Fully funding diabetes care would improve lives, save the health care system money

When Taylor Efford was diagnosed with type 1 diabetes two years ago, the 26-year-old Toronto actress’s life changed essentially overnight.

“Life just flipped upside-down,” recalled Efford, “It was kind of like I was a normal healthy girl living my life and, all of a sudden, my pancreas just shut down. And when that happens, you get sick really quick.”

Fortunately, she was diagnosed quickly, too, and put on life-saving insulin. It took some time, however, for her doctor to figure out the right dosing regimen and, in turn, for Efford to learn how to do all the daily testing and treatment that comes with managing type 1 diabetes — multiple finger pricks to test blood sugars and daily insulin injection(s).

It didn’t take long for Efford, a popular TikTok creator and Instagrammer, to start looking for advice online. And, thanks to her virtual diabetes communities, she quickly learned all about modern alternatives to needles. Within a few months, she bought a continual glucose monitoring (CGM) device, a sensor inserted under the skin that, as the name suggests, constantly measures blood sugar levels.

“Not only does it eliminate a kind of yucky process, it helps me feel safe, because an alarm will go off on my phone if I’m low or high,” she said. “And I don’t have to be someone who always has to excuse themselves from social scenarios to go prick their finger to see if they’re dying — not to be overly dramatic.”

The other piece of technology Efford uses is an insulin pump. That came later, though, because her endocrinologist wanted her to fully grasp how the disease worked on her body. So, for the first year, she administered her own insulin the old-fashioned way.

Now, in what’s known as integrated insulin pump therapy, she uses both the CGM and the pump. The monitor sends real-time blood-sugar readings to the pump, which can then respond by delivering precision doses.

“In my opinion, it’s life-changing technology,” said Efford. “We’ve had 101 years of insulin now, which is amazing, since the insulin allows us to exist with this disease. But the new technology allows us to actually live and go about our daily life as easily as possible, which, with such a complicated disease, is everything.”

To Efford, that peace of mind is well worth the money she paid out of pocket to get set up with the CGM in the first place — it costs about $300 per month. She and her partner had to discuss the expense, since it’s a lot of money. She’s fully aware, though, that she’s fortunate to be in a position to be able to make choices and opt to buy it.

Although we’re supposed to have universal health care in Canada, and insulin costs less here than in the United States, diabetes is still an expensive disease to have in Ontario — a message stakeholders are trying to get out during Diabetes Awareness Month.

Medical visits for diabetics are covered by OHIP, but there are gaps in the system when it comes to paying for insulin and all the delivery and monitoring tools — low-tech and high.

The formula for coverage involves both age and the severity of disease, so it’s a little complicated. The upshot is that not everybody is eligible for a fully integrated pump and monitor system in Ontario.

“Unfortunately, some people don’t meet the criteria for the funding under the current provincial government system,” said Dr. Ilana Halperin, a Toronto endocrinologist. “So, we’re not able to offer them the best technology out there that’s evidence-based.”

Integrated insulin pump therapy is about more than patient quality of life (not that this shouldn’t be a top priority — it should). It’s also about making people healthier.

“The person living with the condition is so much more in the driver seat than their clinician,” Halperin explained. “So my job is to give patients tips and tricks on how to stabilize glucose levels for as much time as is possible, while minimizing the burden that the disease puts on their day-to-day activities.”

“But the person living with diabetes and making decisions like ‘What am I going to eat?’ and ‘Am I going to exercise?’ needs to know what their current glucose level is and how much insulin they have on board,” she continued. “Which is why I’m such a strong advocate for more universal coverage of these advanced diabetes technologies. They help patients achieve what I would almost describe as the ‘Holy Grail of diabetes,’ which is more time in the target range and less glucose variability.”

All of this amounts to preventative medicine, which, in this case (and pretty much every other case, too), would not only improve lives, it would save the health care system money in the long run, as well. Improving glucose control, Halperin said, would lead to fewer complications like vision loss, dialysis and amputations, all of which cost the health care system and, in turn, the taxpayers, far more hardship and money than simply keeping someone on a continuous glucose monitoring system in the first place.

Plus, it would allow people to do all those everyday things that people who aren’t sick often take for granted, such as caring for their kids, going to work and being productive members of society.

And, as Efford pointed out, when you’re sick, getting your daily life back is, well, everything.

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