I AM an endocrinologist with over 25 years of experience working with diabetes and have a focus on mood disorders. Mood disorders and diabetes are one of my major interests because people with diabetes, whether it is type 1 or type 2, have two to three times the rate of depression and anxiety compared with people without diabetes.

I currently have multiple patients with diabetes who struggle with the management of their condition, resulting in an impact on their mental health. I believe that the better the management of diabetes, the better the effect on quality of life and mood.

As of 2017–2018, 1.2 million people are diagnosed with diabetes in Australia, including 120 000 with type 1 diabetes. With COVID-19-related restrictions over the past year and changes to routine, it has made it more difficult for many of these patients. I have seen a deterioration in people’s diabetes control, as their routine has changed. Many work from home, are isolated, and are not exercising as much, and this may be impacting their mental health. It has been a consistent observation of mine.

Being involved in a busy clinic where I see a lot of patients, it can be difficult for a diagnosis of mood disorders to be made. Sometimes, finding the time to talk about depression and mental wellbeing is challenging, but it is vitally important that we do so.

The full impact of diabetes can only really be appreciated by understanding its possible complications, which include heart and kidney failure, impaired vision and amputation. The key to avoiding these long term complications is to manage glucose levels well. People living with diabetes can live a successful life, but trying to balance all the requirements can be challenging. According to Diabetes Australia, people with the condition make an estimated 180 diabetes-related decisions each day.

Traditionally, people living with diabetes must prick their fingers and draw blood several times a day to monitor their glucose levels and log these data manually. This can be a distressing experience for some, resulting in them checking their glucose reading only a few times each day. This does not give them the full picture of their glucose levels and can have an impact on their long term health.

Nowadays, wearable medical technology such as flash glucose monitoring or continuous glucose monitoring (CGM) can replace these painful routine finger pricks and store a person’s glucose data in the cloud automatically. Remote glucose data sharing means their health care team can access this information without a face-to-face appointment.

A study completed by a team of clinical psychologists in the UK found that individuals who used flash glucose monitoring reported an increase in freedom and autonomy, which had a positive impact on their mood, confidence and psychological wellbeing. Another study in the Netherlands also noted improvements in mental wellbeing in patients using flash glucose monitoring to manage their diabetes. It would be great to see Australian studies investigating the impact of these modern glucose monitoring technologies on mental health.

However, these medical technologies are not accessible to all Australians with diabetes. Currently, the National Diabetes Services Scheme (NDSS) CGM subsidy scheme is available for people with type 1 diabetes who are women actively trying to have a baby, are pregnant or breastfeeding, have concessional status, or are under the age of 21 years. The Australian Government announced that these groups are eligible for subsidised CGM since March 2019 and flash glucose monitoring since March 2020.

I have witnessed first-hand the benefits of expanding the subsidy scheme to include flash glucose monitoring last year. It was a game changer and made a big difference for patients who qualified. It did, however, cause issues for those who did not qualify, with some simply not able to afford the technology.

Expanding the access to these modern glucose monitoring technologies to all Australians living with type 1 diabetes would have a huge impact. This would provide more choice for these people, who are living with a lifelong condition that requires a lot of attention. Those who are vulnerable and do not meet the criteria are missing out on flash glucose monitoring and CGM, meaning they need to rely on finger pricking to keep their glucose levels in check. Using these technologies also allows patients to be better connected to their doctors thanks to glucose data sharing through cloud-based platforms, which was significant in the time of COVID-19.

I hope that the federal government expands the CGM subsidy scheme to all people with type 1 diabetes in 2021. Better access to modern glucose monitoring technologies is critical, as they give patients and endocrinologists the chance to better develop monitoring strategies to deal with mental health challenges and help manage diabetes.

Dr Stephen Thornley is an endocrinologist based in Sutherland, NSW. He runs a large multidisciplinary practice which includes the expertise of a diabetes psychologist. He receives no funding from the glucose monitoring devices sector.



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.

6 thoughts on “Time to make glucose monitoring technology available to all

  1. Anonymous says:

    Thanks Stephen, great insight.
    To add another lived experience perspective: As a single mum with Type 1 for over 24 years, my financial situation constantly makes me choose between my health and the needs of my family. I have never met any of the subsidy criteria.
    I work full time and dream one day to afford CGM or even be able to try a pump. However, investment in the future of my children is more important than my quality of life and longevity.
    The inequities created by the existing subsidy schemes lead to advantage the few (then drop many high and dry) and not the majority of Type 1 diabetics.
    Subsidies are a great news story for pollies, and of course, deservedly- great for those who can meet the criteria, but for the rest of us- it’s almost like having to relive the trauma (deciding between my health and the needs of my kids, or, for other: uni and work; having to live with family or having the freedom to move out, etc) when touted about as a success.
    Don’t get me wrong I don’t begrudge those who are subsidised- this is only my story, but why not make it fair (wrt to health access) for everyone?
    Perhaps, I’ll answer that- finances you say? Well show me the independent analysis and assumptions- where’s the data (quantitative and qualitative) which informed these federal govt decisions- maybe that’s where we can unpick the mess!
    I fear moral arguments will never motivate an Aussie politician into action, but maybe data and strategic marketing could?

  2. Anonymous says:

    I agree everyone with any type of diabetes should have access to CGM’s.
    Dr R Bernstein’s book “diabetes solutions “ can sometimes prevent need for bariatric surgery if you follow his way of eating- very low carb and protein diet- please read?
    Some of his medications for carb craving are amazing too?

  3. Penny says:

    Continuous glucose monitoring has cured my food anxiety. I used to always be thinking about when and what the next meal would be and balance that against my insulin dose and expected exercise. Consequently I would let it run high so I could think about other things. That was damaging my long term health. Now I have learnt to trust my CGM and eat when I’m hungry not ‘just in case my sugar May drop’

  4. Anonymous says:

    Thanks and totally agree Dr Thornley.
    As a mother of a T1DM 20yo for the last 12 years and a medical professional, I have both the lived experience and medical/psychiatric knowledge to support CGM totally.
    It liberated my daughter, improved her medical and psychological state, liberated me as carer, and it has saved her life on several occasions by detecting unexpected hypos.
    When she turns 21yo, the cost returns to over $500 per month for sensors and transmitters. This is unaffordable to many but what price do we put on a life?

  5. Anonymous says:

    Hear, hear!
    So much more information to optimise even if perfection not realistic. So much more safety. So much more usable for the carpenters, plumbers, painters, labourers, chefs, teachers, retail workers, the kids who have grown up with this and have funding cut off at age 21, often mid student years, just out of home and with low paying jobs that JUST knock them off the subsidised list…. So much more usable data on those for whom we may only have 2-3 non consecutive data points. It would only take one politician to get Type 1 diabetes for coverage to be universal – oh, like in the NHS. If the NHS funds something, it is probably good value to fund. Have had a few HbA1cs go from 10s to 7s just through visibility for us and our patients.

    THEN we need to have this – at least for 6 months every couple of years – for anyone with insulin treated T2DM. The data is so valuable, can we afford NOT to do it?

  6. Kailas Roberts says:

    Great idea! I have been increasingly concerned about the role of high blood sugars well as spikes in blood sugar in ‘healthy’ individuals (no diabetes or even pre-diabetes) as pertaining to their brain health/dementia risk. I think everyone could benefit from knowing what impact their lifestyle choices (diet, exercise etc) are having on their blood sugars.

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