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Continuous Glucose Monitoring Original Research
An Economic Evaluation of Continuous Glucose
Monitoring for People with Type 1 Diabetes
and Impaired Awareness of Hypoglycaemia
within North West London Clinical Commissioning Groups in England
Shraddha Chaugule, 1 Nick Oliver, 2 Brigitte Klinkenbijl 3 and Claudia Graham 1
1. Global Access, Dexcom Inc., San Diego, CA, US; 2. Section of Diabetes, Endocrinology and Metabolism, Faculty of Medicine, Imperial College,
London, UK; 3. International Access, Dexcom Operating Limited, Tanfield, Edinburgh, Scotland, UK
O bjective: To assess the economic impact of providing real time continuous glucose monitoring (CGM) for people with type 1
diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) within North West (NW) London clinical commissioning groups
(CCGs). Methods: The eligible population for CGM and inputs for the economic budget impact model developed were derived from
published data. The model includes cost of CGM; cost savings associated with lower hypoglycaemia related hospital admissions, accidents
and emergency visits; self-monitoring of blood glucose (SMBG) strip usage; and glycated haemoglobin (HbA1c) reduction-related avoided
complications and insulin pump use. Results: The cost of CGM for T1D-IAH (n=3,036) in the first year is £10,770,671 and in the fourth year is
£11,329,095. The combined cost off-sets related to reduced hypoglycaemia admissions, SMBG strip usage and complications are £8,116,912
and £8,741,026 in years one and four, respectively. The net budget impact within the NW London CCGs is £2,653,760; £2,588,068 in years one
and four respectively. Conclusions: Introduction of CGM for T1D-IAH patients will have a minimal budget impact on NW London CCGs, driven
by cost of CGM and offsets from lower hypoglycaemia-related costs, reduced SMBG strip usage, avoided HbA1c-related complications and
lower insulin pump use.
Keywords Continuous glucose monitoring, economics,
type 1 diabetes, clinical commissioning group
Disclosure: Shraddha Chaugule is an employee
of Dexcom, Inc. Brigitte Klinkenbijl is an employee
of Dexcom, Inc. and owns stock in the company.
Claudia Graham is an employee of Dexcom, Inc.
and owns stock in the company. Nick Oliver has
nothing to declare in relation to this article.
Acknowledgments: The authors would
like to thank Dr Mark Charney for help with
the initial model conceptualisation and Dr
John Welsh for editorial assistance.
Compliance with Ethics: This study involves
an economic evaluation and did not involve
any studies with human or animal subjects
performed by any of the authors.
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: 11 July 2017
Accepted: 11 August 2017
Citation: European Endocrinology, 2017;13(2):81–5
Corresponding Author: Brigitte Klinkenbijl, International
Access, Dexcom Operating Limited, Tanfield, Edinburgh,
EH3 5DA, Scotland, UK. E: email@example.com
Support: The publication of this article was
supported by Dexcom, Inc. The views and opinions
expressed are those of the authors and do not
necessarily reflect those of Dexcom, Inc.
TOU CH MED ICA L MEDIA
About 10% of adults with diabetes in the United Kingdom (UK) have type 1 diabetes (T1D) and are
treated by daily insulin doses – taken either by injections or via an insulin pump. 1 Diabetes is a
leading cause of morbidity and mortality and is associated with substantial healthcare and societal
costs. The cost of diabetes to the National Health Service (NHS) is over £1.5m an hour or 10% of
the total NHS budget for England and Wales. This equates to over £25,000 being spent on diabetes
every minute. 2 Intensive therapy that lowers average glucose levels has been shown to reduce the
risk of the long-term complications of diabetes but it also increases the risk of hypoglycaemia, 3–5
which results in significant morbidity and mortality and may cause fear of hypoglycaemia which is
a major barrier to optimising glucose control. 2
Real-time continuous glucose monitoring (CGM) is the most advanced glucose monitoring
technology that continuously measures interstitial glucose levels, displays the current glucose
level and direction and rate of change, and uses alarms and alerts to inform patients and
caregivers when glucose levels are exceeding or falling below specified thresholds. 6,7 This
complete picture of glycaemic activity helps guide diabetes management decisions (e.g., insulin
dosage adjustments, changes in diet) to avoid glycaemic excursions. 6,7 In the recently conducted
DIAMOND randomised controlled trial (RCT) in T1D participants on multiple daily injections (MDI)
with a mean baseline glycated haemoglobin (HbA1c) of 70 mmol/mol (8.6%), there was a 10.9
mmol/mol (1%) demonstrated reduction in HbA1c for the CGM group compared with 4.4 mmol/mol
(0.4%) reduction in the self-monitoring of blood glucose (SMBG) group at 24 weeks from baseline.
Participants in the CGM group also spent significantly less time (p=0.002) in hypoglycaemia (duration
of hypoglycaemia) at <2.8 mmol/L, <3.3 mmol/L and <3.9 mmol/L; had a significant reduction in
diabetes distress (p<0.001); less fear of hypoglycaemia (p=0.02); and an increase in hypoglycaemia
confidence (p<0.001) and well-being (p=0.01), compared with conventionally monitored patients
using SMBG alone. 8,9 Similarly, in the GOLD RCT, T1D participants on MDI and HbA1c above target, a
significant reduction in HbA1c was seen using CGM compared with SMBG alone. 10
Recurrent hypoglycaemia induces a maladaptive response that impairs the ability of patients to
detect the early warning signs of hypoglycaemia, a condition known as impaired awareness of
hypoglycaemia (IAH). IAH significantly increases the risk of severe hypoglycaemia, which requires
assistance from a third party to treat 11 and often requires costly emergency medical care. 12 Tools
are needed that can help people with insulin-treated diabetes to lower their blood glucose levels