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THIS is, supposedly, the health care election, yet Australia’s biggest health challenge – diabetes – is not getting the attention it warrants from both major parties.
I can’t help feeling sorry for my patients who have been left behind in this election – people living with type 1 diabetes.
There are 1.2 million Australians living with diabetes, and of these, 120 000 have type 1. It’s not as emotive as cancer, but I would argue it’s a bigger health challenge.
New data from the Australian Institute of Health and Welfare show the incidence of insulin-treated diabetes in Australia. In 2017, there were 29 797 people who began using insulin to treat their diabetes, while 2742 people were diagnosed with type 1 diabetes. Of this number, 61% (1665 people) were under the age of 25 years.
Diabetes is a burden to patient and health resources. While there are some subsidies, people living with diabetes have considerable out-of-pocket costs. For people with type 1 diabetes, the financial burden includes technology such as glucose monitoring, insulin pump and pump supplies, insulin, finger prick strips, batteries, spare insulin pens, glucagon kits, jelly beans, appointments with an endocrinologist, diabetes educator, optometrist, ophthalmologist, podiatrist and GP.
If patients do not adequately manage their diabetes, they are at risk for heart disease, kidney failure, loss of vision and amputations – all of which require extensive health investments, but are avoidable with the right resources.
The current approach to diabetes management isn’t working. The most important measure for diabetes control – management of glycated haemoglobin (HbA1c) levels – hasn’t improved in 6 years.
The Australian National Diabetes Audit – Australian Quality Self-Management Audit found that the average HbA1c level for Australians living with type 1 diabetes is 8.5%, which is higher than the recommended general control target of 7.0%. Among children with type 1 diabetes, only one-quarter are achieving the target HbA1c level.
Both major parties have promised money, of course. In January, the Australian Labor Party promised a $50 million investment in type 1 diabetes research, should they be elected on 18 May. The Coalition matched that by promising $54.1 million for type 1 diabetes research, according to a Greg Hunt announcement in February.
Technology that is the standard of care for managing type 1 diabetes in other countries remains unsubsidised here. Flash glucose monitoring, for instance, is already subsidised in more than 30 other countries, including Spain, Ireland and Greece. Flash glucose monitoring replaces intrusive, disruptive and painful, regular finger prick tests. It is an unobtrusive scan and takes only seconds for someone to pass a phone or reader over the sensor on their arm.
The more you scan, the better outcomes you get. Data for people using flash glucose monitoring show that users checked their glucose levels on average 12 scans per day, giving them better awareness of their blood glucose highs, lows and trends.
The British Prime Minister Theresa May uses it.
It costs Australians $2400 a year to use a flash glucose monitoring device. I hear from my patients every day that they really want it, but they either need to make sacrifices to afford it or simply cannot access it.
In November 2018, Minister Greg Hunt declared that flash glucose monitoring devices would be available to eligible patients as part of the government’s $100 million Continuous Glucose Monitoring initiative, effective from 1 March 2019.
“Our Government also plans to add the new the FreeStyle Libre flash glucose monitoring system to the scheme for these people with type 1 diabetes. This will provide patients with more choice in how they manage their diabetes through this important program.”
People are still waiting for the National Diabetes Services Scheme to list flash glucose monitoring devices as a subsidised device. Its current product list includes only continuous glucose monitoring devices.
Families with young children, people aged under 21 years, and women planning pregnancies in the coming months or already pregnant were left disappointed and confused by this broken promise. They would have benefited from subsidised flash glucose monitoring and now have to rethink their diabetes management.
I am perplexed as to why both parties are not respecting the needs of Australians with type 1 diabetes.
Type 1 diabetes is not a choice or a lifestyle disease. I can’t see a reason why Australia wouldn’t follow other nations in subsidising technology that is proven to improve the lives of people with it.
Better management of blood glucose puts less pressure on the health system and saves money in the long term, so it should be the standard of care.
Professor Maria Craig is a paediatric endocrinologist in Sydney. Her major research interest is childhood diabetes, including studies focused on prediction and prevention of type 1 diabetes.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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As usual Governments never invest in the future. The quality of life for people with Type 1 diabetes should be prioritised. This disease isn’t self inflicted. Investing in Pumps and CGM monitors will in the future save money as less people will have mental health concerns and physical problems in the future. Their quality of life shouldn’t be denied them
I agree with all this. I have been a type 1 for 36 years and been on the Dexcom G5 for the past year. I needed to go on it as have too many hypos and esp at night. I used to wake up with them but now I don’t so need the alarm on the Dexcom.
The downside is the huge expense for me. It should definitely be subsidised and not fair that it is only for under 21 year olds. I’m 69 now and not working any more so it’s a big expense for me.
Come on Government please help us out.
Marguerite Abbott
Government ignores the expenses and health challenges that Type 1 diabetics face because it is an invisible disease. No one can see a high or low BGL. No one can see the nerve damage kidney damage or heart disease or retinopathy forming. We are self funding a lot of the diabetes costs involved in treatment to stabilise BGLs with CGMs $6500 per annum.
Frozen shoulder trigger finger all require specialist treatments
Treatments for retinopathy is expensive one person said it cost $20,000 to save his eyesight.
Endocrinologist educators and other specialists are either expensive or hard to access in the public system. 6 months between 15 minute visits. Other diseases get a one off PBS funding or can access medical NDIS funding. But for lots of reasons type 1 is over looked.
Well done Maria for advocating publicly for our patients living with Type 1 diabetes. You are correct that politicians are repeatedly ignoring interventions that may make a significant difference, including Flash Glucose Sensors. Minister Hunt refuses to answer questions on the irregularities relating to the Diabetes in Schools project and refuses to release publicly funded reports. There is scant regard given to legal compliance, medicolegal obligations, parental consent, privacy and data collection. The Diabetes in Schools project now plans to not comply with international best practice guidelines despite Minister Hunt predicating the project on ISPAD standards. So after $6m is spent, nothing more that more generic information will have been delivered with no person centred care. So money to burn, even establishing a new paradigm in health care – a charity providing medical advice and instruction without holding any clinical responsibility for the outcome.
Add in Minister Hunt’s new gold tier status for insulin pumps which will significantly impact many people, especially rural people and young adults living with Type 1. Minister Hunt has also enabled the removal of the carer allowance and health care card for many children with Type 1.
Perhaps the root cause of this disservice to our patients should be examined. What is not occurring is direct communication with the Minister by clinicians who are not conflicted. Rather some groups of clinicians have signed an MoU to support a charity to be their mouthpiece. A better and more effective “alliance” would be all doctors and Diabetes Educators working collaboratively to advocate for best outcomes for our patients.
Flash sensing is a valuable tool and suits many adolescents and young adults far better than the bulky CGM. It is one of many important issues of type 1 Diabetes that is being deliberately ignored by the current Minister and perhaps ultimately, many clinicians are to blame.
Your comment about the Libre is silly
The CGM is subsidised, so why not use that. The only thing holding up the Libre being subsidised is the Dept of Health and Abbott agreeing to a price. If that can happen, then it will be added to the list of subisidised CGM – so a wider choice, but until then, those who do qualify for subsidy, can use CGM NOW !
Libre is a very poor cousin to proper CGM, no real time alarms, critical for overnight lows when sleeping etc, or busy trying to pay attention to stuff like dealing with kids, driving, working. I don’t want to have to pull out a phone or reader to scan to check. I want real time alarms
Besides many people find the Libre very inaccurate since it cannot be calibrated to suit individuals… CGM does. Even the new Dexcom G6 (but still pending in Australia, c’mon TGA, pull your finger out) can be calibrated to ensure the factory calibrations work for the user
Yes with certain add-on’s such as the Miao Miao or BluCon etc, the Libre can be converted into a proper CGM, allowing calibrations and real time alarms
Oh and your price is wrong too. Yes they are $92.50 each, but then Abbott charge shipping. Most people will be charged closer to $2650-2700/yr. A number of us (who self fund) using Dexcom G5, with extending sensor life and using rebatteried transmitters get the full bells and whistles functionality at roughly $600-1000 PER YEAR cheaper