Glucose monitors for people with diabetes have finally been funded, but chronic labor shortages will limit the benefits

Pharmacist financing decision continuous glucose monitoring and automatic insulin delivery systems for the approximately 18,000 people currently living with type 1 diabetes in Aotearoa Modern Zealand are good news.

The decision came after years of pressure from patient groups and doctors.

However, there are problems in the wider system – particularly around labor shortages – which mean it will likely take years for patients to fully access insulin pump training.

Failure to address these issues will also perpetuate health inequalities among Māori and Pacific people who have been less likely to apply the monitor and pump in the past and may have to wait longer for training. These delays may undermine the positive impact of Pharmac’s financing decisions.

Intricate balance

Type 1 diabetes is an autoimmune disease that causes the pancreas to stop producing insulin. This extremely critical hormone is necessary to move glucose to every cell in the body.

Without insulin, cells (and humans) “starve to death.” Although the current approach to treating type 1 diabetes – pricking fingers to check blood glucose levels and injecting insulin – is effective, it is intricate.

Inject too much insulin and you will experience low blood sugar (hypoglycemia). This causes a person with Type 1 to feel shaky and faint, and may even fall into a coma. Do not inject enough medicine, which will cause persistently high blood sugar levels (hyperglycemia). This leads to long-term health complications.

Determining the right amount of insulin is elusive. Needs are constantly changing depending on the time of day, diet, exercise, illness, caffeine, alcohol, stress and other factors. This may cost you psychologically and physiologically.

Up-to-date solutions

Continuous monitors measure blood glucose levels 24 hours a day using a sensor placed under the skin, replacing finger prick testing. They are widely financed and used abroad.

Monitors alert users to low blood glucose levels, and they have significantly reduced number of hospitalizations for people with type 1 diabetes.

Combining monitors with a pump and an appropriate algorithm automates insulin delivery when glucose levels rise above the patient’s target range – significantly reducing the burden of daily therapy.

But continuous monitors and insulin pumps are costly.

Before Pharmac’s decision, the monitors were completely out of funding. Prices ranged from NZ$2,600 to NZ$4,800 per year. Insulin pumps were funded, but only for a petite group of people.

This has created an ever-widening capital gap. Māori and Pacific people with type 1 diabetes were less likely to have access monitors AND patent shoes. They were also more likely to have them repeated hospitalizations for diabetes-related events.

Labor shortage

Compared to other countries, Modern Zealand is tardy to fund monitors.

Unfortunately, compared to international guidelines, there are also significant staff shortages among diabetes staff.

There is a shortage of all qualified health professionals dealing with type 1 diabetes, including endocrinologists, nurses, diabetes nurses, dietitians, psychologists, social workers and podiatrists.

To meet international recommendations, Modern Zealand would need to more than double its clinical workforce.

Most people with type 1 diabetes will be able to access monitors quickly because both GPs and diabetes specialists can prescribe them. However, insulin pumps and automatic insulin delivery will only be available to specialists.

Although insulin pumps offer benefits in controlling glucose levels, learning how to apply the device takes time and support from your physicians. This is likely to be a problem, particularly for those who already struggle to access healthcare services in the country.

The issue of equity

Māori and Pacific people have a lower risk of developing type 1 diabetes current users of insulin pumps. This means there is a clear risk of labor shortages, with those who would benefit most from automated insulin delivery being among the last to have access to it.

Increasingly, evidence of continuous glucose monitors AND automatic insulin delivery shows that they improve control of type 1 diabetes for everyone.

Monitor apply has been shown to reduce differences in glucose control between Maori and non-Maori children with type 1 diabetes.

Automatic insulin delivery may also be an effective tool for children and adolescents at very high risk of glycemia.

Thank you, Pharmac. Funded devices are a game changer. Modern Zealand has moved from an archaic, unfair funding system for technology to treat type 1 diabetes to a progressive and fair system. However, much more needs to be done to support all those suffering from this disease.