Realistic help needed for type 1 diabetics wanting to live a 'normal life'

Patients and their families said the government should expand the reiumbursement system so that continuous glucose monitors (CGMs) and insulin pumps can be supported by health insurance instead of medical expense subsidies to help people with type 1 diabetes and their families live “normal lives.”

Families of type 1 diabetes patients urged the government to support using devices for efficient diabetes management, including wireless insulin pumps, at the “Debate on Securing Access to Insulin Pumps for People with Type 1 Diabetes” held at the National Assembly on Thursday.

Insulin pumps are an important medical device for people with type 1 diabetes. Without them, there is a high likelihood that hypoglycemia and hyperglycemia can lead to emergencies and complications.

The development of continuous glucose monitors and insulin pumps in the overseas market has led to efficient ways to manage type 1 diabetes, but it is difficult for Korean patients to use them.

A case in point is wireless insulin pumps. Due to the small number of patients, medical device companies have had difficulty making a profit, forcing type 1 diabetes patients and their families to buy them directly from foreign companies at high prices.

“Blood sugar needs to be monitored around the clock, not only during the day but also at night,” said Lee Mi-seon of the Insulin Diabetes Family Association. “It doesn't end if the blood sugar turns better one day. We must consider hundreds of variables to manage blood sugar, including the type of food, the child's physical condition, the child's state of mind, and even the failure of continuous glucose monitors and insulin pumps, so every day is difficult.”

“While the out-of-pocket costs for type 1 diabetes have been reduced for youth under 19 since March of this year, expanding access to patchable wireless insulin pumps is still very limited,” Lee said. “Recently, the out-of-pocket cost has doubled. She said it costs 600,000-700,000 won ($418-$488) a month to purchase the product directly, paying shipping, customs and VAT,” he said.

Lee noted that the National Health Insurance Service (NHIS) does not provide health insurance coverage for a single product, so patients who want to use wireless insulin pumps choose to use wired insulin pumps or injections despite the inconvenience.

“We hope that health insurance coverage for wireless patch-type diabetes patients will be reviewed soon so that they can enjoy a daily life similar to that of non-diabetics by providing convenience in activities and improving the quality of life of diabetics,” Lee said. “The government should also consider the positive results that can be expected by minimizing complications and increasing the financial health of health insurance.”

Professor Kim Dae-jung of the Department of Endocrinology at Ajou University Hospital, who served as the moderator of the event, called for the government to provide support for type 1 diabetes patients to expand the range of medical devices they can choose from “through health insurance benefits instead of medical expense subsidies.

“Fundamentally, it is a device that is very necessary for the treatment of type 1 diabetes, but it is discussed as part of medical expense subsidy outside of health insurance,” Professor Kim said. “The government says medical subsidy is the same as insurance benefits, but we can narrow the difference of opinions only by bringing the matter into the health insurance system.”

“The government should actively consider wireless insulin pumps for type 1 diabetes, as many people do not receive benefits,” Kim said. “I would like the Health and Welfare Ministry to actively create a forum for discussion so that various types of discussions can continue. It would be nice if they could open a window to discuss with the NHIS officials and persuade them.”

The government said it would consider expanding support for continuous glucose monitors, insulin pumps, and the NHIS, given the medical device market conditions.

“We have been expanding support for insulin pumps since February this year, reflecting the difficulty of managing type 1 diabetes patients under 19 on their own,” said Jeong Ji-hyung, an official at the ministry’s Insurance Benefits Division. “Patch-type insulin pumps have many advantages that help children with type 1 diabetes learn and grow in school, but we cannot skip the discussion on its cost.”

“It is necessary to consider medical necessity and benefit prioritization comprehensively in including it in the health insurance system,” Chung said. “The ministry will review it with the NHIS by watching the market situation and other related things.”