Almost 30 000 children living with type 1 diabetes in the UK (are set to be offered new technology to help them manage their condition and at the same time reduce the need for painful finger prick testing by up to 50%.
Updated guidance from the National Institute for Care and Health Excellence (NICE, 2022) has recommended, for the first time, the use of real-time continuous glucose monitoring (rtCGM) for children – and adults - living with type 1 diabetes. The technology will give them a continuous stream of real-time information on a smartphone about their current blood glucose level.
Alongside new rtCGM technology, the use of intermittently scanned glucose monitoring (isCGM) devices – also known as flash monitoring – is being expanded to the whole of the type 1 patient population. Patients will now have a choice in picking the technology which is right for them in discussion with their diabetes team.
Both techniques remove the need for such frequent finger prick testing, which many children and young people find painful, inconvenient and intrusive on their day-to-day lives.
It means that children will be able to find the blood-testing system that best suits their needs and lifestyle. Flash monitoring and rtCGM systems differ in that with a CGM the latest sugar levels show up on device or mobile automatically, transmitted by Bluetooth. With a flash glucose monitor, the patient needs to wave or scan their device over the sensor to get their blood sugar reading.
The rtCGM sensor is attached discreetly to the child's body and collects the data which is transmitted to their smartphone. The data provides current and previous glucose levels as well as a prediction of where the levels are headed, meaning they can take action to stabilise their levels if necessary.
The real-time systems also feature active alerts or alarms that warn users of immediate and/or impending high or low blood sugar. Research has found both real-time and flash devices can help people maintain optimal blood sugar control.
Until now, NICE had only recommended technology for continuous glucose monitoring for adults with type 1 diabetes in certain circumstances and capillary blood glucose monitoring (finger-prick testing) for people who were not eligible for the technology.
With the introduction of new technology for everyone with type 1 diabetes, children and young people will no longer have to monitor their condition with finger-prick testing as regularly as before. Instead, the technology, calibrated using the person's blood, will do that work for them. Experts predict this will reduce by half the need for finger-prick testing.
Dr Paul Chrisp, director of the centre for guidelines at NICE, said: ‘This will be a step forward in helping all people with type 1 diabetes manage their condition.
‘Many people find finger-prick testing to be painful and time consuming and the introduction of technology for all people living with type 1 diabetes will reduce this considerably. This group of people also live with the constant worry of suffering from an attack brought on by dangerously low blood sugar while they sleep. Having an alarm which will alert them if this happens will give them the peace of mind.’
Chris Askew, chief executive at Diabetes UK, said: ‘These landmark guidelines promise to be transformational for people living with diabetes. Having campaigned for many years for wider access to Flash and continuous glucose monitoring, and contributed to NICE's consultation, we are delighted that the voice of people with diabetes has been heard, and that our calls have been listened to.
‘What we are seeing today is a key shift in thinking – a move to recognising that technology is an integral part of diabetes management, not simply an added luxury.
‘There is still work to do. Local health systems will need to support health-care professionals to deliver these guidelines equitably and we will play our part too, in helping the NHS to get this right.’
Meanwhile, Professor Partha Kar, national NHS speciality adviser for diabetes, added: ‘This announcement is the biggest step forward for type 1 diabetes care in years. These monitors are a win-win – they support diabetes patients to live healthier lives, reduce their risk of hospitalisation while also helping to reduce pressure on NHS services and provide better value for money for taxpayers.’
According to research, adolescents and young adults with type 1 diabetes exhibit some of the worst glycaemic control among people with type 1 diabetes across all ages. Although rtCGM has been shown to improve glycaemic control in adults, its benefit in adolescents and young adults had not been demonstrated, until recently.
‘Many people find finger-prick testing to be painful and time consuming and the introduction of technology for all people living with type 1 diabetes will reduce this considerably.’
However, a study carried out in the United States 4 years ago of 153 individuals aged 14 to 24 years with type 1 diabetes, who were being treated by 14 endocrinology settings, found that continuous glucose monitoring, compared with standard blood glucose monitoring, resulted in a ‘small but statistically significant improvement in glycaemic control over 26 weeks’ (Laffel et al, 2020).
It concluded that further research was needed to understand the clinical importance of the findings.
Another study presented at a recent Diabetes UK conference found that artificial intelligence (AI) can help spot children with previously undiagnosed type 1 diabetes.
The charity said that a quarter of patients were not being diagnosed until they presented with potentially life-threatening symptoms of diabetic ketoacidosis and the new predictive tool could help to reduce this number.
The tool has been trained to spot patterns in a children's health record such as urinary infections, bedwetting and a family history of the disease. It was tested again using data on GP records of 2.5 million children and successfully identified 75% of children who would go on to develop type 1 in the following 90 days.
FURTHER INFORMATION
National Institute for Health and Care Excellence
Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Updated NICE guideline [NG18]: https://www.nice.org.uk/guidance/ng18/chapter/Recommendations#continuous-glucose-monitoring
Diabetes UK
https://www.diabetes.org.uk
Juvenile Diabetes Research Foundation
https://jdrf.org.uk