Spotlight at Guidelines on Continuous Glucose Monitoring in Type 2 Diabetes

00:00:00:

00:00:13: There's a new set of guidelines being presented on diabetes distress this year at EASD.

00:00:19: but it's not the only set of guidelines that are in the spotlight at the moment.

00:00:24: So with me, I have two people to discuss another set of guide lines on continuous glucose monitoring both from the UK so Melanie Davis from Leicester and Amanda Adler from Oxford.

00:00:40: Why?

00:00:40: Of all the many topics which there could be guidelines, Melanie is a guideline for CGM.

00:00:49: So I think it's great that ESD have gone down this route of guideline development.

00:00:53: This is a relatively new thing, and as you say the distressed one.

00:00:58: They went out to the membership and looked at suggestions for guidelines, and CGM came through very strongly as being a priority both of people living with type II diabetes but also many clinical experts.

00:01:13: It's technology that is increasingly available But we don't really have good evidence-based guidelines Of its use in people who live with type I diabetes.

00:01:24: And it's important to policy makers because because we'll have big implications for policy makers.

00:01:33: Amanda, what do you particularly think about when your starting to develop a set of guidelines on CGM?

00:01:42: What's the first step?

00:01:44: The first step is get questions correct Because if you don't get the correct question You are launched off wrong path.

00:01:51: So process involves identifying population or subpopulation, as you know it's people with type two diabetes.

00:02:02: But there are some populations—people who use insulin for example and those that don't.

00:02:08: The intervention is CGM but importantly we need to compare.

00:02:15: what someone would otherwise get might be something different —but for type-two diabetes its probably not CGM or possibly even checking blood glucose at all.

00:02:25: And then we have to identify the outcomes that are important for people.

00:02:30: And in diabetes, blood glucose control has always been an important outcome but it's not the only outcome...

00:02:36: Yes and what I've picked up from this year's ESD meeting is being glucose centric isn't quite as important than it used to be in the past.

00:02:47: We were kind of obsessed about it back in the day But now that doesn't mean everything will end.

00:02:52: No,

00:02:52: it's not at all.

00:02:53: So if someone had a better health-related quality of life for example or felt more confident in controlling their diabetes that would be important.

00:03:04: whether someone changed their behavior such as they lost weight?

00:03:10: That might also be important.

00:03:12: so hemoglobin A and C is the measure of diabetes.

00:03:15: control isn't our only endpoint we're looking at.

00:03:19: Okay, so how do you set up your group?

00:03:24: So the first thing we have a guideline oversight committee.

00:03:30: A member of that committee was nominated as a co-chair and then went out essentially to open competition co-chair the committee or to serve on the Committee as a clinical expert.

00:03:46: And then we've also worked with an organisation called DDoC, to make sure that people living with diabetes are on the group and they have two methodologists who help us undertake everything in a robust way pull all the evidence together and they do that independent of our group.

00:04:15: So it's a really thought-through process, lots people on the panel.

00:04:19: It is great to work with but thats how we have to pull everybody

00:04:24: together And as were hearing earlier in an interview with Methodology its very important conflicts or interests are avoided.

00:04:33: Yeah, absolutely.

00:04:34: So for all of guideline development it's really important.

00:04:36: you have a process across all the panel making sure that we actually capture all of that.

00:04:43: And there is probably more matter managing conflicts and avoiding them completely.

00:04:50: Yes because its almost impossible isn't to completely avoid.

00:04:54: And not all conflicts of interest are financial.

00:04:57: So someone who felt deeply or about the correct answer to...

00:05:03: We've all met people like that,

00:05:06: we would want that in some way.

00:05:09: Yes and it's an important thing too do so.

00:05:12: what was the gestation over clinical guideline?

00:05:16: So I think it does take time, but we're learning from the distress guideline.

00:05:23: that's taken about eighteen months and will still not be fully published yet.

00:05:29: We are aiming to present our results next year as ESDs.

00:05:35: so in a years' time

00:05:37: Back on this sofa, yes.

00:05:38: I'm telling you where we've got to but there's a huge amount of work to make sure that we extract all the literature... ...that we carefully review all the data and clearly then go out to consultation to get feedback on our results as well.

00:05:53: So

00:05:53: i mentioned policy makers and the resource implications.

00:05:58: But actually what do say in this clinical guideline may have a major impact in terms of resource because Yes, drugs are quite expensive but CGM is seen as an expensive thing.

00:06:12: So CGM has a intervention.

00:06:14: that's interesting because one could look at it simply as diagnostic tool and we can be asking... Is there any accurate reflection of blood glucose?

00:06:22: But what we're actually asking is if it's a health intervention.

00:06:26: So, If people who use it experience better health outcomes not simply get an accurate reading of their blood glucose and We cannot within our resources or being European-wide guideline address cost effectiveness because that traditionally takes into account costs which by definition differ around Europe, but also a quality of life which also differs by country.

00:06:52: But what we will be able to do is produce estimates of effectiveness for which policy makers can then take and build on it

00:07:01: And they are hugely important these guidelines to policymakers I know in making their decisions.

00:07:08: Are you looking forward all this?

00:07:10: or with some kind of trepidation?

00:07:12: No, I think there is a serious amount of trepotation because it's huge responsibility.

00:07:17: It's very robust process to go through but i think its exciting and important that we do these guidelines Because we need more evidence in type two diabetes

00:07:32: And keep an open mind about what you might find.

00:07:38: But the question does needs And there is no right answer, but it does need to be asked.

00:08:07: Bye

00:08:12: for

00:08:34: now!