Advocating for diabetes technology to improve lives
For people with diabetes in wealthier countries, CGMs and insulin pumps are improving outcomes so much that people with diabetes, parents, families and healthcare professionals feel optimistic that the odds for a complication-free life for children and adults with type 1 diabetes are improving. Access is limited however. The insulin pump market is used by approximately one million people worldwide, which is roughly a third of the total number of people living with type 1 diabetes in the US (estimated at three million). For the Medtronic 670G, most users in the US are covered commercially. The one-time cost of the new system ranges anywhere from 6000 to 9000 US dollars but doesn’t include the annual costs for durables and sensors which are in the thousands. The Dexcom CGM is currently used by about 200,000 people in the US and about 70,000 people in international markets primarily by people with type 1 diabetes (only about 10% are used by people with type 2 diabetes, mostly in the US, Sweden and Germany). “Getting reimbursement for technology from countries is key and something we work on nonstop,” says Sayer.
Awareness and access to advanced diabetes technology is greatest in North America and after, in Europe, but for most it depends on availability and coverage per country, awareness of diabetes technology, and professional education and training. In low- and middle-income countries, healthcare teams have likely never seen an insulin pump or a CGM, and for people with diabetes, having access to a blood glucose meter and a few test strips is considered advanced.
Galindo faces the access problem a good deal, “Access is the gap. Technology will evolve. Costs will continue to come down. The challenge is access. I can go into any (low or middle income) country today – we’ve done it – and offer at no cost insulin pump therapy for paediatric patients with type 1 diabetes and you’d think the paediatric endocrinologist would not even hesitate for something at no cost to the patient, and the reality is most won’t do it. If the professional endocrinology network in a country won’t prescribe then this is a great challenge. HCP’s need awareness and education and so do people with diabetes. Only then can we have broader access with (government) healthcare reimbursement.” To make progress, Galindo and his team must start at the bottom, educating health care teams about technology and helping address stigma. “Education and awareness are what truly allow healthcare systems to think and be conscious about perhaps providing broader access.”
There have been successes. One example is Chile where until 18 months ago there was no access for people with type 1 diabetes – all technology was an out-of-pocket expense. The paediatric endocrinology community and families started a robust campaign aided by professional football star Arturo Vidal, who wears a tattoo of an insulin pump on his abdomen in honour of his son. “The government listened and provided insulin pumps and CGMs to all paediatric patients,” says Galindo. “This was a huge landmark success in Chile, which then becomes a footprint for other countries who may be in the same spot. The outcome worked because people advocated and fought for access.” The hashtag for the campaign is #bombadeinsulinaalauge and the news report in Spanish can be found here.
Worldwide, diabetes technology needs an awareness boost. With much of the world poor in diabetes technology access, education is key as well as stakeholder advocacy to ensure that not only the most basic technology (faster, more effective analogue insulins, and SMBG kits including test strips) get to people with diabetes worldwide but also that newer advanced device technology is getting to people with type 1 diabetes, especially for the youngest and most vulnerable.
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