Alberta has been a leader in diabetes research and care, but we have fallen behind other provinces.
In 2013, Alberta launched the most generous insulin pump therapy program in the country. Insulin pumps and supplies were provided free of charge to adults and children with Type 1 diabetes who needed them. Low income was no longer a barrier to access, but the province ending up taking on the costs of pumps for people who already had coverage through private benefit plans.
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As well as the pumps which allow accurate delivery of life-preserving insulin without four or more injections per day, the provincial insulin pump therapy program (PIPTP) provided blood sugar test strips (approx. $7 per day) for free — if you were part of the program. People who preferred to use injections or were not eligible for a pump got nothing.
Like cellphones, pumps get updated and new models released, but there was no mechanism to add new pumps to the PIPTP. Only two of four pumps sold in Canada are available through the PIPTP; one is now three generations out of date. There was no coverage for continuous glucose monitoring (CGM) either. Instead of finger pokes, CGM gives real-time blood sugar levels, and alerts warning of dangerous fluctuations. Next-generation pumps integrate with CGM systems to partially automate insulin doses — resulting in better, safer blood sugar levels, better health and ultimately lower health-care costs.
Substantial, thoughtful work was undertaken to address these challenges with the goal of improving access to the latest insulin pumps and technology, irrespective of income, while being sustainable for taxpayers. The plan involved using existing administrative structures (Alberta Blue Cross), negotiating best prices from device manufacturers, and provided access to CGM for children. Unfortunately, the plan was not well-communicated.
As a result of public outcry, changes to the PIPTP were suspended and the establishment of a working group to review “the province’s entire diabetes care pathway” and help shape a provincial diabetes strategy was announced in July 2022. A provincial strategy for diabetes is hugely important, particularly given recent federal legislation. A private member’s bill “to establish a national framework for diabetes” (Bill C-237), was passed in June 2021 and a Framework for Diabetes in Canada tabled by the federal minister of health in October 2022. This is important work which should not be rushed.
But, time is running out to deliver on access to next-generation pumps “starting as soon as possible in 2022.” There is no need to delay access to next-generation pumps and allow adults (as well as children) access to CGM to fully realize the benefit of next-generation pumps. Only minor changes to earlier proposals are required and need not increase costs.
Briefly, for people without existing coverage (from private benefit plans) next-generation pumps would be accessed by enrolling in a government-sponsored benefit plan. For seniors and those with low income, or on AISH, there would be no premium. Others would pay a monthly premium ($63.50 for a single person; $118 for a family) — which would also provide prescription drug coverage.
The change I would recommend is that patients are allowed to use the expanded coverage for diabetes test strips (included in the government sponsored benefit plan — $2400/year) to pay for CGM. Patients could then choose how they wish to monitor their blood sugar levels (finger pokes or CGM).
CGM for Type 1 diabetes is fully covered in the U.K. and substantially improves blood sugar levels for better health. It is also recommended by Diabetes Canada’s Clinical Practice Guidelines. CGM is most significant advance for people with Type 1 diabetes in my 30-year career. But many of my patients don’t have access to CGM or next-generation pumps.
We don’t need to wait. There is a plan, a good price has been negotiated, and a $2,400 allowance for supplies already built in. Albertans with Type 1 diabetes deserve the choice of how they monitor their blood sugars and how they take insulin.
Dr. Peter Senior is the Charles A. Allard Chair in Diabetes Research, director of the Alberta Diabetes Institute and professor of endocrinology at the University of Alberta. He is a member and past chair of Diabetes Canada’s Clinical Practice Guidelines Steering Committee and contributed to the Revised Criteria for Alberta’s Provincial Insulin Pump Therapy Program.
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