Pharmacist financing decision continuous glucose monitoring and automatic insulin delivery systems for the roughly 18,000 people currently living with type 1 diabetes in Aotearoa New Zealand are excellent news.
The decision got here after years of pressure from patient groups and doctors.
However, there are problems in the broader system – particularly around labor shortages – which mean it will likely take years for patients to totally access insulin pump training.
Failure to handle these issues will also perpetuate health inequalities amongst Māori and Pacific people who have been less more likely to use the monitor and pump in the past and should have to attend longer for training. These delays may undermine the positive impact of Pharmac’s financing decisions.
Complex balance
Type 1 diabetes is an autoimmune disease that causes the pancreas to stop producing insulin. This extremely essential hormone is needed to maneuver glucose to each cell in the body.
Without insulin, cells (and humans) “starve to death.” Although the current approach to treating type 1 diabetes – pricking fingers to envision blood glucose levels and injecting insulin – is effective, it’s complex.
Inject an excessive amount of insulin and also you will experience low blood sugar (hypoglycemia). This causes an individual with Type 1 to feel shaky and weak, and should even fall right into a coma. Do not inject enough medicine, which will cause persistently high blood sugar levels (hyperglycemia). This results in long-term health complications.
Determining the correct quantity of insulin is elusive. Needs are consistently changing depending on the time of day, weight loss plan, exercise, illness, caffeine, alcohol, stress and other aspects. This may cost you psychologically and physiologically.
Modern 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 so they have significantly reduced variety 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 goal range – significantly reducing the burden of every day therapy.
But continuous monitors and insulin pumps are expensive.
Before Pharmac’s decision, the monitors were completely out of funding. Prices ranged from NZ$2,600 to NZ$4,800 per yr. Insulin pumps were funded, but only for a small group of people.
This has created an ever-widening capital gap. Māori and Pacific people with type 1 diabetes were less more likely to have access monitors AND patent shoes. They were also more more likely to have them repeated hospitalizations for diabetes-related events.
Labor shortage
Compared to other countries, New Zealand is slow to fund monitors.
Unfortunately, in comparison with international guidelines, there are also significant staff shortages amongst diabetes staff.
There is a shortage of all qualified health professionals dealing with type 1 diabetes, including endocrinologists, nurses, diabetes nurses, dietitians, psychologists, social staff and podiatrists.
To meet international recommendations, New Zealand would want to greater than double its clinical workforce.
Most people with type 1 diabetes will find a way to access monitors quickly because each 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 methods to use the device takes time and support out of your physicians. This is more likely to be an issue, particularly for those that already struggle to access healthcare services in the country.
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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’s a transparent risk of labor shortages, with those that would profit most from automated insulin delivery being amongst the last to have access to it.
Increasingly, evidence of continuous glucose monitors AND automatic insulin delivery shows that they improve type 1 diabetes control for everyone.
Monitor use has been shown to cut back differences in glucose control between Māori and non-Māori children with type 1 diabetes.
Automatic insulin delivery might also be an efficient tool for children and adolescents at very high risk of glycemia.
Thank you, Pharmac. Funded devices are a game changer. New Zealand has moved from an outdated, unfair funding system for technology to treat type 1 diabetes to 1 that’s progressive and fair. However, far more must be done to support all those affected by this disease.
