Type 1 diabetes

Access criteria make CGM ‘largely inaccessible’, say diabetes educators

Patients with type 1 diabetes are finding they are unable to access subsidised continuous glucose monitoring (CGM) devices because of restrictive access criteria under the expanded eligibility scheme, according to diabetes educators.

New CGM funding came into effect on 1 March with an estimated 37,000 patients theoretically set to benefit from the changes, including people with T1D aged 21 years or older with concessional status and who have a high clinical need to access CGM products; women with T1D who are pregnant, breastfeeding or actively planning pregnancy; and young people with conditions very similar to type 1 diabetes – including cystic fibrosis related diabetes and neonatal diabetes – who require insulin.

But the Australian Diabetes Educators Association (ADEA) says its members have been voicing concerns that subsidised CGM has so far been largely inaccessible to the new target groups. In the latest ADEA newsletter president Brett Fenton outlined eight major issues his membership had constantly raised over the past two months, among them:

  • The criteria for establishing the required “high clinical need” for patients 21 and over is extremely restrictive, making it difficult for anyone to access the devices under this category.
  • Information sought from diabetes educators and their patients to support CGM need is over and above what should be required to be eligible to access the program, seems irrelevant and personally invasive.
  • CGM access postpartum should be up to six months, considering WHO and other international guideline
  • Uncertainty about how criteria apply to pregnant women or those trying to conceive, particularly if the period of trying to conceive is longer than 12 months, a woman wants to take a break from actively planning pregnancy, or in the event of a miscarriage.
  • The wording ‘very similar to type 1 diabetes’ and list of CGM eligible conditions other than type 1 diabetes “may be misleading and incorrect in many instances”
  • Exclusion of Credentialled Diabetes Educators as authorisers for the third ‘other, similar conditions to type 1 diabetes, who require insulin’ group.

Mr Fenton said ADEA was now working with other groups such as the Australian Diabetes Society (ADS), the Australasian Paediatric Endocrine Group (APEG), the Australasian Diabetes in Pregnancy Society and Diabetes Australia to take up the issues with government .

“ADEA through Diabetes Australia have advised the Department of Health that we understand the financial constraints however, the current eligibility criteria do not align with current diabetes management guidelines,” he wrote.

ADEA was committed to to working with the Australian Diabetes Society “to put forward issues and concerns with strong evidence base to decision makers, via Diabetes Australia and NDSS, to expand the access to benefit people with type 1 diabetes and other, similar conditions to type 1 diabetes, who require insulin,” he said.

Other diabetes organisations told the limbic they were taking a wait-and see approach to the issue of CGM access criteria

Associate Professor Jane Holmes-Walker, honorary secretary of the Australian Diabetes Society and staff specialist in the Department of Diabetes and Endocrinology at Westmead Hospital, Sydney, told the limbic she believed it was reasonable for government to put restrictions on access criteria for CGM until it got a sense of  demand and costs.

“It’s an expensive piece of equipment and I think they want to get a better understanding of who would benefit,” she said.

“We need to keep our advice evidence-based, rather than emotion-based, and gather enough [data] to show various groups benefit, then do the cost/benefit analysis to show government it’s worthwhile investing in these individuals.”

Diabetes Australia  CEO Professor Greg Johnson said the organisation was happy with the Government’s $243 million four years CGM Funding Initiative, which included the March expansion to additional patients groups.

“In only five weeks almost 1300 people have accessed CGM under the expanded program,” he said.

“The issues raised by Australian Diabetes Educators Association are not surprising. Many of these were discussed in the initial planning and all of these matters will be further considered in coming months as the implementation of the new program continues. The ADEA will be represented in this process,” he added.

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