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Continuous Glucose Monitoring Original Research Is Continuous Glucose Monitoring Underappreciated in the UK? Christopher G Parkin, 1 Melissa Holloway, 2 Jeffrey Truesdell 3 and Tomas C Walker 3 1. CGParkin Communications, Inc., Boulder City, NV, US; 2. Speaking Diabetes Ltd, London, UK; 3. Dexcom, Inc., San Diego, CA, US I ntroduction: Information about continuous glucose monitoring (CGM) use in the UK is limited. We conducted an online survey of a representative sample of current CGM users in England, Scotland and Wales to address this deficit. Methods: The 29-item online survey was conducted between 29 December 2016 and 25 January 2017. Persons with type 1 diabetes (T1D) and caregivers of T1D children/ adolescents were recruited from mailing lists, using Nielsen and Harris Polling databases. Results: 315 patients and caregivers responded to the survey – 170 adult patients and 145 caregivers. Among respondents, 144 received full funding for CGM use, 72 received partial funding and 83 received no funding. Most reported improvements in glycated haemoglobin (HbA1c) (67.0%), fewer hypoglycaemia episodes (70.2%), improved hypoglycaemia awareness (77.5%) and better diabetes management (92.4%). Self-funders reported significantly higher CGM use (76.1%) than those who were fully funded (58.9%) and/or partially funded (65.9%), p=0.0008. Fewer than 50% of all respondents reported receiving guidance in interpreting CGM data from their diabetes care team; 30.1% of self-funders reported receiving no CGM support from their diabetes team compared with fully funded (2.8%) and partially funded (1.4%) respondents, p<0.0001. Conclusions: Patients with T1D and their caregivers are realising benefits from CGM use but are largely unsupported by the UK healthcare system. Keywords Continuous glucose monitoring (CGM), insulin, multiple daily insulin injections (MDI), type 1 diabetes, self- monitoring of blood glucose (SMBG) Disclosure: Christopher G Parkin has received consulting fees from CeQur, Dexcom, Inc., Insulet, Mannkind, Roche Diabetes Care and Senseonics. Melissa Holloway is Chief Adviser of INPUT Patient Advocacy and has received consulting fees from Dexcom, Inc. and Ascensia Diabetes Care UK Limited. Jeffrey Truesdell and Tomas C Walker are employees of Dexcom, Inc. Dexcom, Inc., provided funding for the development of this manuscript. Compliance with Ethics: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions. 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: 29 June 2017 It is well known that optimising glycaemic control reduces the development and/or progression of microvascular and macrovascular disease in type 1 diabetes (T1D). 1,2  Unfortunately, a significant percentage of individuals with diabetes are not achieving their recommended glycated haemoglobin (HbA1c) goals. 3 Although achieving and maintaining optimal glycaemic levels through self-management remains a challenge for all individuals with T1D, regardless of geographic location, the quality of care and support patients receive is also a factor, which appears to differ from country to country. It is estimated that up to 74% of adults with T1D in the UK have HbA1c levels >7.5%, 4 which is in stark contrast to other Western countries. A comparison of glycaemic control between countries showed notable differences in median HbA1c levels in the UK, US and Germany among adults aged ≥25 years 3 (Figure 1A). Similar differences in glycaemic control are observed among children/adolescents <18 years enrolled in the UK National Paediatric Diabetes Audit (NPDA), the US T1D Exchange (T1DX) and the Austrian/German Prospective Diabetes Follow-up Registry (DPV) 5 (Figure 1B). The past decade has seen significant advancements in diabetes management tools and technologies that have been demonstrated to improve glycaemic control in individuals with T1D. Real-time continuous glucose monitoring (rtCGM) is one such tool. Numerous studies have shown that use of rtCGM confers significant benefits on individuals with T1D using the technology, including improvements in HbA1c and reductions in the occurrence of severe hypoglycaemia and/ or duration of hypoglycaemia. 6–22 Accepted: 2 August 2017 Citation: European Endocrinology, 2017;13(2):76–80 Corresponding Author: Christopher G Parkin, CGParkin Communications, Inc., Boulder City, NV, US. E: chris@cgparkin.org 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. Although the majority of previous studies have been conducted among patients who use CGM in conjunction with insulin pump therapy, 6–11 recent randomised clinical trials have demonstrated that patients using multiple daily insulin injections (MDI) can safely use CGM to reduce HbA1c, reduce hypoglycaemia and replace fingerstick testing for routine diabetes care decisions. 21–26 Regardless of the method of insulin delivery, the benefit of CGM is primarily seen in patients who regularly use their devices at least 70% of the time. 6,12,21,22 Use of CGM has increased significantly in the US, particularly over the last 4 years, 27 but adoption of this technology has been relatively slow in Europe due to lack of reimbursement, lack of awareness regarding the benefits of CGM and/or pursuit of cost containment. However, in 2016 German 76 TOU C H ME D ICA L ME D IA