It’s time for Manitoba to fully fund insulin pumps

Hey there, time traveller!
This article was published 11/07/2018 (2834 days ago), so information in it may no longer be current.

A Manitoba-based petition to the House of Commons is rapidly gathering signatures. Sponsored by Doug Eyolfson, local physician and member of Parliament for Charleswood-St. James-Assiniboia-Headingley, it calls upon the federal health minister to work to eliminate the age restriction for insulin-pump coverage and introduce a national pharmacare program to ensure drug affordability for those living with diabetes.

The petition was initiated by Winnipeg-born Josh Goldstein, who has needed to continuously balance his physical activity and carbohydrate intake with insulin injections since his diagnosis with Type 1 diabetes at age 14.

Type 1 diabetes is characterized by a deficiency in insulin, the essential hormone that lowers sugar levels in the blood. Comprising roughly five per cent of diabetes patients in Manitoba, or nearly 6,500 people, it is traditionally managed by multiple daily injections (MDI) of insulin. Insulin is not only life-saving in the short term, it is also necessary to reduce the long-term complications of chronically high blood sugars such as heart attacks, strokes, blindness, limb amputations and kidney failure/dialysis.

Now a 24-year-old paramedic living in The Pas, Goldstein finds it challenging to choose consistently appropriate insulin doses to inject, given the significant variability and unpredictability of his days and nights.

Many diabetes specialists would argue that the treatment of choice for someone like Goldstein is an “insulin pump,” a small pager-sized electronic device used specifically in Type 1 diabetes that delivers insulin continuously through a catheter beneath the skin.

The pump-wearer programs how much insulin to inject — both the background amounts and extra “boluses” to cover sugar surges at meals. The insulin infusion rates are individualized and can vary by time of day. Infusions can also be adjusted in real time, a flexibility not possible with injectable insulin doses, which cannot be reversed.

However, insulin pumps are not cheap and personal finances are often a barrier. In Canada, each device can cost up to $7,000, with an expected lifespan around five years.

Funding currently varies by province and age. In Manitoba and Quebec, insulin pump coverage is only available for those under 18 years old. Prince Edward Island provides funding for those under age 19, and Saskatchewan, New Brunswick, Nova Scotia and Newfoundland fund pumps until age 25. Meanwhile, in Ontario, Alberta, the three territories, and now — as of July 3 — British Columbia, coverage is available regardless of age.

In previous news stories, Manitoba provincial spokespeople have responded that pumps’ clinical effectiveness must be proven before funding is expanded. However, multiple large and widely reported studies over the past 15 years, such as the 2010 “STAR 3” trial, have shown that insulin pumps both reduce blood sugar variability and safely lower average blood sugars compared to MDI, in both children and adults. Improved blood-sugar control translates into reduced risks of diabetes complications.

Furthermore, a publicly available report by Diabetes Canada, titled “The Economic Benefit of Public Funding of Insulin Pumps in Manitoba,” details how the costs of pump funding are offset by savings achieved through improved diabetes management, leading to fewer diabetes complications. Comparing the costs of insulin pumps to the diverse direct and indirect savings from fewer heart attacks, strokes, limb amputations and dialysis patients, they calculate a net initial annual cost to Manitoba of only $640,000, and lead to a net annual savings of $480,000 within 20 years.

Insulin pumps are not just about convenience. Whether it’s through a national pharmacare formulary or through expanded provincial eligibility, funding insulin pumps for all ages is both best-practice medical care and a financially responsible measure. It’s time for Manitoba to catch up with the rest of the country.

(The referenced petition can be found at petitions.ourcommons.ca/en/Petition/Details?Petition=e-1596).

Eyal Kraut is an endocrinology sub-specialty resident at the University of Manitoba.