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ALTHOUGH I have been working as a paediatric endocrinologist caring for children living with type 1 diabetes for 20 years, telling a family that their child has been diagnosed with the condition is still a difficult conversation.
Type 1 diabetes is a life-long, incurable condition affecting more than 120 000 people in Australia, which can result in serious complications such as blindness, heart and kidney failure, and amputations. With contemporary treatment, it is important to reassure families that their child will lead a healthy life as long as their diabetes is well managed.
Until recently, a person living with diabetes would have needed to prick and draw blood from their fingers multiple times a day to check their glucose levels. Given that many children, and sometimes their parents, are afraid of needles and blood, many people do not check their levels as often as they would like.
New technology means that users do not need finger pricks, but it is often expensive. Since 1 March 2020, the continuous glucose monitoring (CGM) subsidy scheme has been expanded by the federal government to include the flash glucose monitoring (FGM) device.
Those eligible for the subsidy scheme include:
- children and young people, under 21 years of age, with type 1 diabetes;
- children and young people with conditions very similar to type 1 diabetes, such as cystic fibrosis-related diabetes and neonatal diabetes, who require insulin;
- women with type 1 diabetes who are planning for pregnancy, are pregnant, or immediately after pregnancy; and
- people with type 1 diabetes aged 21 years or older and who have concessional status.
This means that 58 000 people living with type 1 diabetes now have the choice between using a CGM or an FGM to manage their glucose levels.
I am delighted to hear that the FGM device will now be included under this scheme, as this gives more choice to families of children living with type 1 diabetes.
The FGM device allows people living with diabetes to hover a phone or a reader over a slim wearable sensor stuck to their arm in order to obtain a glucose reading. The sensor measures interstitial glucose levels every minute and does not alert the user if levels are trending too low or high. This device does not require calibration with finger pricks.
CGM devices are wearable sensors placed either on the lower stomach or arm that constantly measure interstitial glucose levels. The data are transmitted to a smartphone or CGM receiver so the user can view their current glucose level and how they are trending. Alarms let the user know if their levels are too low or too high. These devices require a couple of finger pricks each day for calibration, and some can work alongside an insulin pump.
A real-world study has shown that FGM users check their glucose on average 12 times a day compared with four times for those who are finger pricking. These real-world results from 896 million glucose scans continue to show improved glucose management. Estimated glycated haemoglobin decreased from 8.2% to 6.7%, hypoglycaemia reduced by 31% and “time in glucose range” increased by 43% (from 11.7 to 16.8 hours per day) as scan rate increased. More frequent checking and the breadth of data gathered by the device will reduce hospital admissions and, therefore, the burden on the health care budget.
Commonwealth health care card holders over the age of 21 years will also benefit from the subsidy. It is estimated that more than half of type 1 diabetes cases are detected in adults. Many adults and seniors living with type 1 diabetes are on a pension and could not previously afford these modern technologies, but they will now have access to improved management and quality of life. The eligibility criteria of the CGM subsidy scheme have also been relaxed: although Commonwealth health care card holders could previously access reimbursed CGM devices under the scheme, the person living with diabetes was required to have experienced severe recurrent hypoglycaemic events to be eligible.
This is an important move from the federal government and the effects of this subsidy will be realised in the years to come. I anticipate that Australians living with type 1 diabetes who have access to the subsidy scheme will develop fewer complications. It is a long term investment and I am sure that colleagues in the field welcome this step forward.
Not all Australians living with type 1 diabetes will be able to access the CGM subsidy scheme: approximately half the Australian type 1 population will still need to invest substantial amounts of money if they wish to manage their condition with these devices.
Many adults with type 1 diabetes who have been living with the condition for a long time are experiencing complications and the inability to feel hypoglycaemia, which can be fatal. The opportunity to see a 24-hour glucose monitoring profile could have a major impact on their lives and would alleviate the burden on the health care system.
FGM is subsidised in 35 other countries, including France, Germany and Japan, and Australia is playing catch-up. Subsidised access to these technologies for all people living with type 1 diabetes in Australia is the next step.
Professor Maria Craig is a paediatric endocrinologist at the Children’s Hospital at Westmead
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.