Universal CGM subsidies have transformed technology uptake and glycaemic outcomes in young adults with type 1 diabetes, real-world Australian data show.

Research published in Diabetes Care [link here] included 418 patients aged 15-25 who attended a young adult diabetes service at Westmead Hospital, and found:

• Use of continuous glucose monitors increased from 29.4% to 76.2% over the study duration of 2019-2024, likely to due universal subsidisation,
• Patients using hybrid closed loop (HCL) insulin pumps increased from 5.1% to 35.4% over the study period, and
• Median HbA1c levels fell from 68 mmol/mol (8.4%) to 64 mmol/mol (8.0%) over the five years, in line with the increased access to HCL and CGM technologies.

On the other hand, insulin pump use remained unchanged, at 52%-57%, with pump access limited by cost, according to the study authors.

“The benefits of diabetes technologies to glycaemic outcomes are well documented which has been reassuringly reflected in our real-world data,” they wrote.

They noted that when the study began in July 2019, median HbA1C levels were no different from what was seen at the same clinic between 2001 and 2012.

“Despite the emergence of multiple diabetes technologies prior to 2019, uptake remained low and limited by cost until subsidies were introduced,” they said.

“It is therefore likely that improvements in overall glycaemia in this clinic population resulted once substantial uptake of diabetes technology had occurred by the end of the 5 years.”

Insulin pump therapy in focus 

But funding gaps remained in the Australian health system, particularly around insulin pump therapy and the use of automated insulin delivery, the authors said.

“An increase in pump therapy was only observed in those of the lowest sociodemographic cohort, attributed to expansions in the insulin pump program targeted to low-income households, although a reduction in usage was observed in middle socio-economic groups,” they noted.

Rates of DKA and hypoglycaemia remained unchanged across the cohort, but a reduction in DKA was observed in patients on insulin pump therapy.

The findings come as a network of Australian diabetes groups demand the federal government spend $405 million on expanded subsidised access to AID and CGM systems, arguing this would deliver billions in health savings over the coming decades [link here].

The groups, including Diabetes Australia, pointed to a widening gap between the evidence of the effectiveness of tools like CGMs and AID systems and the affordability of options.

Study co-author Professor Jane Holmes-Walker said the work added to building evidence about the value of automated insulin delivery across all age groups, even the 15-25 age group, which has been challenging to manage in the past.

She said there was no reason subsidies for insulin pump therapy should stop at age 21, given the clear benefits for older patients.

“The benefits are regardless of IRSAD quintile. There was also benefit for reduction in incidence of DKA and clear benefit for improving glycemic outcomes with automated devices even in a challenging young adult cohort,” she told the limbic.

“Others will have looked at cost benefit. The significant reduction in DKA admissions is important as DKA is one of the most common causes for admission in young adults and has significant adverse impact on mental health and social impact with loss of work.”

Professor Holmes-Walker highlighted that New Zealand had introduced fully subsidised automated insulin delivery with the T slim or Ypso pump device for all patients with type 1 diabetes as well as those with pancreatectomy, all cystic fibrosis-related diabetes and monogenic diabetes.

Chief medical officer at Diabetes Australia Dr David Simmons said the group had heard feedback from people with type 1 diabetes that more affordable insulin pumps would make a big difference to them.

“The pumps that make AIDs possible have been shown to be very cost-effective, but there’s ongoing inequity across Australia as they are simply unaffordable for many people, particularly once teens and young adults get older,” he said. 

“This inequity is the basis of the diabetes community’s submissions to the Federal Government ahead of the 2025-26 Budget. It seems counter-intuitive in today’s world to allow out-of-pocket costs to prevent larger health service savings and better health outcomes for individuals.”