The Health Information and Quality Authority has published a rapid health technology assessment (HTA) on the use of continuous glucose monitoring (CGM) systems in adults with type 1 diabetes. This HTA was requested by the Health Service Executive (HSE).

People with type 1 diabetes need daily injections of insulin to manage their blood glucose levels. Self-monitoring of glucose levels is a crucial part of their diabetes management. Glucose readings can be used to guide insulin treatment. The aim is to achieve optimal glucose control and reduce the occurrence of complications of diabetes, such as heart disease and kidney disease.

Traditionally, self-monitoring has been performed with a finger-prick test to get point-in-time information on current glucose levels. An alternative to this is to use a continuous glucose monitoring, or CGM, system. With these systems, a small disposable sensor is inserted by the user under the skin. The sensor frequently monitors glucose levels with the readings either sent directly to a reader or obtained by scanning the sensor. HIQA found some evidence that use of CGM led to improved average blood sugar levels for people with type 1 diabetes compared with self-monitoring with a finger-prick test.

There are a number of CGM systems available which differ in price, but have similar effectiveness. Currently, not all adults with type 1 diabetes have access to CGM devices in Ireland. The HSE has a managed access programme for one of these systems; however, the arrangements for accessing the other systems has differed. Annual HSE expenditure on CGM systems for adults with type 1 diabetes increased from €0.9 million in 2016 to €30 million in 2022. Over 90% of the expenditure in 2022 related to the more expensive CGM systems as they have been more easily accessed by adults.

Conor Teljeur, HIQA's Chief Scientist, said: "CGM is an alternative form of blood glucose monitoring currently used by over half of all adults with type 1 diabetes in Ireland. Different routes to accessing CGM have meant that the more expensive systems have been easier to obtain. We are advising the HSE that a single managed access programme with clearly defined eligibility criteria would improve equity of access and could help to control costs."

The budget impact of providing access to CGM to all adults with type 1 diabetes would be between €24.8 million and €84.8 million over five years, depending on which system is adopted.

Dr Teljeur added: “We have advised that CGM should continue to be provided in the context of the existing model of care for people with T1DM which includes oversight by specialist diabetes services and empowerment of individuals through access to structured diabetes self-management education.”

The full report can be found at the page's top link.

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Further information:

Marty Whelan, Head of Communications & Stakeholder Engagement

01 814 7480/085 805 5202, mwhelan@hiqa.ie

Notes to Editor:

• It is estimated that there are just over 24,000 adults with type 1 diabetes in Ireland, though there is uncertainty in relation to this figure given the lack of a national diabetes registry in Ireland. The day-to-day burden of managing type 1 diabetes includes glucose monitoring, adjustment of insulin dosing, and restrictions with respect to carbohydrate intake and timing of physical activity.
• Individuals with type 1 diabetes are at risk of hypoglycaemia (when blood glucose is too low) and hyperglycaemia (when blood glucose is too high). Self-monitoring of glucose levels is used to guide insulin treatment.
• The standard method of glucose monitoring since the 1980s has been self-monitoring using capillary blood glucose. It is commonly done through intermittent use of a finger-prick test with a lancet, using testing strips and electronic blood glucose meters to determine blood glucose concentration.
• Continuous glucose monitoring (CGM) systems provide an alternative to the finger-prick test, by measuring glucose levels in the interstitial fluid (a thin layer of fluid around the cells). CGM systems can provide current glucose levels as well as trend data (increasing, decreasing, stable, rate of change). This technology reduces the need for finger-prick testing.
• The current Irish National Clinical Guideline for T1DM can be found here. 
• More information on type 1 diabetes can be found here.