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What's new?: Chronic sleep disturbance is common for people with Type 1 diabetes.Fear of nocturnal hypoglycaemia is causing frequent nocturnal blood glucose testing causing impaired sleep.New strategies for the prevention of nocturnal hypoglycaemia need to be devised and tested.The consequences of chronic sleep disturbance for people living with diabetes and their families needs to be appreciated by their clinical advisors. [ABSTRACT FROM AUTHOR]

The article discusses a study focusing on the access to and reimbursement for continuous glucose monitoring systems (CGM) for Type 1 diabetes patients in England. Topics discussed include the clinical guidelines published by the National Institute for Health and Care Excellence (NICE) in 2015; the Clinical Commissioning Groups (CCGs) in England, which provide funding for real-time CGM; and the discrepancies in policy regarding cost-effective use of routinely commissioned CGM.

Abstract: Aim: Hypoglycaemia in Type 1 diabetes is associated with mortality and morbidity, especially where awareness of hypoglycaemia is impaired. Clinical pathways for access to continuous glucose monitoring (CGM) and flash glucose monitoring technologies are unclear. We assessed the impact of CGM and flash glucose monitoring in a high‐risk group of people with Type 1 diabetes. Methods: A randomized, non‐masked parallel group study was undertaken. Adults with Type 1 diabetes using a multiple‐dose insulin‐injection regimen with a Gold score of ≥ 4 or recent severe hypoglycaemia were recruited. Following 2 weeks of blinded CGM, they were randomly assigned to CGM (Dexcom G5) or flash glucose monitoring (Abbott Freestyle Libre) for 8 weeks. The primary outcome was the difference in time spent in hypoglycaemia (below 3.3 mmol/l) from baseline to endpoint with CGM versus flash glucose monitoring. Results: Some 40 participants were randomized to CGM (n = 20) or flash glucose monitoring (n = 20). The participants (24 men, 16 women) had a median (IQR) age of 49.6 (37.5–63.5) years, duration of diabetes of 30.0 (21.0–36.5) years and HbA1c of 56 (48–63) mmol/mol [7.3 (6.5–7.8)%]. The baseline median percentage time < 3.3 mmol/l was 4.5% in the CGM group and 6.7% in the flash glucose monitoring. At the end‐point the percentage time < 3.3 mmol/l was 2.4%, and 6.8% respectively (median between group difference −4.3%, P = 0.006). Time spent in hypoglycaemia at all thresholds, and hypoglycaemia fear, were different between groups, favouring CGM. Conclusion: CGM more effectively reduces time spent in hypoglycaemia in people with Type 1 diabetes and impaired awareness of hypoglycaemia compared with flash glucose monitoring. (Clinical Trial Registry No: NCT03028220) [ABSTRACT FROM AUTHOR]