The Scottish Health Technologies Group (SHTG) advice49 in 2018 recommended the availability of flash glucose monitoring for individuals with diabetes who are actively engaged in the management of their condition and who intensively manage their disease with multiple daily insulin injections* or insulin pump therapy, with some restrictions.
*NICE define multiple daily injections as ‘two or more daily insulin injections, which could either be a basal-bolus regimen or more than one daily insulin injection.’
NICE guidance2 supports the pre-existing guidance from SHTG and recommends offering intermittently scanned continuous glucose monitoring (isCGM), commonly referred to as 'flash', to adults with T2DM on multiple daily insulin injections if any of the following situations apply:
- recurrent hypoglycaemia or severe hypoglycaemia
- impaired hypoglycaemia awareness
- a condition or disability (including learning disability or cognitive impairment) where the individual cannot self-monitor blood glucose using capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them)
- would otherwise be advised to self-measure at least eight times a day (SHTG recommend at least six times per day)
Additionally, adults with insulin-treated type 2 diabetes who would otherwise need help from a care worker or healthcare professional to monitor their blood glucose, should be offered isCGM.
Good practice point
Those prescribed flash glucose monitors only require two sensors per 28 days (26 within a year).
If the sensors become detached or are faulty, people should contact the manufacturer directly for replacements.
It is good practice to utilise prescribing data to identify patients who may be over-ordering and/or put in place mechanisms which prevent this, such as annual serial prescription for 26 sensors, to reduce inappropriate prescribing and associated costs.
For all individuals requiring glucose monitoring there should be a documented plan outlining frequency and duration of testing, along with what to do with results. Most people require diabetes assessments every three to six months and this should be tailored according to the individual needs to improve care. Use of diabetes digital resources to support self-management are recommended, such as My Diabetes My Way (a list of further resources is available in lifestyle interventions and remission).