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New report calls for greater access to continuous glucose monitoring for type 2 insulin users

New report highlights the benefits of continuous glucose monitoring (CGM) for people with type 2 diabetes who use insulin but finds that access remains limited due to stigma and financial barriers.
  1. Other groups who could benefit from CGM in the shorter-term include people who are newly diagnosed, undergoing pharmaceutical intensification, awaiting surgery and the elderly. CGM could be employed in the shorter-term as a preventative measure for those at risk.
  2. The benefits have been evidenced by NICE guidelines and examples from clinicians where patients have made behavioural changes after seeing their real-time data. Thanks to CGM, clinicians have access to a rich dataset allowing them to create strong and more personalised treatment plans. While acquisition costs are still an issue, CGM technology can save costs in both the short and long-term.
  3. There is still a significant stigma around wearing a sensor due to the potential identification of an individual as having diabetes. The impact of CGM technology is further limited due to a lack of trust, particularly among marginalised groups, in sharing data with healthcare professionals and organisations. Another big factor is the stigma felt by people living with type 2 diabetes, who unlike type 1 diabetes, are sometimes made to feel their condition is due to unhealthy life choices.
  4. Commissioners should rely on physicians’ decision-making in the use of CGM for people living with type 2 diabetes insulin users. While there is fear around extended access excessively flooding the market and making the spending appear unattainable, a restrictive approach may cause some patients to be left behind.

A new report from Public Policy Projects (PPP) highlights that continuous glucose monitoring (CGM) can provide significant benefits for people with type 2 diabetes who use insulin, but that access remains limited due to stigma and financial barriers.

With more than four million people with type 2 diabetes in the UK, the use of new technologies is becoming essential for effective diabetes care and patient empowerment. PPP’s report finds that primary care staff are under-resourced to deal with the number of new guidelines published, and this is influencing willingness to adopt and push this technology. Also, financial constraints and stigma around the visibility of the sensor are slowing down the effective rollout of the technology across the UK.

The report consists of the findings that emerged during the second roundtable of PPP’s System-wide Strategies for Better Diabetes Care programme. The programme is designed to identify opportunities for improvements and transformation in diabetes care. The roundtable was attended by more than 30 sector leaders from primary and secondary care, pharmacy and integrated care system (ICS) and key industry representatives. The overarching theme was the opportunities and challenges brought by CGM technology to type 2 insulin users and other patient groups.

Professor Parth Kar, National Specialty Advisor for Diabetes at NHS England, chaired this session and commented: “We have the evidence to demonstrate the benefits of CGM to those with diabetes, both in terms of quality of life from a reduction in finger pricking but also, importantly from an economic standpoint of better diabetes management and a reduction in long-term complications and associated comorbidities.”

Recent evidence has shown improved management and outcomes from using CGM, warranting the upfront cost of the technology purchase. These improvements are likely linked with the publication of NICE guidelines in 2022, which approved the use of CGM technology for around 50,000 type 2 diabetes insulin users in the UK. Roundtable attendees expressed a sense of renewed motivation and engagement from patients using CGM, as the feedback empowers them to be less reliant on healthcare professionals and make informed decisions about their care.

The discussion also covered other groups that could benefit from CGM use. For instance, people who are at risk of developing diabetes (such as those with pre-diabetes or those whom population health management techniques have identified as at risk of developing type 2 diabetes), can benefit from real-time data being used to promote behavioural changes.

Additionally, CGM could be used preventatively among patients awaiting surgery, where short-term use of CGM could help them manage their blood glucose before surgery. Preventative use of CGM can also support those with a new diagnosis of type 2 diabetes, as well as those whose treatment is being intensified and the elderly.

The report also highlights the existing barriers that impede the effective implementation of the technology. These barriers include financial restraints and stigma, which have the high potential to widen health inequalities.

Delegates from a commissioning background reported that most integrated care boards (ICBs) are eager to adopt this technology for their patients, but the elevated acquisition costs are the greatest challenge in its rollout. There are relevant geographical differences across ICBs in adopting the guidelines and creating a policy to support implementation.

Delegates pointed out that inequalities are widening in areas lacking specific ICB policies. Data from France where CGM has been implemented shows that over a set time, there is a 50 per cent reduction in emergency admissions associated with diabetes. In a similar way, greater access of CGM could reduce hypoglycaemia-related hospital admissions, which each episode costs the NHS £1000 .

In addition to financial barriers, there is still significant stigma around type 2 diabetes. One of the challenges is the CGM device’s visibility, which can lead to patients being identified as having type 2 diabetes. A paediatric diabetologist pointed out that this is particularly the case for young people. Also, the colouration of sensor covers has previously been limited and designed for Caucasian skin tones, creating another barrier to people with diabetes from ethnic minorities. These circumstances may exacerbate existing stigma, bringing individuals with type 2 diabetes less likely to feel empowered and fight for access to technology.

Commenting on the report, a stakeholder present at the roundtable stated: “We are always looking at how we can best meet the needs of people with diabetes and that includes product design. Feedback is useful for our R&D team for consideration as they work on future product updates.” The issue of data sharing and trust was also discussed. Broader issues concerning public trust in sharing their health data could hamper the progress and uptake of CGM.

The report underscores the importance of industry support to promote effective rollout of CGM. Thanks to their understanding of product design, capabilities, and limitations, industry can support effective use of the devices by health and care professionals (HCPs) and people with diabetes through training and educational support. Partnerships between industry and the NHS need to persist and grow for successful uptake of CGM more widely.

Recommendations from the report

For integrated care boards (ICBs)

  • Develop a policy to facilitate implementation of CGM technology for type 2 diabetes insulin users. Learn from ICBs with existing policies to manage up-front costs (for instance, phased implementation aligned to NICE guideline NG28).
  • Create system-level strategic partnerships with industry to ensure that primary care staff across localities receive the support and training needed on CGM technology and that patients understand its benefits. Such training partnerships should be embedded in ICS policies for CGM implementation.
  • Optimise CGM technology use and streamline existing pathways for local patients’ support with CGM, by working with clinical pharmacists who dispense repeat prescriptions of the technology and assist users with their understanding of CGM.

For primary care leadership

  • Proactively encourage primary care teams to learn and advocate for CGM technology; collaborate with industry to understand CGM technology and upskill. Identify intuitive aspects of the technology to start building understanding from that entry point.
  • Provide training and materials to all HCPs on the value of data sharing for patients and the data protection processes to build trust and confidence in data sharing.
  • Have peer-to-peer training and share best practice to promote the adoption of CGM, as well as other technology innovations that come in via primary care.
  • Mobilise all primary care staff to help reduce the stigma surrounding type 2 diabetes by promoting the patient voice and having positive conversations around diabetes management and treatment.

For NHS England and central government

  • Review how NICE guidelines can be better implemented at system level. Consider pairing new NICE guidelines with resources to ensure they are possible to implement, for instance, staff resources and funding.
  • Review the evidence for short-term use of CGM in particular cohorts. For instance, pre-operative preparation or for educational purposes in people who are at risk of diabetes (pre-diabetic) or intensifying treatment.
  • Ensure updated or new NICE guidelines consider primary care clinicians’ time and provide additional resources for effective implementation. Extend training to every aspect of primary care including those working in the community (such as district nurses) to prevent people who are housebound or have additional needs being left behind. Ensure additional funding and resources are available and that the longer-term cost savings are highlighted to ensure understanding by HCPs of the health economic argument and the patient experience. Provide successful case studies.

To view the report in full, click here.

The use of technology, health inequalities and stigma experienced by people with diabetes will be further explored at Panel 3 and Panel 5 at the Diabetes Care Conference 2024 on 27 June. While Panel 3 will be dedicated to discussing the role played by technology in bridging the inequality gap and the impact of deprivation health outcomes for people with diabetes, Panel 5 will focus perspectives on the challenges, opportunities and game changes from a primary care, an ICB leadership and a population health perspective. The conference is an invaluable opportunity for our delegates and speakers to engage in an extensive dialogue to deep dive into evidence-approved medicines for type 2 diabetics, as well as how we can go further in reducing inequalities and outcomes and how we can overcome barriers to adoption and the role of clinical pathways.

For more information and to register your place, click here.

For more information about PPP’s Diabetes Care Programme 2024, or to request interviews, please contact:

Ameneh Saatchi, Director of Market Access and Policy, at ameneh.saatchi@publicpolicyprojects.com.

* All PPP roundtables operate under the Chatham House Rule, so individuals cannot be named.


References

1 NICE recommends life changing technology is rolled out to people with type 1 diabetes | News | News | NICE

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