Diabetes advocates call for continuous glucose monitor funding

By Catherine Griwkowsky April 17, 2023

Advocates for people with diabetes are calling on Alberta to expand coverage for technologies that manage and treat the disease, but the government says it is awaiting a report from the Diabetes Working Group, which is expected in the fall.

The push for funding of continuous glucose monitors comes after the Manitoba government announced expanded coverage for residents up to 25 years old in last month’s budget.

Proponents say covering the devices will reduce overall costs and improve patients’ mental health.

For Edmontonian Kristy Muckler, the continuous glucose monitor has offered reassurance when driving and overnight when her husband is out of town.

Muckler was diagnosed with Type 1 diabetes at age 12 after starting to rapidly lose weight and suffering other symptoms.

“[As] I was walking into the doctor’s office, I collapsed, and my older sister picked me up and brought me into the doctor’s office,” Muckler recounted.

She spent two weeks in hospital and temporarily lost her vision.

Her first glucose monitor took five minutes to produce a reading, and when a new monitor came out with a reading in two minutes, it felt revolutionary. Now monitors can produce a reading in seconds.

A few years ago, Muckler decided to switch to a continuous glucose monitor. Despite her insurance coverage, the pharmacy initially told her the device wasn’t eligible.

“I started crying at the pharmacy because I was really excited to try it,” she said.

Her husband paid upfront and the insurance company eventually reimbursed the couple for the monitor.

Muckler said her blood sugar often drops at night. Before using the continuous glucose monitor, she would ask her co-workers to call her husband if she didn’t show up for work in the morning on days when he was working out of town. She bought a fridge for her bedroom to store juice in, so she wouldn’t have to walk downstairs in the middle of the night if her blood sugar dropped.

The monitor can sync with other devices to set off an alarm when her blood sugar is close to being outside the normal range.

With manual monitors, testing is typically done three to five times per day, with test strips costing around $1 each.

Muckler said she now gets up to 20 readings per day when she isn’t feeling great. The continuous glucose monitor has also helped her by offering a more accurate sense of blood sugar patterns.

She also has been able to work out and pursue her health goals, and has seen improvements to her mental health.

“Not having to call 911 in the middle of the night because I’m having a seizure from low blood sugar is fabulous,” she said.

Kristy Muckler holds the long-acting insulin she uses to manage her Type 1 diabetes.

Pump therapy program cancelled, decision reversed

The government’s diabetes working group, which began work in February, was struck following outcry at a 2022 decision to cancel the coverage of automated insulin pumps.

The government backed down on the plan, instead creating the working group.

The group’s report will inform a long-term strategy due back in the fall, Health Minister Jason Copping’s press secretary Scott Johnston told Alberta Today.

“The government continues to monitor innovations in diabetes management technologies,” Johnston said. “We are examining opportunities to expand benefits while making sure current programs remain sustainable.”

Alberta saw the largest increase in diabetes cases of any province in the past decade and is expected to have the largest increase over the next 10 years.

As of 2022, the direct cost of diabetes to the health-care system was $494 million, a figure expected to grow to $692 million by 2032.

Monitors and insulin pump technology have evolved, policy lags

Endocrinologist and director of the Alberta Diabetes Institute Dr. Peter Senior told Alberta Today continuous glucose monitors have the advantage of offering “actionable” feedback. If only one diabetes technology can be funded, Senior says, it should be the monitors.

“If you lived in a land where there was lots of photo radar, but no cars had speedometers, you could be paying a lot of tickets and there’d be a risk to road safety,” he explained. “Essentially, what we’ve now got is speedometers [with which] people can see where they’re at easily all of the time, and they can make adjustments.”

Senior added that, depending on the continuous glucose monitor, readings every five to 15 minutes can paint a picture in data uploaded to the cloud.

“Let’s use machine learning to identify high-risk people that need some extra care,” Senior said.

Newer insulin pumps can now communicate with continuous glucose monitors and take the guesswork out of diabetes management. Senior said the algorithms aren’t perfect and people still need to add “inputs,” such as eating or exercising, but much of the process is automated.

He continued the car metaphor by saying it’s a bit like adaptive cruise control. Ultimately, the goal will be to have “self-driving” cars.

It’s an exciting time for diabetes management, Senior noted, with two classes of drugs emerging in the past five years: GLP-1/GIP receptor agonists, and SGLT2 Inhibitors. The former category, including the brand name medication Ozempic, is covered by Alberta Health, while SGLT2 inhibitors such as Invokana require special authorization for coverage.

Senior said that sometimes it is the people who have the best access to specialists who know how to work the system and get coverage, rather than the people who stand to benefit the most.

“These are effective drugs for diabetes management — they reduce heart attacks and strokes and heart failure and kidney disease — and they should be really used much earlier,” Senior said. “They shouldn’t be used as a last resort.”

System-wide approach needed

In addition to funding of technology, Senior said, Alberta must come up with a strategy for system-wide management of diabetes.

According to him, other jurisdictions have a “pyramid of care” — everyone has a family doctor for routine monitoring, some get management from a diabetes-trained community nurse, and others with more complex needs get elevated to a specialist.

“Right now, it is completely haphazard,” Senior said. “Everyone is doing their own thing their own way. Some people are getting excellent care and some people are getting no care.”