Continuous glucose monitoring (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Continuous glucose monitoring covers both real-time continuous glucose monitoring (rt-CGM) and intermittently scanned continuous glucose monitoring (is-CGM, commonly referred to as 'flash'). CGM measures interstitial glucose levels.

When prescribing CGMs, continue to supply blood glucose monitoring strips (on repeat or acute prescription) for the patient to order when needed, as the patient will still need to perform finger prick testing of blood glucose levels. 
Patients with type 1 diabetes, or who require to ketone test, will still require a supply of blood ketone testing strips. 

Adults:
GPs can ONLY prescribe CGM for individuals identified by the Adult Diabetes Team who are eligible based on clinical need and the eligibility criteria below:

Eligibility criteria:

  • Individuals with diabetes who are attending diabetes specialist services and treated with intensive insulin therapy, with multiple daily insulin injections, or insulin pump therapy, who are already performing multiple (5 or more) fingerprick blood glucose tests per day.
  • Individuals with recently developed impaired awareness of hypoglycaemia who are not yet candidates for (more costly) continuous glucose monitoring systems.
  • Women planning pregnancy.
  • Those who required a third party to perform monitoring, or where dexterity or disability denote that conventional testing is difficult or impossible.

Other criteria: 

  • Deemed by the team to have the required knowledge and skills to effectively self-manage their diabetes. This may include having undertaken a recognised diabetes structured education programme (eg HEIDI), and/or 1 to 1 carbohydrate counting.
  • Completion of the on-line Libre Academy modules at: https://freestylediabetes.co.uk/freestyle-libre/academy. Agreement to attend a locally provided flash glucose monitoring education session, or an on-line equivalent, if appropriate.
  • To agree to review glucose a minimum of six times per day.
  • To use sensors as recommended.
  • To agree to share glucose monitoring data with the diabetes clinic and complete any associated clinical questionnaires.

Paediatrics: 
GP's will be notified by letter by the Paediatric Diabetes Team if a specific patient has met all the requirements for these to be safely prescribed as per NICE NG18, below:

  • Offer real-time continuous glucose monitoring (rtCGM) to all children and young people with type 1 diabetes, alongside education to support children and young people, and their families and carers, to use it.
  • Monitor and review the child or young person's use of CGM as part of reviewing their diabetes care plan, and explain to them the importance of continuously wearing the device. 
  • If the child or young person is not using their CGM device at least 70% of the time
    • ask if they are having problems with their device.
    • look at ways to address any problems or concerns to improve their use of the device, including further education and emotional and psychological support. 
  • 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.

Ongoing prescription:

Determined by the specialist diabetes team at review appointments: Requires effective use of the technology to improve self-management, eg, reduction in hypoglycaemia, improvement in HbA1c, reduction in hospital admissions.

Further information for Health Care Professionals

Patient information

For technical problems, individuals should contact the manufacturer directly rather than contacting their GP or the diabetes team.

Dexcom UK Technical Support:
Telephone: 0800 031 57 63
Or Product Support Request

  • Monday to Friday 7am to 6pm
  • Saturday & Sunday 8am to 4:30pm
  • Excluding public holidays

FreeStyle Libre
Abbott UK General Customer Service:
Telephone: 0800 1701177

  • Monday to Friday 8am to 8pm
  • Excluding bank holidays

Patient info via Dexcom ONE app.
And via: Dexcom.com.
FAQs: 

 Patient information: FreeStyle Libre Abbot.
If the individual does not have a compatible smartphone then the company will provide one free of charge.
See: compatible smartphones		 If the individual is unable to use a smartphone/ device a reader is supplied free of charge.

GLUCOSE INTERSTITIAL FLUID DETECTION SENSOR

Therapy notes

  • Dexcom ONE and FreeStyle Libre 2 are FIRST LINE cost-equivalent alternatives. 
  • Dexcom ONE+ and FreeStyle Libre 2 Plus are newer devices that have improved accuracy and will be used in place of Dexcom ONE and FreeStyle Libre 2 over time
  • FreeStyle Libre 3 is less cost-effective and is used SECOND LINE only for those eligible patients who are using insulin pumps. 

Formulation and dosage details

Formulation:

Dexcom ONE CGM system (Restricted: Specialist recommendation only)

FIRST LINE ALTERNATIVE:

  • On the advice of the Specialist Diabetes Team, for eligible patients based on clinical need and the eligibility criteria above.
  • For individuals who prefer to apply the sensor to their abdomen. 
  • For individuals who have had issues with alternative CGM devices.

Three-month supply: 1 x transmitter and 3 x 3 sensor kits

Dexcom ONE Sensor

  • Can be used for up to 10 days.
  • Is water-resistant (eg shower, swimming).
  • Approved for use on the arm and abdomen (all ages) and the upper buttock (age 2 to 17 years).
    It can be worn at different sites to Freestyle Libre (which is only licensed for use on the back of the arm). 
  • It has fewer alarms than the more advanced Dexcom G6 and G7 glucose monitors, does not link with insulin pumps, and cannot be “followed” on a partner or family member’s phone.
  • High and low alarms can be set on the associated smartphone app/reader device.
Dexcom ONE Transmitter (also to be prescribed)
  • Sends glucose readings every 5 minutes to smartphone or receiver.
    The continuous nature of the device means individuals do not need to physically scan the sensor to obtain glucose data.
  • Lasts 90 days, to be re-used across multiple sensors
  • Individuals alerted via the app when a new transmitter is required.

Formulation and dosage details

Formulation:

FreeStyle Libre 2 CGM system (Restricted: Specialist recommendation only)

FIRST LINE ALTERNATIVE:

  • On the advice of the Specialist Diabetes Team, for eligible patients based on clinical need and the eligibility criteria above.
  • For individuals who have had issues with alternative CGM devices.

Two-month supply: 2 x 2 sensor kits

  • Can be used for up to 14 days
  • Is water-resistant (eg shower, swimming)
  • When a new ‘reader’ is ordered an envelope will be sent to return the old reader/meter to Abbot for recycling. For further information see: website.

Formulation and dosage details

Formulation:

Dexcom ONE+ CGM system (Restricted: Specialist recommendation only)

ALTERNATIVE: to Dexcom ONE

  • On the advice of the Specialist Diabetes Team, for eligible patients based on clinical need and the eligibility criteria above.
  • For individuals who prefer to apply the sensor to their abdomen, or have had issues with alternative CGM devices eg adhesive or accuracy in the past. 

Three-month supply: 3 x 3 sensor kits

  • All-in-one sensor/ transmitter. No need for a separate transmitter
  • Can be used for up to 10 days, with 12 hour grace period for sensor replacement
  • Is water-resistant (eg shower, swimming)
  • Sends regular glucose readings to your smartphone or receiver
  • Facility for users to add notes to highlight events, eg, food intake, exercise
  • Facility to share glucose data with up to 10 followers
  • Improved accuracy compared to Dexcom ONE
  • Reduced warm up (30 min) compared to Dexcom ONE
Until this device is added to the Vision dictionary, please use a handwritten prescription to prescribe.

Formulation and dosage details

Formulation:

FreeStyle Libre 2 Plus CGM system (Restricted: Specialist recommendation only)

ALTERNATIVE: to FreeStyle Libre 2

  • On the advice of the Specialist Diabetes Team, for eligible patients based on clinical need and the eligibility criteria above.
  • For eligible individuals using a compatible insulin pump with hybrid closed loop functionality, eg, Omnipod 5

Two-month supply: 2 x 2 sensor kits

  • Can be used for up to 15 days
  • Is water-resistant (eg shower, swimming)
  • When a new ‘reader’ is ordered an envelope will be sent to return the old reader/meter to Abbot for recycling. For further information, see: website.
Until this device is added to the Vision dictionary, please use a handwritten prescription to prescribe.

Formulation and dosage details

Formulation:

FreeStyle Libre 3 CGM system (Restricted: Specialist recommendation only)

SECOND LINE:

  • On the advice of the Specialist Diabetes Team, for eligible patients based on clinical need and the eligibility criteria above.
  • AND for individuals using a compatible insulin pump with hybrid closed loop functionality eg Ypsomed/CamAPS FX.

Two-month supply: 2 x 2 sensor kits

  • Can be used for up to 14 days
  • Is water-resistant (eg shower, swimming)
  • When a new ‘reader’ is ordered an envelope will be sent to return the old reader/meter to Abbot for recycling.  For further information, see: website.

Editorial Information

Last reviewed: 23/04/2024

Next review date: 27/06/2024

Author(s): Endocrinology.

Version: 2.2

Approved By: TAMSG of the ADTC

Document Id: F180