Tim Street Profile picture
Oct 20, 2022 10 tweets 6 min read Read on X
If you're in #Lomdon and have #T1D, you may be interested in this thread. It outlines the @NHSLdn_CN for Diabetes pan-London plan for #cgm access.

There are three linked documents and some commentary.

#GBDoc

/1
The first document is the written pathway, that outlines the suggested implementation of NG17 across London:

england.nhs.uk/london/wp-cont…

#CGM
#GBDoc
/2
The second document is a list of systems, split into three lists.

List 1 is the "specialist rtCGM" that needs your clinic involvement.

List 2 is FP10 (on prescription) rtCGM.

List 3 is FP10 isCGM (scanned).

england.nhs.uk/london/wp-cont…

#CGM
#GBDoc
/3
The final document is a flowchart that outlines the decision making process for which should be provided.

england.nhs.uk/london/wp-cont…

#CGM
#GBDoc
/4
It's worth bearing in mind that the London ICSs have been involved in the creation of this guidance, so you should be able to take this to your GP and say, "This is London guidance. Please give me "X" from the FP10 list.".

#CGM
#GBDoc
/5
Within London, the following specific reasons are recommended for the List 1 devices.

#CGM
#GBDoc
/6 Image
Warning. The last page does discuss prioritisation of individuals where required and provides guidance as to how this might be done. Be aware that this included, as some areas may decide to implement it.

/7
As I understand it, most areas will have something similar to guide provision of CGM according to NG17, as well as a similar approach for children and adolescents set up specifically for them.

If your area hasn't done anything yet, I suggest waving this under their noses.

/End

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More from @Tims_Pants

Mar 12
A brief update on the #Simplera now that I'm three days into using it.

Whilst I haven't been closely tracking proximity to fingerpricks, I've done the occasional "soft calibration".

The Dexcom ONE that went on at the same time appears to be tracking more closely.

#ATTD2024 Three photos merged showing fingerpricks test at 7mmol/l, Simplera app with white text on black background showing 5.7mmol/l and xDrip from Dexcom ONE showing 7.1mmol/l.
The Simplera is regularly between 0.5mmol and 1.5mmol lower than the Dexcom ONE. At the current readings, it's a bit over 18% lower.

This sensor has been consistently low, but this is n=1.

The sensor is susceptible to compression lows, just like the ONE.

#ATTD2024
Let's talk about the app. The black background with white CGM trace & numerals are likely to be easier to see if you have vision problems, but the constant vertical axis set to the full range of the sensor, with no ability to reduce it, will annoy some.

#ATTD2024
Read 10 tweets
Mar 9
@MDT_Diabetes #Simplera time....

#ATTD2024 Image
Because we're now entering the "Simple Era"....

🤔

#ATTD2024
And side by side with a brand new Dexcom One.

Going to be fun....

#ATTD2024 Image
Read 7 tweets
Mar 6
So, we're off on Roche talking about their new CGM. How close were Diabettech's predictions?

#ATTD2024
via @diabettechdiabettech.com/cgm/a-new-cgm-…
Lots of focus on sleep and Hypos in @drpratikc 's presentation. Wonder why? 🤔
@drpratikc Where might this go next?

#ATTD2024 Image
Read 13 tweets
Aug 1, 2023
Remember this? Well now we've a few measurements to try and figure out how well it really works.

Obviously as an Interstitial Fluid based sensor there are going to be differences compared to blood tests, but what are they? /1
Firstly, it seems that CKMs are prone to the same compression problems as CGMs, which should be no real surprise. You can see this here overnight where readings are lost. /2 24 hour CKM chart showing loss of data overnight when presumably sleeping on sensor.
From a measurement perspective, values are noticeably different with ketones present. The blood tends to be considerably higher than the sensor reads. /3
Blood ketones 1.4, CKM ketones 0.8
Blood ketones 1.5, CKM ketones 0.7
Read 10 tweets
Dec 4, 2022
After two weeks, the #BattleRoyale (an n=1 comparison) for CGM is done. And there's clear water between the three sensors being tested, which were the Dexcom G6 & G7, plus the #Libre3. What follows is a brief summary of the results. /1
First up, the consensus error grids for all three sensors. Firstly, the Dexcom G6:
/2 Dexcom G6 Consensus Error Grid
Second, the Dexcom G7:
/3 Dexcom G7 consensus error grid
Read 13 tweets
Aug 9, 2022
#SixOfTheBest CGMs on the same grid.

Data from an n=1 experiment.

Caveat 1: earlier grid had an error, giving readings incorrect dispersion.

Caveat 2: Libre2 data from an earlier experiment due to device failing early in this test and replacement taking 10 days.

Thread.

/1
Calibration was done according to manufacturer directions:

Dexcom ONE & G6 - never;
Aidex - when I felt it was needed;
Glucomen Day - every 24 hours;
Medtrum Nano - Factory calibration was enabled, but calibration was done when it appeared to drift too much;
Libre2 - never.

/2
Dexcom ONE and Dexcom G6 have almost identical dispersion, as you might expect given the sensor and calibration technology is identical:

/3
Read 12 tweets

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