HNY Policy and Pathway Repository - Humber

Diabetes Mellitus

These interventions are commissioned for:

• Adults (18 years of age and older), young people and children with type 1 Diabetes
• Adults (18 years of age and older), young people and children with type 2 Diabetes 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 OR
  • would otherwise be advised to self-monitor at least 8 times a day OR
  • have recurrent or severe hypoglycaemia
  • have impaired hypoglycaemic awareness
• Young people and children with type 2 Diabetes who are on Insulin therapy
• Pregnant women with type 1 Diabetes
• Pregnant women who are on insulin therapy, do not have type 1 diabetes, but have:
  • problematic severe hypoglycaemia (with or without impaired awareness of hypoglycaemia) OR
  • unstable blood glucose levels that are causing concern despite efforts to optimise glycaemic control

The choice between real-time and intermittently scanned monitoring should be based on joint decision making with patients according to individual preferences, needs, characteristics and the functionality of devices available.

If multiple devices meet the needs and preferences of the person, the device with the lowest cost should be used.

Diabetes Mellitus is a collective term covering multiple metabolic disorder subtypes in which either not enough insulin is produced or the insulin produced is not effective enough. Humber and North Yorkshire ICB commissioning policies only refer to Type 1 and Type 2 Diabetes mellitus. This is consistent with published NICE guidance on management of Diabetes mellitus. There are however multiple other subtypes of Diabetes mellitus that are defined (e.g. CF Diabetes, Type 3c Diabetes). Commissioning policies should be taken as applying to whichever of Type 1 or Type 2, the patient’s particular subtype is clinically most equivalent to (e.g. CF Diabetes and Type 3c both involve deficient/absent insulin production so policies for Type 1 apply).

Continuous glucose monitoring (CGM) is associated with better outcomes for people on Insulin therapy, including improved glucose control and reduction in the number of hypoglycaemic events. There are additional benefits for those who would otherwise require assistance to monitor glucose control or would need to test very frequently daily. Both real-time and intermittently scanned CGM can deliver these benefits, so the choice between the two should be a joint decision with each patient based on individual factors.

NG3 Diabetes in pregnancy: management from preconception to the postnatal period (NICE)

NG17 Type 1 diabetes in adults: diagnosis and management (NICE)

NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NICE)

NG28 Type 2 diabetes in adults: management (NICE)