Children with type 2 diabetes (T2D) on insulin treatment are to be offered automated blood glucose monitoring technology, as is already available to children with type 1 diabetes. New guidelines from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and management of diabetes in children and young people aged under 18 for the first time recommended that the technology be extended to some children with T2D.
NICE said that currently children who have to manage their condition with finger prick testing several times a day could now be offered the choice of real-time continuous glucose monitoring (rtCGM) or intermittently scanned glucose monitoring (isCGM) devices - also known as flash monitoring. These technologies virtually automate the process and were potentially "life changing", NICE said.
Diabetes UK welcomed the move. Policy manager Nikki Joule said: "We are pleased to see the new NICE guidelines recommending that continuous glucose monitoring devices are made available for some children with type 2 diabetes.
Managing Diabetes 'Really Challenging' for Children
"Diabetes is a relentless condition, requiring constant, careful management, which can be really challenging for children and young people. It’s important that these devices are now rapidly offered to affected families to help them manage their child’s condition well. That will require healthcare systems to swiftly make plans to equitably roll out these devices to children who are eligible."
NICE said that the technology could benefit hundreds of children with T2D who are currently using finger prick testing, which it described as 'burdensome', 'tiring', and 'stressful'. Instead, rtCGM or isCGM devices give "a continuous stream of real-time information on a smartphone" from a discreetly-worn body sensor that monitors current and previous glucose levels.
Monitoring Devices Help Maintain Optimal Glucose Control
The devices also give a prediction of where glucose levels are headed, meaning that children can inject themselves with insulin to stabilise their levels if necessary, allowing better and speedier management of the condition. NICE said that research had shown that both real-time and flash devices help people to maintain optimal blood sugar control.
Children and their families will be allowed to choose whichever technology meets their preferences. However NICE noted that currently use of isCGM for children aged 3 years and under is off-licence. It said that if multiple devices met the person’s needs and preferences, clinicians should offer the one with the lowest cost.
Dr Judith Richardson, programme director in the Clinical Directorate at NICE, said: "Type 2 diabetes in children is the most aggressive form of the disease and recommending new technology is a clear step towards giving children on insulin therapy the ability to manage their own condition in a less invasive way, and to live happier and healthier lives."
She added: "This technology can take away the burdensome task of several finger prick tests a day, which can be tiring, stressful and have a negative psychological impact on the child. Improvements made in managing a child’s diabetes at an early stage can reduce the health impact of the condition later in their lives, and the potential impact on the health service."
Devices Also Offered to Those With Complex Needs
The updated guidance said that children and young people with T2D should be offered insulin if their HbA1c level was 69 mmol/mol (8.5%) or more. As well as those children using insulin, NICE's guideline committee also recommended that monitoring technology be offered to those who:
- Have a need, condition or disability (including a mental health need, learning disability or cognitive impairment) that means they cannot engage in monitoring their glucose levels by capillary blood glucose monitoring
- Would otherwise be advised to self-measure at least 8 times a day
- Have recurrent or severe hypoglycaemia
- Have impaired blood sugar awareness
Professor Partha Kar, national specialty advisor for diabetes at NHS England, said: "Some of the [affected] children and young people often have the most complex needs, with a high proportion of them having either a learning disability, special educational need or mental health issue.
"Asking these children to carry out finger prick testing when non-invasive sensors are progressing to become standard care in diabetes is not right, so I am pleased these evidence-based recommendations have been made to offer this life-changing technology to them."
NICE said that eligible children or their families should speak to their diabetes team to access real-time or flash monitors on prescription.