A young Manitoban who must measure his blood sugars multiple times each day is part of a group trying to attract the attention of Health Minister Heather Stefanson to suggest that providing continuous glucose monitors (CGMs) could prevent emergencies while saving the province money.
“It is frustrating,” says Miles Dyer, a fourteen-year-old Manitoban living with type one diabetes who is part of the patient and caregiver group, Emergency Diabetes Support for Manitobans.
“I was diagnosed when I was one year old, so by the time I was nine, I had already had about 35,000 fingerpricks. I wish everyone in the government who makes these decisions could experience just one day of what it is like. Maybe then they would be more willing to fund continuous glucose monitors.”
To make the point, Dyer and other advocates from the group have invited politicians to take “The Great Manitoban Fingerprick Challenge.” Participants must take a manual blood sugar reading ten times in a day, just like an insulin-dependant diabetic.
Group member Liz Miller explains, "As a type one diabetic, I have found that most of the world does not understand the deadly situations we deal with each day. There is so much ignorance and misconception about this disease.”
When a patient’s pancreas stops secreting insulin, whether from type one diabetes or another reason, replacement synthetic insulin must be injected multiple times per day. It is dangerous and precarious, as small underdoses or excesses can quickly lead to low or high blood sugar emergencies. A patient or adult caregiver must take a blood sample and test it multiple times per day to remain safe – an often painful and disruptive activity.
Manitoba Health will currently cover up to 10 fingerprick tests for insulin-dependent diabetics, at a cost of about $3300 per year. A CGM costs about 7 per cent more, but Manitoba Pharmacare refuses to fund them for any patient.
CGMs are small, wearable monitors that take real-time blood sugar readings every five minutes, sending the results to the wearer’s phone or device. The devices warn of dangerous low blood sugars, helping to prevent seizures. CGMs help diabetic patients and their caregivers more accurately and consistently control blood sugars. Automatic alarms and online connectivity can help support patients who live alone or in a remote location.
Emergency Diabetes Support for Manitobans estimates that approximately 600 type 1 diabetes patients are hospitalized due to a diabetes emergency in Manitoba each year. Studies have shown that CGM use among insulin-dependent diabetics reduces the incidence of hospitalizations for diabetic ketoacidosis (DKA) by approximately 50%. With an average hospital stay in Canada costing $7000, CGM devices could create an immediate net savings for Manitoba Health by preventing hospitalizations, advocates say.
Ontario, Quebec, and Yukon already offer coverage for CGMs, and Saskatchewan has announced they are adding coverage.
Ten Manitoba MLAs have participated in the Great Manitoban Fingerprick Challenge so far. In videos posted to social media, many stated that they learned a lot from the experience. Minister of Families Rochelle Squires noted that the tests were painful as she struggled to produce enough blood each time. Health Minister Stefanson has said she will not be taking part in the fingerprick challenge and has not yet agreed to meet with the group.
Opposition NDP Leader Wab Kinew and Liberal Leader Dougald Lamont both took up the challenge and have called on the government to fully fund continuous glucose monitors, an all-ages insulin pump program, and insulin.
Even so, the government has given no indication it intends to improve coverage. A spokesperson for Manitoba Health told Emergency Diabetes Support for Manitobans members that the department is constantly reviewing “new” drugs and devices, but must balance their “incremental clinical value” with cost.
Emergency Diabetes Support for Manitobans says Manitoba Health has not addressed potential cost savings to the health system as well as the life-saving, life-changing benefits of CGMs.
In 2019, the Progressive Conservative platform promised a new diabetes strategy, but a government spokesperson has told the group “the pandemic has caused it to take longer than had originally been planned.”
Diabetic Manitoban Colin Mehmel says, “We are asking the government to cover devices that drastically improve our lives and may save the province money. The annual cost of my diabetes supplies has gone down since I started using a CGM, but the Manitoban government requires I pay this out-of-pocket. Other Manitobans can’t afford to do that and so they go without.”