FOI 2025/1343

I am writing to request information under the Freedom of Information Act 2000 regarding the Manchester Locality’s commissioning policy and implementation of NICE guideline NG28 (Type 2 diabetes in adults: management), specifically the 2022 update which recommends access to Continuous Glucose Monitoring (CGM) for people with insulin-treated Type 2 diabetes.
Despite this national guidance, there appears to be no publicly available policy from Manchester ICB that reflects the updated recommendations. This is concerning given the commitments outlined in the Greater Manchester Joint Forward Plan, which includes:

Relevant Strategic Commitments from the Plan
• A mission to help people stay well and detect illness earlier, including early identification and treatment of diabetes and other risk factors
• A focus on reducing health inequalities through the CORE20PLUS5 framework, which explicitly includes diabetes
• Expansion of digital tools and anticipatory care models to support proactive management of long-term conditions
• A commitment to recover core NHS services, including reducing long waits and improving access to diagnostics and outpatient care
• A system-wide ambition to reduce unwarranted variation in service provision and outcomes

Request for Information
Please provide the following:
1. Current CGM Policy
• Does Manchester ICB have a formal policy or commissioning statement that aligns with NICE NG28 (2022) regarding CGM access for people with insulin-treated Type 2 diabetes?
• If so, please provide a copy or link to the document. If not, please explain why such a policy has not yet been developed or published.
2. Implementation Plans
• What steps has the ICB taken to implement NG28 recommendations on CGM since the guideline update in 2022?
• Are there plans to update local diabetes pathways to reflect NG28? If so, what is the expected timeline?
3. Equity and Access
• How is the ICB ensuring equitable access to CGM for people with Type 2 diabetes in deprived communities, in line with CORE20PLUS5 priorities?
• What data is being collected to monitor uptake and disparities in CGM access across Manchester?
4. Stakeholder Engagement
• Have people with Type 2 diabetes, carers, clinicians, or voluntary sector partners been involved in shaping CGM access policy?
• If engagement has occurred, please provide details or outcomes of these consultations.
5. Funding and Commissioning
• What budget has been allocated for CGM provision for insulin-treated Type 2 diabetes in 2024/25 and 2025/26?
• Are there any commissioning constraints or barriers preventing full implementation of NG28 given this technology saves money over time?
6. Commitment to Review and Update
• Will the ICB commit to reviewing and updating its diabetes technology policy to reflect NICE NG28?
• What is the process and timeline for such a review?
Given the ICB’s stated ambition to improve early detection, reduce inequalities, and embrace digital innovation, the lack of a NICE-aligned CGM policy for people with Type 2 diabetes appears to be a significant gap especially when compared to other ICBs. I urge the ICB to clarify its position and provide transparency on its plans to ensure equitable access to diabetes technology in line with national guidance.

1.
• The ICB has agreed that access to CGM for people with type 2 diabetes should be aligned with NICE NG28.
• Comms/guidance is in production now.

2.
• See 1. above.
• Guidance on prescribing in line with NG28 will be issued, expected Q3 2025/26.

3.
• The ICB can monitor CGM prescribing data broken down by GP practice. This and the primary care data access (see next bullet) will allow the ICB ascertain where unwarranted variation exists and needs to be addressed. Diabetes is included as a central priority in the ICB’s multi-year prevention plan. This supports CORE20PLUS5 priorities and implementation of the ICB’s GP quality standards to offer enhanced care reviews to high-risk diabetes patients.
• The ICB now has near real-time analysis in place that allows interrogation of diabetes population data split by ICB geography, deprivation, ethnicity, locality, PCN and GP practice.

4.
• Yes.
• Engagement has been informal and through clinical network events. The outcome has been positive support for alignment with NG28 and this has supported the successful case to seek ICB approval to implement the recommendations.

5.
• There is no specified CGM budget, expenditure comes under general prescribing.
• No, systems will be asked to prescribe in line with NG28.

6.
• It has now done so.
• n/a.