Dexcom G6 for real-time continuous glucose monitoring

The technology described in this briefing is the Dexcom G6 real-time continuous glucose monitoring system. It measures interstitial fluid glucose levels in people with type 1 or type 2 diabetes.

The innovative aspects are that the Dexcom G6 continuously measures glucose levels using a sensor inserted under the skin instead of routine finger-prick blood glucose testing. Glucose measurements can be shared remotely with carers and family members through the connected app. Alerts sound if glucose levels fall outside of a target range. The sensor can be left in place for 10 days.

The intended place in therapy is as an alternative to routine blood glucose monitoring in people (over 2 years old), including pregnant women, with type 1 or type 2 diabetes, who use multiple daily insulin injections or use insulin pumps and are self-managing their diabetes.

The main points from the evidence summarised in this briefing are from 6 studies: 4 randomised controlled trials, 1 prospective multicentre cohort study and 1 retrospective cohort study, including a total of 10,967 people in diabetes clinics. They suggest that using the Dexcom G6 reduces interstitial fluid glucose levels and the time spent in hypoglycaemia compared with self-monitoring of blood glucose using finger-prick testing.

Key uncertainties around the evidence or technology are that there is variable access to continuous glucose monitors, such as Dexcom G6, across clinical commissioning groups.

The cost of Dexcom G6 is between £1,850 and £2,645 per person per year (excluding VAT) depending on the quantity of units bought. One economic study concluded that over each person's lifetime, the total costs of the Dexcom G6 device were £14,234 higher than finger-prick blood glucose testing (£102,468 compared with £88,234). However, improving blood glucose control could lead to cost savings by avoiding the costs of both short-term and long-term clinical outcomes of poorly managed diabetes.