Continuous glucose monitoring and hybrid closed loop for diabetes

What is a continuous blood glucose monitor?

A continuous glucose monitor (CGM) is a device for people with the following symptoms: diabetes Check your glucose (sugar) levels at any time.

You can see patterns in your blood sugar levels and see if your blood sugar levels are too high or too low. You'll be more informed and able to take action faster to help control your blood sugar levels.

Help you and your diabetes team ensure:

• If your blood sugar levels are rising or falling
• How blood sugar levels change over time
• What happens to your levels when you are asleep?

If your reading is:

structure

CGM consists of:

• Sensor – A small device placed on your arm or stomach that senses how much glucose is in the fluid under your skin, called interstitial fluid.
• A reader or receiver to display the results (if you have a smartphone, you can also get the results on your smartphone)

In some types, called real-time CGM, the sensor sends results to a receiver or mobile phone every few minutes. You can check your blood sugar level at any time with the receiver. Some types can send results to your insulin pump, so you can check your blood sugar levels at the pump.

Other types of CGMs, also known as flash monitors or intermittent scanned CGMs, require you to scan the sensor with a reader or mobile phone to see the results.

There are several different types of real-time CGM. The Abbott FreeStyle Libre 2 is the only type of flash monitor available, but when used with a smartphone, it functions similarly to a real-time CGM. The original Abbott FreeStyle Libre is no longer manufactured.

Most types of CGMs, including the FreeStyle Libre 2, have an optional alarm that alerts you if your blood sugar levels are too low or too high.

Depending on the type of monitor, you typically need to replace the sensor every 7 to 14 days.

Interstitial fluid blood glucose levels lag blood glucose levels by several minutes. This means that you may need to do a finger prick test from time to time, especially when driving or if you have low blood pressure.

To get the most out of your CGM, you need to review the information it provides to your team.

What is hybrid closed loop?

A hybrid closed-loop system (also known as an “artificial pancreas”) is a technology in which a CGM works with an insulin pump to help manage blood sugar.

CGM constantly monitors blood sugar levels. A computer program on your phone or in your insulin pump uses this data to calculate how much insulin you need. The pump automatically delivers the correct amount of insulin.

Still, you need to calculate the amount of carbohydrates in your food or drink and enter this data into the system before you eat.

The hybrid closed-loop system improves blood sugar levels, reduces the risk of hypoglycemia, and makes diabetes easier to manage.

Get CGM or Hybrid Closed Loop on the NHS

If you have type 1 diabetes

CGM should be available on the NHS to anyone with type 1 diabetes. Children and young people are usually provided with real-time CGM. Adults are usually offered a choice of real-time CGM or flash.

Ask your diabetes team about getting a CGM.

Hybrid closed-loop systems are now available on the NHS for some people with type 1 diabetes. The system will be gradually introduced over five years starting in April 2024, starting with those who need it most. Because it takes time for the technology to be safely available to everyone who would benefit from it.

The hybrid closed loop is planned to be available to all children and young people with type 1 diabetes and will eventually be available to adults with type 1 diabetes who are:

• Blood sugar level (HbA1c level) is 58 mmol/mol or higher
• Have serious problems with low blood pressure despite using an insulin pump or CGM alone and trying to carefully manage blood sugar levels
• are pregnant or planning to become pregnant

If you think you might be eligible for hybrid closed loop, talk to your diabetes team at your next appointment. They will explain your options.

If you have type 2 diabetes

If you have type 2 diabetes, you must take insulin at least twice a day and be offered a flash monitor on the NHS if any of the following apply to you:

• Have frequent or severe hypotension
• You don't always notice symptoms when you have low blood pressure
• You cannot monitor your own blood sugar levels using a finger prick test
• Finger prick tests must be performed at least eight times a day

Insulin pumps and hybrid closed loop systems for people with type 2 diabetes are not currently available on the NHS.

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