Quality standard

Quality statement 4: Continuous glucose monitoring in type 1 diabetes

Quality statement 4: Continuous glucose monitoring in type 1 diabetes

Quality statement

Children and young people with type 1 diabetes are offered real-time continuous glucose monitoring (rtCGM).

Rationale

rtCGM helps children and young people with type 1 diabetes and their family members or carers (as appropriate) respond more quickly to changes in blood glucose levels throughout the day. It also leads to a decrease in HbA1c and an increase in time spent within the target range. The monitor can be connected to a phone or device belonging to the child or young person, or their parent or carer, so they can easily track the data and share it with their healthcare professionals when needed. For children and young people with frequent severe hypoglycaemia (particularly those who have difficulty recognising or reporting it), continuous glucose monitoring can help improve their control of blood glucose and HbA1c levels.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that rtCGM is available to all children and young people with type 1 diabetes.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from procurement records.

Process

Proportion of children and young people with type 1 diabetes who receive rtCGM.

Numerator – the number in the denominator who receive rtCGM.

Denominator – the number of children and young people with type 1 diabetes.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Included in the Royal College of Paediatrics and Child Health National Paediatric Diabetes Audit.

Outcome

a) HbA1c level of 48 mmol/mol or lower.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Included in the Royal College of Paediatrics and Child Health National Paediatric Diabetes Audit.

b) Time in range.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

c) Quality of life of children and young people with type 1 diabetes.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient satisfaction surveys. Included in the Royal College of Paediatrics and Child Health National Paediatric Diabetes Audit.

What the quality statement means for different audiences

Service providers (secondary care providers) ensure that systems are in place to offer rtCGM to children and young people with type 1 diabetes. They should ensure education is provided alongside rtCGM to support children and young people and their families and carers to use it.

Healthcare professionals (such as consultants and diabetes specialist nurses) offer rtCGM to children and young people with type 1 diabetes and provide education alongside it to support them and their families and carers to use rtCGM.

Commissioners commission services that offer rtCGM to children and young people with type 1 diabetes. They also ensure that the services provide education and support to use rtCGM to children, young people and their families.

Children and young people with type 1 diabetes are offered real-time continuous glucose monitoring. This is special equipment that checks the person's blood glucose in real time, without them having to do finger-prick tests.

Definitions of terms used in this quality statement

Real-time continuous glucose monitoring

Continuous glucose monitoring gives information about glucose levels every few minutes. The person using it has a sensor that measures the glucose level in the tissue just below the skin. 'Real‑time continuous' means the device takes real-time measurements for as long as it is worn. [Expert opinion and Juvenile Diabetes Research Foundation (JDRF)]

Equality and diversity considerations

Children and young people with type 1 diabetes living in deprived areas are less likely to use rtCGM. This is also the case for Black and Asian children and young people. It is therefore important for the services to work closely with these groups to ensure that they are aware of the benefits of rtCGM and that they can access it and any additional equipment if they want to use it.

Children and young people with type 1 diabetes and their family members or carers (as appropriate) should be provided with information about rtCGM that they can easily read and understand themselves, or with support, so they can communicate effectively with health and social care services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.