On Tuesday, a tragedy occurred in Taean, South Chungcheong Province, where the parents of a nine-year-old girl with juvenile diabetes committed suicide.

At a parliamentary debate two days later, experts pointed out that continuous glucose monitors and insulin injectors, such as insulin pumps and digital pens, have been developed to treat type-1 diabetes with insurance coverage but are not properly used for treatment.

This is due to the lack of a severe diabetes management system, they noted.

Dr. Kim Jae-hyeon, head of the Pancreatic Insufficiency Diabetes TFT of the Korean Diabetes Association and head of the Diabetes Center at Samsung Medical Center, said so at a discussion held at the National Assembly Hall on Thursday to explore ways to advance the management system for severe diabetes that requires insulin.

"Despite insurance coverage, the number of people with type-1 diabetes who use insulin pumps linked to continuous glucose monitors accounts for only 0.4 percent or 241 out of 57,000 people," Kim said. "This is due to the absence of reimbursement for treatment and management and nursing fees, high (device) prices, and the lack of rental systems."

The use of insulin pumps requires professional management and training of medical staff, but there are no related insurance benefits," Professor Kim said. "Since there is no insurance coverage, it is difficult to prescribe these devices that require a lot of time and effort of medical professionals."

Moreover, for elderly patients with type-1 diabetes who have less access to digital devices, repeated education is essential. However, the barriers to access to treatment are high as there is no reimbursement system, forcing patients to purchase the devices outside of the hospital and "take care of themselves" under the current system, Kim pointed out.

"Older patients with pancreatic insufficiency diabetes are in urgent need of management due to high medical expenditures and the development of complications, but the rate of using the latest medical devices is low," Professor Kim said. "Among patients over 60, only 0.1 percent use insulin pumps that work with continuous glucose monitors."

Without system improvements, increasing the use of up-to-date medical devices among older patients will be difficult, leading to complications and unnecessary healthcare expenditures, Kim added.

The diabetes specialist noted that randomized controlled trials have shown that medical devices alone, without medical care and management, have little effect on glycemic control.

As the result of analyzing the annual economic impact of a treatment and management fee of 50,000 won ($38) per month for patients with type-2 diabetes taking rapid-acting insulin, a deficit of 16.8 billion won was projected in 2023 if only continuous glucose monitors were distributed. Ten years later, in 2033, the deficit grew to 26.2 billion won, or 1.5 times larger.

In contrast, if continuous glucose monitors and treatment and management fees were provided, the annual economic effect would be 155.1 billion won in 2023, larger than the deficit when only medical devices were supplied. Still, it turned into a surplus of 12.1 billion won two years later, and the surplus steadily increased to 50.8 billion won in 2033.

"It is necessary to introduce treatment and management fees in addition to the device cost," Kim said. "Also, it is necessary to change to a nursing care reimbursement system instead of a nursing care fee system. Above all, managing highly hazardous devices outside of hospitals is dangerous. It would be far better to categorize the beneficiaries not by age but by the severity of the disease."

Due to the lack of a proper reimbursement system, treating type-1 diabetes in hospitals is one of the “avoided areas,” in which the more the treatments, the larger the deficits. As a result, finding an endocrinologist who treats type-1 diabetes is like “winning the lottery.”

"Reimbursement for the training courses on continuous glucose monitors was introduced last year but remains insufficient," said Kim Chong-hwa, former director of insurance and government affairs at the Korean Diabetes Association and director of the Endocrinology Department at Bucheon Sejong Hospital. "The biggest problem is that there should be more doctors to treat type 1 diabetes, but the reality is far from it."

Kim pointed out that hospitals support personnel only when they can afford it.

“To provide medical services, there must be sufficient providers to benefit the recipients. It is essential to reimburse management and education."

‘Government will push patient-centered policies with keen interest’

The government has shown a willingness to listen to and collect opinions from the field to promote patient-centered policies.

In the wake of the family’s tragedy, the Ministry of Health and Welfare said that health insurance support for the purchase of medical devices, such as precision insulin pumps used by type-1 diabetes patients under 19, initially scheduled for the end of March, will be advanced to the end of February.

"The ministry is interested in and taking measures to improve the type-1 diabetes system, but many challenges remain," said Jeong Seong-hun, director of the Insurance Benefits Division. "We will review the entire policy on pediatric diabetes, reorganize it from the patient's perspective, and implement it from the end of February by lowering the deductible level. However, there are still areas that need to be improved from an institutional perspective."

Explaining reasons the policy was implemented by limiting the age to under 19, Jeong said, "The key was to prevent the risk of hypoglycemia and the linkage of continuous glucose monitors in prioritization due to the difficulty of self-management and the characteristics of pediatric patients. We will further evaluate the need to expand it to adults."