‘Foot on the brakes’ for type 2 diabetes

3 minute read

The department will not consider subsidising continuous glucose monitoring devices for Australians with type 2 diabetes, despite expert opinion that many could benefit from the technology.

The federal health minister has said he will not continue discussions about subsidised access to Continuous Glucose Monitoring (CGM) devices for Australians with type 2 diabetes, according to opposition health minister Anne Rushton.

Last July, CGM and flash glucose monitoring devices were approved for subsidies via the National Diabetes Services Scheme for the 130,000 Australians living with type 1 diabetes.

However, Senate Estimates suggested that Mr Butler had blocked progression of discussions of subsidies for the devices for type 2 diabetics, an “outrageous” move according to Ms Rushton.

Speaking to The Medical Republic, Australian Diabetes Society CEO Associate Professor Sof Andrikopoulos said that while he acknowledged the financial pressures on the government, affordable access to technology was necessary for all patients with diabetes.

“We know that continuous glucose monitoring in type 2 diabetes can improve glycemia,” Professor Andrikopoulos told TMR.

“And it can also improve quality of life outcomes, particularly for people with type 2 diabetes who are on insulin.”

According to Australian National Diabetes Audit data, about 40% of people with type 2 diabetes are using some form of insulin, a “substantial number” of people considering that there are 1.3 million people living with type 2 diabetes in Australia, said Professor Andrikopoulos.

“[The Australian Diabetes Society] advocates for equitable and affordable access to technology for all people with diabetes who would benefit,” he added.

Professor Andrikopoulos acknowledged that financial pressures may mean subsidised access may need to be prioritised for groups of patients that would benefit the most from CGM devices.

This may include those with type 2 diabetes who are on insulin, basal bolus insulin or those on insulin with other comorbidities, rather than a “blanket” approach for all type 2 diabetics.

Professor Andrikopoulos also highlighted patients aged under 40 years with type 2 diabetes as a “very difficult to manage cohort” that could benefit from CGM technology.

“If you look at the [MBS] data, prevalence over the past 10 years has increased by 30% in people who have type two diabetes under the age of 40,” said Professor Andrikopoulos.

“Ideally, everybody who would benefit should have equitable and affordable access. But we understand that that may not be achievable in the first instance.

“We would advocate for [access for] specific vulnerable groups or specific groups with type 2 diabetes that would benefit the most.”

Amid “significant cost of living pressures” Ms Rushton questioned the health minister’s timing of the announcement, suggesting that the government had “put their foot fully on the brakes” in regard to diabetes care.

Currently, for type 1 diabetics accessing continuous glucose monitoring devices, GPs must refer patients to authorised prescribers – diabetes educators, endocrinologists, nurse practitioners, physicians with a diabetes specialty and paediatricians – to access the subsidised products.

While some, including the RACGP, have denounced this hurdle, Professor Andrikopoulos noted the complexity of the discussion.

According to Professor Andrikopoulos, the technology is constantly evolving meaning that even specialists are “struggle keeping up”.

He added that GPs would need to upskill either through ADS courses on management and implementation of this technology or retain a proper referral pathway to a diabetes health professional.

Professor Andrikopoulos said that the availability of telehealth, which carried Australians through two and a half years of lockdown, made arguments that the process disadvantaged patients a “moot point”.

When asked by TMR for comment on subsidies for CGM devices for type 2 diabetics, the health minister said, “the Government provides considerable financial support to people with diabetes through the subsidy of essential medicines, like insulin, under Pharmaceutical Benefits Scheme and other diabetes-related products, like blood glucose test strips, through the National Diabetes Services Scheme”.

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