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.