Type 1 diabetes in adults

Quality statement

Adults with type 1 diabetes are offered a choice of real-time or intermittently scanned continuous glucose monitoring. [2023]

Rationale

Continuous glucose monitoring (CGM) helps adults with type 1 diabetes to 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 so they can easily track the data and share it with their healthcare professionals when needed. For adults with frequent severe hypoglycaemia, particularly those who have difficulty recognising or reporting it, CGM can help to reduce the risk and burden of hypoglycaemia. Adults should be offered a choice of real-time CGM (rtCGM) or intermittently scanned CGM (isCGM, commonly known as 'flash'). This should be based on their individual preferences, needs, characteristics, and the functionality of the devices available.

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 age, ethnicity or indices of deprivation.

What the quality statement means for different audiences

Service providers (primary care networks, community providers and secondary care services) ensure that systems are in place to offer a choice of rtCGM or isCGM (commonly known as 'flash') to adults with type 1 diabetes. They should ensure education is provided alongside CGM to support adults with type 1 diabetes to use it. They should also address inequalities in CGM access and uptake by monitoring who is using CGM, identifying groups who are eligible but who have a lower uptake and making plans to engage with these groups to encourage them to consider CGM.

Healthcare professionals (such as GPs, diabetes specialist nurses and consultant diabetologists) offer a choice of rtCGM or isCGM (commonly known as 'flash') to adults with type 1 diabetes, based on their individual preferences, needs, characteristics, and the functionality of the devices available. They also provide education to support them to use the CGM device. In addition, they should help to address inequalities in CGM access and uptake by monitoring who is using CGM, identifying groups who are eligible but who have a lower uptake and making plans to engage with these groups to encourage them to consider CGM.

Integrated care systems ensure that rtCGM and isCGM are available to services for adults with type 1 diabetes so that they can make a choice on the type of device based on their individual preferences, needs, characteristics, and the functionality of the devices available. They should also address inequalities in CGM access and uptake by ensuring that they monitor who is using CGM, identify groups who are eligible but who have a lower uptake and make plans to engage with these groups to encourage them to consider CGM.

Adults with type 1 diabetes are offered a choice of isCGM (commonly known as 'flash') or rtCGM based on their individual preferences, needs, characteristics, and the functionality of the devices available to help manage their diabetes. They are also shown how to use their choice of CGM.

Source guidance

Type 1 diabetes in adults: diagnosis and management. NICE guideline NG17 (2015, updated 2022), recommendation 1.6.10

Definitions of terms used in this quality statement

Equality and diversity considerations

Providers and healthcare professionals should address inequalities in CGM access and uptake by monitoring who is using it, identifying groups who are eligible but have lower uptake and making plans to engage with and encourage these groups to consider CGM. For example, data suggests that adults with type 1 diabetes from lower socioeconomic groups are less likely to use CGM.

Adults with type 1 diabetes who are offered CGM should be given information about using the technology 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 adults who do not speak or read English, and it should be culturally appropriate and age appropriate. Adults should have access to an interpreter or advocate if needed.

For adults 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.