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opinion: it's more cost-effective for governments to cover diabetes technology, plus it saves lives. so why aren't we doing it?

all patients with type 1 diabetes should have access to the advanced glucose monitors and insulin pumps that improve health outcomes and reduce complications, hospitalizations, and the risk of death.

by dr. kate potter
published dec 14, 2022
last updated dec 17, 2022
read time 5 minute read
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read time 5 minute read
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imagine choosing between your health and your home
many patients and their families sleep better through the night, thanks to glucose monitoring devices. getty
dr. kate potter is a pediatric and young adult endocrinologist in calgary, alberta.  
in 1921, a type 1 diabetes (t1d) diagnosis was a death sentence. t1d is an autoimmune disease in which the body’s immune system destroys the cells in the pancreas that make insulin. patients with this disease would have only months to live until a year later, when 14-year-old leonard thompson became the first person to be given an injection of a then-experimental drug called insulin. since then, treatments for diabetes have drastically improved but for people living with t1d, managing diabetes is an immense task every day and even with vigilant management, there is always the risk of serious complications.
insulin is still the only treatment for t1d, but it is complex to deliver and a constant balancing act. too much insulin causes low blood glucose levels, which frequently disrupts daily activities (work, driving, exercise, sleep, exams …) for 15 to 45 minutes at a time and can be severe enough to cause confusion or seizures. too little insulin leads to high blood glucose, which can cause a life-threatening condition called diabetic ketoacidosis. chronic high blood glucose can cause severe kidney and nerve damage, blindness, or the need for limb amputations.

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glucose monitoring devices alleviate fears and anxieties

modern advancements in diabetes management have allowed patients to monitor their blood glucose with advanced glucose monitoring devices such as continuous glucose monitors (cgms) and flash glucose monitors (flash gms). advanced glucose monitors are wearable devices that provide patients with real time readings of their glucose levels — alarms alert patients to any lows, highs or rapid changes in blood glucose levels. these devices alleviate many of the fears and anxieties patients have because their readings are immediately available to them, without the need for fingerprick checks. many patients and their families sleep better through the night, thanks to this technology.
these devices also help improve the time that a person with t1d spends in a “normal” blood glucose range, often called ‘time in range.’ the more time spent in range, the lower the risk of potential future diabetes related complications.
continuous glucose monitors also provide real-time data to clinicians to remotely monitor and predict patterns in patients’ blood glucose and advise them to make better decisions for their health. this technology was very important to maintaining the health of people with t1d during the covid pandemic, when access to health care was limited to virtual care.

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life-altering technology

recent advances in technology have allowed advanced glucose monitoring devices to directly communicate with insulin pumps, which are worn by many patients, to change minute-to-minute insulin delivery to match changes in sugars. much like the revolutionary invention of insulin itself, these devices represent life-altering technology that creates an “artificial pancreas” that will revolutionize how well we can manage t1d and reduce the high daily burden of managing diabetes. there is evidence that using advanced glucose monitors and insulin pumps together significantly improves patient health outcomes and reduces the number of diabetes complications, hospitalizations, and reduces the risk of death due to very high or low blood sugars. that is why universal access to these cgms and pumps would ensure that those living with t1d can benefit from the life-changing impact of a closed loop system.
earlier this year, the alberta government ensured the access of continuous glucose monitoring technology to all patients with t1d under 18 years of age. as a clinical community pediatric endocrinologist, i see firsthand how this exceptional step has allowed us to offer equitable access to high-quality care to all children, regardless of family finances, in keeping with the fundamental goals of canadian health care.
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in a short time, access to this technology to all children with t1d under age 18 has had a major positive impact on how well i can care for my pediatric patients. yet, i still worry that the limited resources available to patients after they turn 18 will detrimentally affect their long term t1d outcomes compared to patients in neighbouring provinces who continue to have access to this technology. as many of my patients reach the age of 18, their ability to access insulin and life-changing diabetes technologies is limited by their ability to attend post-secondary education and have access to parental or student insurance, or to obtain gainful employment with extended health coverage.
despite being a lifelong disease, albertans living with t1d who rely on cgms will only receive public coverage up until the age of 18. young adults with t1d are already the highest risk group for poor diabetes control as they transition to adult medical care. access to advanced diabetes technologies in this vulnerable age group will reduce the risk of long-term complications that greatly burden the health-care system and will help to establish a healthier t1d population in alberta with lower health costs.
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patients shouldn’t choose between health and their house

t1d is an expensive disease. when transitioning into adulthood, these patients will face significant financial burdens, and may need to choose between treatment supplies and other living expenses. no albertan should need to choose between paying for their health or keeping a roof over their head.
jdrf canada recently conducted a study that demonstrates it is more cost-effective for governments in the long-term to provide diabetes technology coverage as it reduces medical care and hospitalizations as well as reducing the risk of future complications.
alberta is a world leader in diabetes research, particularly notable for the edmonton protocol that made pancreatic islet transplantation an option to reduce severe complications of t1d. alberta is also a leader in clinical trials that may change eventually halt t1d in the early stages. i am proud to state that some of the physicians i encountered in my medical training in alberta were some of the strongest clinicians and clinician scientists working in t1d in canada. i strongly believe that universal access to a game-changing technology would maintain alberta’s place as a canadian leader in t1d care and the overall health of its t1d population.
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