Continuous Glucose Monitoring
Note: this site is for informational purposes only. To view test results or book a test, use the NHS app in England or contact your GP.
Continuous glucose monitoring (CGM) uses a small sensor placed under the skin, usually on the abdomen or arm, that continuously measures glucose levels in the fluid between cells and sends readings to a monitor or smartphone. It is used to monitor glucose levels in people with diabetes, helping track changes throughout the day and guide treatment decisions.
Why get tested?
To monitor your blood sugar (glucose) concentrations; to evaluate changes and trends in your glucose concentration over time.
When to get tested?
National Institute for Health and Care Excellence (NICE) guidance recommends that all adults with type 1 diabetes should be offered a choice of real-time continuous CGM, or intermittently scanned CGM (‘flash’ monitoring). Real-time CGM should be offered to all children and young people with type 1 diabetes.
For patients with type 2 diabetes, eligibility is restricted to those taking multiple daily insulin injections who either have recurrent or severe hypoglycaemia (low glucose levels), impaired hypoglycaemic awareness, a disability which may affect their ability to perform finger-prick blood glucose checks, or those who are required to test their glucose levels more than 8 times per day.
The purpose of CGM is to help the patient and team control blood sugars better and avoid too many finger prick tests.
Sample required?
A continuous glucose monitoring (CGM) device includes a small sensor that is inserted beneath the skin of the tummy (abdomen) or the upper arm and held in place with an adhesive patch. The sensor measures glucose in the space around cells (interstitial space). CGM measures glucose at frequent intervals and sends the results wirelessly to a smart phone or hand-held reader. These digital readouts let you know your equivalent blood glucose level in real time.
Test preparation needed?
No test preparation is required.
What is being tested?
Continuous glucose monitoring (CGM) measures the glucose in the space surrounding cells (interstitial space). Blood, including finger prick, and interstitial fluid glucose levels are not exactly the same, but they mirror each other closely.
CGM Devices
Some features of CGM devices include:
- A small plastic sensor that is inserted beneath the skin of the abdomen (tummy) or the upper arm and then held in place by a sticky patch for several days (7, 10, or 14) up to 3 months.
- A transmitter above it, on top of the skin.
- A device to show the results, which may be a smart phone, pump or separate hand-held machine. The information can be used in several ways.
- CGM devices can measure and display glucose readings “real-time” at set intervals or display the last glucose result performed when they are scanned (intermittent scanning or flash).
- CGM devices may send alerts and have alarms.
Some CGM devices can be used in conjunction with an insulin pump. When you eat and your glucose level rises, your CGM device measures your glucose levels. Controls in the insulin pump react to this result to deliver insulin. This is called a hybrid closed loop system.
Common questions
CGM is now used by a large proportion of people with type 1 diabetes. As CGM devices become increasingly accurate and user-friendly, their use is increasing.
National Institute for Health and Care Excellence (NICE) recommend CGM for adults, children and young people with type 1 diabetes, and for a limited number of reasons for patients with type 2 diabetes (those requiring multiple daily insulin injections and have either recurrent or severe hypoglycaemic episodes, a disability affecting their ability to perform finger-prick checks, or need to test their glucose levels more than 8 times per day).
Real-time CGM may be used daily and constantly to have better glucose control when you have type 1 diabetes.
CGM may be used periodically when you have diabetes and your healthcare practitioner wants to collect and evaluate data on your day-to-day glucose variability and control.
CGM may be used in limited circumstances when you have type 2 diabetes (see above).
Glucose values from CGM devices generally correlate closely with blood glucose concentrations. Your target range for your glucose levels is determined by your healthcare professional and depends on several factors, such as:
- Your daily activities
- Other underlying conditions you may have, including heart disease
- Your likelihood of diabetes-related complications
- Whether you do not experience distinct symptoms of low blood sugar (hypoglycemia unawareness)
CGM results can identify variability in glucose levels throughout the day, identify trends and anticipate when your glucose level is getting too low (hypoglycemia) or too high (hyperglycemia), and send an alert to your smart phone or reader.
Looking at patterns of glucose data (such as data points collected over several days and graphed in a report) can help you and your healthcare practitioner evaluate variations in your glucose levels and suggest actions that may help stabilise glucose levels and improve glucose control.
Yes, though it may be worth discussing it with your health care team first to advise on the most appropriate system to buy as you will need support in how to use it and interpret the results.
No, they are approved for specific periods of use and need to be replaced as indicated by the manufacturer. It is likely that CGM devices will be able to be worn longer in the future as they continue to improve.
NICE recommend that patients with diabetes who use CGM still use capillary blood glucose measurements (finger-prick checks) to check the accuracy of their CGM device, and as a back-up if the device stops working.