Why is choice important?

Why is choice important?

Cheryl Steele RN-CDE

Managing T1D not only requires physical demand but there is also the psychological impact. Research shows that individuals living with T1D are required to make up to 180 extra decisions a day around managing their condition¹. T1D does not discriminate. Individuals living with the condition come in all sizes and ages, from different cultural and socio-economic backgrounds, and have varying health beliefs and health literacy levels.

It is therefore important the individual who lives with T1D has a choice in the way that they deliver their insulin and monitor their glucose levels. For some it is important to have all the latest technology and for others low tech management systems are preferred.

As Diabetes Educators (DEs) it is vital that we respect the person’s choice and focus our advice on person-centred care². The reasons that an individual living with diabetes may choose a particular system is as varied as the types of people who live with diabetes. For many CGM may be fully subsidised and therefore can also influence the individual’s choice of insulin pump, particularly as some insulin pumps offer automated insulin delivery (AID) technology. Others may choose a particular insulin pump but use a non-compatible CGM as AID is not important to them.

In Australia the only full publicly funded insulin pumps are for individuals aged less than 18 years and the choices are limited. For adults it is necessary to hold Private Health Insurance (PHI) for both a minimum of 12 months and at a sufficient level to cover an insulin pump. The cost of hospital PHI coverage can be prohibitive for those with limited financial capacity. (NOTE: Content has been removed to reflect current subsidy for he the Omnipod DASH System. This device has been subsidised from 1 December 2022. For more information please see our HCP Subsidy Page) 

For those individuals who wish to use insulin pump therapy and AID systems, the cost can be a barrier. In a democratic society it doesn’t seem fair that technology is limited by the ability to pay.

For those who prefer to choose tubeless pump therapy, the cost can also be prohibitive. Last year (2021) Insulet introduced the Omnipod DASH® System to Australia – the first tubeless, waterproof insulin pump. For the general population who purchase an Insulin pump via PHI or outright - Insulin pump consumables are covered today in part through public subsidy: via the NDSS. (NOTE: Content has been removed to reflect current subsidy for he the Omnipod DASH System. This device has been subsidised from 1 December 2022. For more information please see our HCP Subsidy Page) 

The Omnipod DASH® System consists of a handheld Personal Diabetes Manager [PDM] and a Pod. The PDM and the Pod communicate via Bluetooth. The Pod is filled with up to 200 units of U-100 Rapid-acting Insulin and then placed on the skin with an adhesive. A small cannula is inserted for insulin delivery. Each Pod provides continuous delivery for up to 3 days.  

The clients that I have commenced on this system have chosen it for a variety of reasons including not being comfortable wearing a tubed pump, the feeling of being tethered that comes with a tubed pump, or to use as an alternate system whilst on holidays when their tubed pump isn’t waterproof.  There is no one reason why individuals choose Omnipod DASH® System over a traditional tubed pump. Just like individuals who live with diabetes, the reasons are many and varied for choosing the Omnipod DASH® System. It is very important that we as DEs respect our client’s choices. (NOTE: Content has been removed to reflect current subsidy for he the Omnipod DASH System. This device has been subsidised from 1 December 2022. For more information please see our HCP Subsidy Page) 

The Working Group of the Diabetes Alliance advocates for greater access to technology for people living with T1D, stating that “all people with type 1 diabetes should have equitable access to the most effective management systems, including technology, where clinically appropriate, regardless of age, concessional status or level of private health insurance cover” ³.

Let’s hope that in the near future individuals living with T1D can choose the Omnipod DASH® System without significant financial burden.