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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: 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.
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
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