Quality statement 3: Continuous glucose monitoring | Diabetes in pregnancy | Quality standards

Quality statement

Pregnant women with type 1 diabetes are offered continuous glucose monitoring. [new 2023]

Rationale

Continuous glucose monitoring (CGM) allows women with type 1 diabetes to monitor their glucose levels during pregnancy to ensure they can maintain or work towards the level agreed with their healthcare professional. This can help to reduce the risk of adverse outcomes, such as a baby that is large for gestational age, trauma during birth, neonatal hypoglycaemia and perinatal death. The likelihood of caesarean section and neonatal intensive care unit admissions should also be lower. Women should be offered real-time CGM (rtCGM) but, if they are unable to use rtCGM or would prefer to use intermittently scanned CGM (isCGM, commonly referred to as 'flash'), this should be offered instead.

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.

Services may want to use these measures to focus on dimensions of health inequality, for example, by reporting data grouped by ethnicity or indices of deprivation.

Process

Proportion of pregnant women with type 1 diabetes who use CGM.

Numerator – the number in the denominator who use CGM.

Denominator – the number of pregnant women with type 1 diabetes.

Data source: The National Pregnancy in Diabetes Audit began collecting data on the use of CGM in 2021. Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) Adverse foetal and neonatal outcomes for babies of women with 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 patient records. The National Pregnancy in Diabetes Audit collects data on congenital anomalies and serious adverse outcomes and their association with HbA1c levels in early pregnancy. It also collects data on the relationship between HbA1c levels in late pregnancy and the percentages of babies admitted to neonatal care, preterm live births before 37 weeks, perinatal deaths and babies who are large for gestational age.

b) Time in range during pregnancy for women with 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 patient records. The National Pregnancy in Diabetes Audit collects data on congenital anomalies and serious adverse outcomes and their association with HbA1c levels in early pregnancy. It also collects data on the relationship between HbA1c levels in late pregnancy and the percentages of babies admitted to neonatal care, preterm live births before 37 weeks, perinatal deaths and babies who are large for gestational age.

c) Maternal diabetic complications.

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 patient records.

What the quality statement means for different audiences

Service providers (such as GP practices and community and secondary care diabetes services) ensure that pregnant women with type 1 diabetes are offered rtCGM (or isCGM if they prefer it or are unable to use rtCGM). Service providers also ensure that they are supported to confidently use the type of CGM they have selected.

Healthcare professionals (GPs, community midwives and healthcare professionals in joint diabetes and antenatal care teams) ensure that they offer pregnant women with type 1 diabetes rtCGM (or isCGM if they prefer it or are unable to use rtCGM). They support the woman to confidently use the type of CGM she has selected.

Commissioners (integrated care systems and NHS England) ensure that they commission services that provide rtCGM or isCGM where appropriate, to pregnant women with type 1 diabetes.

Pregnant women with type 1 diabetes are offered an rtCGM, or an isCGM (commonly referred to as 'flash') if they prefer it or are unable to use rtCGM. They are also supported to confidently use the CGM with which they have chosen to monitor their glucose levels during their pregnancy.

Source guidance

Diabetes in pregnancy: management from preconception to the postnatal period. NICE guideline NG3 (2015, updated 2020), recommendations 1.3.17 and 1.3.18

Definitions of terms used in this quality statement

Continuous glucose monitoring

This covers both rtCGM and isCGM.

A CGM is a device that measures blood glucose levels and sends the readings to a display device or smartphone. [NICE's guideline on type 1 diabetes in adults: diagnosis and management, terms used in this guideline]

Equality and diversity considerations

Pregnant women with type 1 diabetes living in deprived areas are less likely to use CGM. This is also the case for pregnant women with Black or Asian family backgrounds. It is therefore important for services to work closely with these groups to ensure that they are aware of the benefits of CGM and that they can access it and any additional equipment if they want to use it.

Pregnant women with a physical, mental health related or learning disability may need additional support to use their CGM device.

Commissioners, providers and healthcare professionals should address inequalities in CGM access and uptake by:

monitoring who is using CGM
identifying groups who are eligible but who have a lower uptake
making plans to engage with these groups to encourage them to consider CGM.

[NICE's guideline on type 1 diabetes in adults: diagnosis and management, recommendation 1.6.18]

Pregnant women with type 1 diabetes should be given information about CGM that they can easily read and understand themselves, or with support, so they can communicate effectively with health 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 and age appropriate. People should have access to an interpreter or advocate if needed.

For pregnant women with type 1 diabetes 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.