More than 130,000 people are living with type 1 diabetes (T1D) in Australia. For many of these people, managing the condition is a difficult and time-consuming responsibility.
“Living with type 1 diabetes is a 24-hours-a-day, 365-days-a-year job,” Diabetes Australia Group CEO Justine Cain said recently.
Technologies such as continuous glucose monitoring (CGM) have been shown to be beneficial for many people with T1D, not only reducing the burden of daily finger prick tests (which can translate to improved mental and emotional health and a better quality of life) but also significantly improving health outcomes.
CGMs have been available in Australia and fully subsidised for certain eligible groups for some time. But access was set to be expanded significantly from 1 July with an extension of the subsidy, meaning those with T1D not currently eligible will be able to pay just $32.50 per month to access the technology.
What does this mean for people living with T1D?
In the July issue, Retail Pharmacy spoke with JDRF Australia and Diabetes Australia, two bodies instrumental in advocating for the change.
Understanding T1D
T1D is a lifelong autoimmune disease that usually becomes apparent in childhood but can be diagnosed at any age. It is caused by the immune system (which normally functions to provide protection from invasion by pathogens, fight infection, and facilitate wound healing) mistakenly targeting healthy cells of the body, according to JDRF Chief Scientific Officer Dr Dorota Pawlak.
“In type 1 diabetes, the immune system attacks specific cells in the pancreas called beta-cells that produce insulin,” she said. “Insulin is a hormone that helps the cells of the body convert glucose (a type of sugar) from food into fuel. Without insulin, cells have no fuel and glucose can build up in the bloodstream to dangerous levels and cause long-term complications.”
Since people with T1D cannot produce insulin naturally, they must administer it either through daily injections or by infusion from an insulin pump.
“T1D is different to type 2 diabetes (T2D), which occurs when people develop insulin resistance and their bodies don’t use insulin as well as they should,” Dr Pawlak said. “This is generally caused by a combination of genetics and lifestyle factors and can most commonly be managed initially by dietary changes, exercise, and medication. However, [as T2D is] a progressive and chronic condition, some people may need to inject insulin as the disease advances,” Dr Pawlak said.
Some people initially misdiagnosed with T2D have latent autoimmune disease of adults (LADA).
“People with LADA can have features of both T1D and T2D in that their immune system appears to be attacking the insulin-producing beta-cells of the pancreas, and they may also have insulin resistance,” Dr Pawlak said.
Importance of monitoring
As people with T1D cannot produce insulin themselves, they’re required to consistently monitor their blood glucose levels to determine when and how much insulin they need to administer.
“Keeping a close eye on what glucose levels are doing is an important part of type 1 diabetes management,” Diabetes Australia Manager (Type 1 Diabetes and Communities) Renza Scibilia said.
Traditionally, this monitoring would involve a blood glucose meter, a lancet to prick the skin, and blood glucose strips.
“What we we’d do is we’d prick our finger, and we’d have a snapshot telling us there and then what our blood glucose was,” said Ms Scibilla, who has T1D.
“We’d then make decisions about whether or what we’d eat; how much insulin we’d need to give ourselves; if we needed to stop, etc.”
While this method provides an accurate measure of glucose levels at a particular point in time, it lacks the detail and trends that can be provided through CGM. This is important when considering that blood glucose levels are impacted by several factors, such as food, exercise, sleep, stress and more.
“Technology that helps people with T1D monitor these levels in real time, for many, is a vital element of disease management and can make it easier, more accurate and less stressful,” Dr Pawlak said.
A 2019 consensus between international leaders in diabetes care, including JDRF, recommended the management of blood glucose levels be guided by ‘time in range’ (time spent within the range of optimal glucose levels) rather than level of glycated haemoglobin (%HbA1c) with the use of CGMs.
“CGMs measure time spent in range, whereas traditional blood glucose meters cannot, and this information is automatically collected and can be shared directly with healthcare teams to help make informed disease management choices,” Dr Pawlak said.
Role of pharmacists
Community pharmacists play an important role in supporting people with T1D.
“When you live with type one diabetes, it’s a bit of a cast of thousands in some ways, so a really great relationship with a community pharmacist and the community pharmacy is important,” Ms Scibilia said.
“For me, the most critical thing that makes life so much easier is having a community pharmacist who you feel is on your side,” she said.
One way pharmacists can improve the experiences of people living with T1D, and their carers, is through managing expectations around timelines – how soon insulin and other supplies can be accessed.
“The feedback that we get from people who have those really great relationships is that they know, for example, that they need to phone ahead to say they need an insulin prescription filled, to give the pharmacist time to get it in – because, in most cases, their insulin might not be automatically kept available at the pharmacy, and the same with NDSS products.”
She suggests having open lines of communication and for pharmacists to be clear about what the timelines are, how much notice is required, and how long it’s likely to take for items to become available.
JDRF CEO Mike Wilson’s advice to pharmacists is to “be familiar with the specific glucose monitoring technologies … and the new pricing and access arrangements, once they’re implemented, so their customers with T1D can access the benefits of the announcement without delay”.
Ms Scibilia says it’s important for pharmacists to remember that diabetes is a tough gig.
“It’s complex to live with and it’s really hard work, 24/7,” she said. “There’s a lot of stigma associated with all types of diabetes. Being really mindful of that, and mindful of language and communication when speaking to people with diabetes is really important.”
This feature was originally published in the July issue of Retail Pharmacy magazine.
To read the feature in full, visit: retailpharmacymagazine.com.au/magazine/retail-pharmacy-july-2022
