitely think that the CGM is extremely beneficial and advantageous and am defo considering getting one.
 
I would like to see a CGM available on prescription, from the guidlines Neemo posted it seems that a lot of the treatment for diabetes is about cutting cost rather than quality of care.
 
TooMuchGlucose said:
I would like to see a CGM available on prescription, from the guidlines Neemo posted it seems that a lot of the treatment for diabetes is about cutting cost rather than quality of care.
Click to expand...
In a perfect world all Type 1s should/would get these, would make a HUGE difference to their lives.
 
Last edited by a moderator:
Daibell said:
Overall it's a very sensible document. Pity that many GPs won't have time to read it or follow it.
Click to expand...

Or that the CCGs still haven't got business or funding managers that can truly weigh up costings of a freestyle navigator or cgm compared to strips for those persons that wish to look after themselves...
 
Just to add; the CGM seems to be pretty expensive and the NHS budget is finite (aging population, increase in obesity and cancer).

I think, at the very least they should consider subsidising the costs of a CGM..
 
Spiker said:
So they are now recommending CGM for a much wider set of circumstances. See 1.6.21-24
Click to expand...

That seems pretty reasonable, obviously I'd love everyone to get one. Hopefully with more people getting them, the cost will come down and eventually it will be made available to all.
 
1.3. 1-3 They say offer DAFNE to all, and if the person does not want to do group education offer them an equivalent. This puts BDEC Online on a NICE approved footing I think?
 
From discussions on this forum the cost to run CGM is similar to the cost to run a pump. So with these new guidelines it might be possible for an individual to choose to have CGM funded rather than a pump? I'm speculating.
 
It's nice to see that detemir is the preference for basal insulin now, as I posted in the other thread about how the long acting human insulin was known to increase nocturnal hypoglycaemia and this is not recommended anymore (Section 1.7.3).
 
I think to achieve a 6.5 or below for type1 diet plays the biggest part...........ie as little carbs as possible...

a cgm to me is still just a tool to carry out basal tests and to help with hypos.....
 
@Neemo, @CatLadyNZ , your off topic posts have been deleted.
If you wish to carry on your debate that is not relevant to the thread, will you please do so via PM. as per the forum rules.

• This is a forum of many different personalities – if you disagree with someone then use the PM system or start a constructive debate. It doesn't do yourself or anyone else any favours to have to read miles of disagreeing posts.
 
The cgm I use is the dexcom 4 because I have a receiver already in the animas pump I gave. They do a starter kit for £500. It has the transmitter and four sensors. Then the sensors cost £186 for four.
The sensors officially last 1 week. But I restart them after the 7 days and get between 15 - 21 days of rational readings.
I fund this by not drinking, smoking or going out - I have no friends! It is brilliant of a night as my low alarm goes off at 4.4 so it's annoying but makes me safe. I always wake up up I hypo in that disgusting sweaty state but since using cgm it's a case of ho-hum correct with tabs/ oat biscuit as required and back to sleep.
Will be looking at the new guidelines to check funding.
Hope this helps.
 
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