‘A perception it’s your fault’: Call for all people with diabetes to receive new tech

Clinicians are urging the federal government to widen eligibility for life-changing diabetes technology, warning the current model entrenches misconceptions that Type 2 is solely a “lifestyle” disease.

There were 136,771 people with Type 1 Diabetes registered with the National Diabetes Services Scheme as of December 2023, and 308,885 people with Type 2.

However, continuous glucose monitoring devices are only available through the subsidised scheme to those with Type 1.

More than 90,000 Australians now use a wearable glucose monitoring device. Credit: Edwina Pickles

The devices, which are used by more than 90,000 Australians, allow people with diabetes to constantly monitor their blood glucose, with a running graph of their levels available through a smartphone app. When combined with an insulin pump, people with diabetes can manage their condition without frequent use of needles.

About one in four people with Type 2 diabetes use insulin to manage their blood glucose level in the same way as people with Type 1.

A coalition of peak groups are calling for the federal government to consider subsidising the devices, sold under names such as Dexcom and Freestyle Libre, for people with Type 2 who use insulin.

Sof Andrikopoulos, CEO of the Australian Diabetes Society, said these patients unfairly experienced greater stigma and attracted less sympathy than those with Type 1 because their risk of disease was increased by lifestyle factors such as excess weight, poor diet and high blood pressure.

“There’s a perception it’s solely caused by lifestyle: it’s your fault you have diabetes because you’re fat or because you’re eating crap,” he said.

“But all forms of diabetes are a genetic disposition. Type 2 is just a relative deficiency of insulin as opposed to absolute.”

The Australian Diabetes Society, Australian Diabetes Educators Association and Diabetes Australia are seeking $4.5 million in federal government funding over four years for a small trial of the devices in Type 2 patients, with the goal of having devices subsidised for all people with diabetes who use insulin.

Andrikopoulos said he would like to eventually see all people with diabetes accessing the devices, noting research overseas had found they were useful for people who did not use insulin, as they provided real-time information that can motivate people to adjust their diet.

“But we are cognisant and conscious that we are at a time when funding isn’t regularly available, so we would like to start with people with Type 2 who use insulin,” he said.

Amanda Bartlett, president of the Australian Diabetes Educators Association, said the organisation would support people living with Type 2 diabetes having access to the devices provided they were assessed for suitability.

“It’s definitely appropriate for people who use insulin,” she said.

“There’s no doubt it would enhance treatment and mental load. Particularly for elderly people living alone, it could help to keep them safe.”

While Bartlett acknowledged the “motivational” role of monitoring for people who did not use insulin, she said the association currently only supported use by people who did.

Pascal Veuillet, from Sydney’s east, was diagnosed with Type 2 diabetes 17 years ago, aged 41.

Veuillet recently briefly used a continuous glucose monitoring device, paying for it outright to investigate with his diabetes educator what was causing his sugars to spike.

“I discovered that having a drink of alcohol was not catastrophic, but having a slice of bread with some jam on it was. So, you can reprioritise the way that you do things,” he said.

However, he said this was not a long-term option for him due to the prohibitive cost: obtaining the devices off the scheme costs just short of $3000 a year.

Ross Hutchinson, who has Type 2 diabetes, said checking his glucose manually was “a misery”.Credit: Anna Kucera

For Ross Hutchison, an 81-year-old former dancer from Penrith in Sydney’s west, insulin has been “the main reparatory part of [his] life” after being diagnosed with Type 2 diabetes 15 years ago.

An active senior who is a healthy weight, monitoring his glucose and taking insulin was the only way he could manage his diabetes. After finding pricking himself to be “a misery”, he recently paid for a monitoring device.

“It would be fantastic if we could get it for less. I don’t know anyone else who has it, because of the cost,” he said.

Federal Health Minister Mark Butler said the government was looking forward to the upcoming report from the Standing Committee Inquiry into Diabetes, at which these groups also made the case for extending device subsidies.

“The committee provides an important opportunity to hear from diabetes stakeholders about what matters most,” Butler said.

“While we await the outcomes of the committee’s work, our government has been focused on strengthening Medicare and general practice, which is at the heart of good diabetes care.”

Andrikopoulos said the tide was changing on treatment of Type 2 diabetes, with the arrival of drugs such as in-demand appetite suppressant Ozempic – which has been widely prescribed off-label for weight loss, resulting in a critical shortage last year – and blood sugar-regulating drug Mounjaro.

“In the next five years we are going to get a barrage of these new drugs coming through,” he said. “By then, Type 2 will be a different disease.”

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