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Continuous Glucose Monitoring Editorial Continuous Glucose Monitoring Adoption in the United Kingdom – An Economic and Policy Perspective Nick Oliver Section of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK C ontinuous glucose monitoring (CGM) technology provides real-time glucose concentration data to people with diabetes. The data enable timely treatment decisions that can lead to avoidance or mitigation of hypoglycaemia, with potential cost savings. This commentary discusses CGM implementation and funding policies in the UK, and regional disparities that confront many people with diabetes who could benefit from the technology. Keywords Continuous glucose monitoring, commissioning, hypoglycaemia Disclosure: Nick Oliver has received research support from Dexcom, Inc. This article is a short opinion piece and has not been submitted to external peer reviewers, but was reviewed by the editorial board for accuracy before publication. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 3 July 2017 Published Online: 22 August 2017 Citation: European Endocrinology, 2017;13(2):73–5 Corresponding Author: Nick Oliver, Section of Diabetes, Endocrinology and Metabolism, Faculty of Medicine, Imperial College, Du Cane Road, London, W12 0HS, UK. E: Support: The publication of this article was supported by Dexcom, Inc. The views and opinions expressed are those of the author and do not necessarily reflect those of Dexcom, Inc. People with type 1 diabetes are at risk of diabetes-specific microvascular complications of retinopathy, nephropathy and neuropathy, and face an increased risk of cardiovascular disease compared with the general population. 1 These risks can be modified by optimising glucose self- management, 2 commonly measured by glycated haemoglobin (HbA1c), and achieved through appropriate selection of insulin preparation, 3 structured education programmes, 4 insulin pump therapy, 5 capillary blood glucose monitoring, and continuous glucose monitoring (CGM). CGM devices display contemporaneous glucose concentration, glucose direction and rate of change, and a graphical representation of the preceding glucose trend. They also provide alerts and alarms for glucose values outside of defined thresholds, and for rapid rates of change. Randomised controlled trials have demonstrated that, compared with intermittent self-monitoring, CGM improves HbA1c, reduces time spent in hypo- and hyperglycaemia, improves fear of hypoglycaemia and quality of life, and lowers the risk of severe hypoglycaemia. 6–10 With the publication, in 2015, of the National Institute for Health and Care Excellence (NICE) guidelines for type 1 diabetes, 11,12 CGM was advocated as a therapeutic option for children and adults living with type 1 diabetes in England (Table 1). The NICE guidance for children supports offering CGM to children with frequent severe hypoglycaemia, to those with impaired awareness of hypoglycaemia associated with adverse consequences (such as seizures or anxiety), or where there is inability to recognise, or communicate about, symptoms of hypoglycaemia due to cognitive or neurological disabilities. In addition, CGM should be considered in neonates, infants and pre- school children with type 1 diabetes, in children and young people who undertake high levels of physical activity (for example, sport at a regional, national or international level), and in children and young people who have comorbidities (for example anorexia nervosa) or who are receiving treatments (such as corticosteroids) that can make blood glucose control difficult. The adult guideline supports consideration of CGM for adults with type 1 diabetes who meet one or more of the following criteria: more than one episode a year of severe hypoglycaemia with no obvious preventable precipitating cause; complete loss of awareness of hypoglycaemia; frequent (more than 2 episodes a week) asymptomatic hypoglycaemia that is causing problems with daily activities; extreme fear of hypoglycaemia; hyperglycaemia (HbA1c level of 75 mmol/mol [9%] or higher) that persists despite self-monitoring of capillary blood at least 10 times a day. 11 Adults accessing CGM should commit to using the system for at least 70% of the time and it must be provided by a centre with expertise in its use, as part of strategies to optimise HbA1c and reduce the frequency of hypoglycaemia. The NICE guidelines are stricter than those in other territories and may prevent some groups from accessing CGM, such as those with impaired awareness of hypoglycaemia and a Gold score between 4 and 6. In order to change this in future guidance, further evidence may be required. TOU CH MED ICA L MEDIA 73