Part 1 of Access to hope: The discovery of insulin 100 years on
Bec Johnson, Type 1 Diabetes Family Centre CEO
November 14, 2021
Diabetes devices are the technologies people with type 1 use to measure and monitor their blood glucose levels and administer insulin. For many years, insulin was delivered through syringes: boiled, sharpened, and re-used, and urine testing was the only way to check for excess glucose in a person’s body. Blood glucose testing emerged in the 1970s, although it took another decade before devices small and portable enough for home testing were developed.
The last 30 years have seen a proliferation of new devices that have made a profound impact on diabetes management, including continuous glucose monitoring systems, which transmit a person’s glucose level around-the-clock to a receiver such as a smart phone, and insulin pumps. Closed-loop technology, where basal insulin delivery is adjusted by an algorithm in response to the person’s current glucose level and trend, is an exciting recent development. In Australia, most children, and increasingly adults, are taking up these technologies and experiencing their many benefits over traditional finger-prick blood testing and delivery of insulin via needles, which range from the ability to precisely fine-tune insulin delivery and 24-hour visibility of glucose patterns and trends, to the protection of alarms that sound if their blood glucose levels are rising or falling too fast. These devices not only help people proactively manage their condition and strive towards good health, they save lives.
It’s fair to say that continuous glucose monitors and insulin pumps should be options for every person living with diabetes, however they are not easily accessible, even in Australia. Whilst we have safety nets for both health services and medicines, there are no such safety nets for diabetes devices. If a person spends $481 on healthcare services in a year, the Medicare Safety Net is activated, and that person receives 100% of the scheduled fees back for subsequent services. If a person spends $1,497 on medications, the PBS Safety Net kicks in: medicines cost $6.60 after that. Every Australian has access to these safety nets, because it is recognised that cost is a key barrier to accessing healthcare and medicine, and without safety nets, people get sicker, faster.
Despite this, Australians with type 1 diabetes must self-fund their devices: $9,000 for an insulin pump - either upfront, or via top-level health insurance, and $5,000 a year for continuous glucose monitoring if you are over the age of 21. This is in a context where 87% of adults with type 1 diabetes fail to meet vital glucose management targets and type 1 diabetes costs Australia $2.9 billion a year in healthcare, lost productivity and welfare, with 75% of these costs borne by people with preventable diabetes complications. Not having a safety net for diabetes devices limits access, which comes at a high cost to both our health system, and to people with diabetes.
Beyond the absence of safety nets for devices, further inequities run deep through our system: young people have access to fully funded continuous glucose monitoring, but people over the age of 21 must fund it themselves. Insulin pumps are accessible to most only through top-level private health insurance, leaving many of those without insurance without access. And while the majority of insulin pumps are on our Prosthesis List, which means they can be accessed through health insurance for those who have it, one new pump’s breakthrough tube-free design (the Omnipod) has bewildered Australia’s slow-moving health technology assessors to the point where a reimbursement pathway has not been found – meaning users must self-fund, even if they are insured.
While the National Diabetes Services Scheme, which provides subsidised access to the basics such as glucose test strips, insulin pump consumables, and needles, is valued and important, it is not enough. Safety nets are urgently needed for diabetes devices, universal access must be prioritised, and regulatory pathways that allow advanced new devices to rapidly come to market must be created. The logic is compelling: investing in these vital tools enables people with diabetes to manage their condition well, which will not only help our health system reduce the spiralling costs of healthcare associated with diabetes complications – it will save untold heartache for people with diabetes and their families.
 Australian Government/Services Australia (2021) Medicare Safety Nets. Online here: https://www.servicesaustralia.gov.au/individuals/services/medicare/medicare-safety-nets. Accessed 8 November 2021.  Australian Government/Services Australia (2021) PBS Safety Net Thresholds. Online here: https://www.servicesaustralia.gov.au/individuals/services/medicare/pharmaceutical-benefits-scheme/when-you-spend-lot-pbs-medicines/pbs-safety-net-thresholds. Accessed 8 November 2021.  Holmes-Walker D.J. et al. (18 June 2021) Glycaemic outcomes in Australasian children and adults with Type 1 Diabetes: failure to meet targets across the age spectrum. Intern Med J. https://doi.org/10.1111/imj.15426 JDRF and Accenture. Economic Cost of Type 1 Diabetes in Australia. April, 2021.