TODAY, 1.4 million people are living with diabetes in Australia. Diabetes has significant consequences to a person’s health if not managed well, including blindness, diabetes-related foot disease leading to amputation, death from heart attacks and strokes.
The year 2020 was a difficult one. One consequence of the COVID-19 pandemic was isolation, the shutting down of many aspects of life, including some forms of medical care. Face-to-face consultations were replaced with telehealth and that had a big impact on how diabetes care was delivered.
Because diabetes is a lifelong condition you cannot switch off, for many patients, the thought of not being able to access their health professional as normal caused a lot of stress.
Something that was a great help during the 2020 lockdowns was the existence of modern glucose monitoring technology that allowed people with diabetes to remotely share their glucose data with health professionals. Both flash glucose monitoring and continuous glucose monitoring (CGM) have this functionality. Being able to access glucose monitoring data remotely allowed the clinician to be prepared for the telehealth consultation.
Traditionally, people living with diabetes are required to prick their fingers to draw blood many times a day to monitor their glucose levels. This can be a painful and traumatic experience for some. Nowadays, wearable medical technology such as flash glucose monitoring or CGM can replace these painful routine finger pricks and store data in the cloud.
Flash glucose monitoring allows people with insulin-requiring diabetes to check their glucose level by hovering a smartphone over a small sensor on the back of their arm. CGM sensors are placed on the stomach or arm and do not require the hovering motion, as glucose data are shared with the patient’s smartphone via Bluetooth. For both technologies, the glucose data are securely stored in the cloud and can be shared with the patient’s health care team. Being able to access flash glucose monitoring and CGM provided relief for both the health professional and patient during lockdowns.
Currently, the National Diabetes Services Scheme CGM subsidy is available for people with type 1 diabetes who are women actively trying for a baby, who are pregnant or breastfeeding, and people who have concessional status or who are under the age of 21 years. These groups have been able to access fully reimbursed CGM since March 2019 and flash glucose monitoring since March 2020.
However, this means that once the patient turns 21 years of age, that subsidy is subject to the patient holding a health care card. We know that losing access to the subsidy all of a sudden causes real stress at a critical time in the lives of young people. Some will have only ever used flash glucose monitoring or CGM since their diabetes diagnosis, so losing reimbursed access to these technologies means that, all of a sudden, they need to learn how to finger prick. This process can be painful and distressing for many. We also receive feedback from people living with type 1 diabetes asking that they not be stopped from accessing this subsidy scheme just because they have a full-time job and are not eligible for a health care card.
That inequity is an issue for people with type 1 diabetes. Flash glucose monitoring and CGM are important components in the management of this condition. They can provide real clinical benefit.
The federal government is currently conducting a review of the flash glucose monitoring and CGMs it subsidises to ensure that the funding is appropriate and that the devices are giving the best clinical outcomes.
I believe this review will demonstrate that there is a real benefit for people who are using these technologies. The Australasian Diabetes Data Network has already conducted a preliminary assessment of people with type 1 diabetes under the age of 21 years using CGM which showed improved control of their glucose levels. Hopefully, being able to see a similar benefit after the review would lead to an expansion of the National Diabetes Services Scheme CGM subsidy to all people with type 1 diabetes. I hope that any funds saved after conducting this review will be returned to subsidise more diabetes technologies and diabetes management.
The Australian Diabetes Society, together with the Australian Diabetes Educators Association, the Australasian Paediatric Endocrine Group and the Australasian Diabetes in Pregnancy Society, have written a consensus statement for the use of flash glucose monitoring, CGM and insulin pumps in Australia. The consensus statement was recently published in the MJA. The recommendation in this consensus statement is that there should be equitable access to technology for all Australians living with type 1 diabetes. It also recommends that those people living with type 1 diabetes should use flash glucose monitoring or CGM to manage their glucose levels.
A key advocacy point in the consensus statement is an expedited review of diabetes management technologies.
Diabetes technology is rapidly evolving, and it is appropriate that we have a quick and efficient process to assess these new technologies. Already, we have a new CGM device — FreeStyle Libre 2 (Abbott) — approved by the Therapeutic Goods Administration and soon to be available in Australia. This technology will give people with insulin-requiring diabetes the option of alarms to alert them of too high or too low glucose levels. This will be a significant advance in the management of Australians living with diabetes.
There are a number of countries in Europe, including the UK, where flash glucose monitoring is readily available through the National Health Service (NHS) to all people with type 1 diabetes. The Association of British Clinical Diabetologists assessed the impact of subsidised flash glucose monitoring on patients and the health care system. Overall, there were improvements in glycaemic control, hypoglycaemic awareness and improved diabetes-related distress. More broadly, flash glucose monitoring use on a national level was associated with significant reductions in paramedic call-outs and in hospital admissions due to hypoglycaemia and hyperglycaemia. The flash glucose monitoring subsidy allowed these substantial reductions in costly resources which represent significant health care savings to the NHS.
It is important that every person with type 1 diabetes in Australia does have access to flash glucose monitoring or CGM if they choose to and if their endocrinologist and their diabetes educator deems it appropriate. In 2021, I am hoping that the NDSS CGM subsidy scheme can be expanded to all Australians living with type 1 diabetes. That would be a life-changing outcome for many.
Sof Andrikopoulos is an Honorary Associate Professor at the University of Melbourne, and Chief Executive Officer of the Australian Diabetes Society.
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.