In a debate in the House of Lords this week, we were pleased that the Liberal Democrat peer Lord Rennard raised the issue of the inequality in access to CGM for people with type 2 diabetes with Health Minister Baroness Merron.
Despite updated national guidance in 2022 that recommended continuous glucose monitoring (CGM) for some groups of people with type 2 diabetes, the progress towards rolling out the technology to those eligible across England has been slow.
The latest figures from our Diabetes Tech Can’t Wait campaign show that only around half of the local health systems in England have policies which align with the guidance. This compares to over 80% of areas which have CGM policies for people with type 1 diabetes in line with the relevant guidance published at the same time.
The benefits of CGMs include providing a far better insight into a person’s glucose levels, compared to finger-prick testing, which research has showed results in lower HbA1c – which is associated with a reduced risk of long-term diabetes complications.
Over two years on from the guidance, there is a risk that these disparities in access to CGM between different eligible groups of people will persist, unfairly denying people with diabetes access to tech that can have life-changing benefits, which has been evaluated as being clinically and cost-effective by the National Institute for Health and Care Excellence (NICE) - the recognised national clinical guidance body.
CGM access criteria for type 2 diabetes
NICE guidance currently recommends CGM for adults with type 2 diabetes who take more than one daily insulin injection and meet at least one of these other criteria:
- Finger-prick testing at least eight times a day
- Experiencing recurrent or severe hypos
- Impaired hypo awareness
- Having a condition or impairment which means someone can’t finger-prick test but could use CGM or have someone else help them too.
It also recommends CGM for adults with type 2 diabetes who use insulin and would need help from a care worker or healthcare professional to monitor their blood sugar levels.
There are gaps in access to CGM
We believe that access to technology should be based on need, not type of condition or where you live, and the current discrepancy in adoption of CGM policies deny many with type 2 diabetes an important tool to self-manage their condition.
Worryingly, this also intersects with other things we know about health inequalities: with people from Black and South Asian backgrounds and more deprived areas being more likely to develop type 2 diabetes, less likely to receive essential diabetes care and go on to experience worse health outcomes.
Without a national focus on improving the current situation, people who are already disproportionately impacted by the condition will face a very steep uphill battle to get this tech.
Data has been a key enabler to increasing access to CGM and reducing inequalities for people with type 1 diabetes – where it is now estimated that around nine in 10 people use CGM and significant progress has been made to reduce disparities – but information relating to type 2 diabetes is not yet available to the same level of detail. This makes it difficult to understand where exactly the gaps are arising, find out why and develop plans to address and close them.
What’s next?
The Minister confirmed that from 2025 the National Diabetes Audit will be collecting and reporting on data related to inequalities based on deprivation and ethnicity for CGM usage in type 2 diabetes.
This is welcome and will be important for driving improvements, but it is expected this data will only be available from the latter half of 2025 and there is work to be done still to build support, share examples of success and empower advocates – to ensure rolling out CGM technology to people with type 2 diabetes remains high on the agenda for diabetes care, and so that we avoid entrenching inequalities and ending up with an unfair postcode lottery.
Read Lord Rennard's question in the debate on the UK Parliament website.
