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.
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.