Improved Access is Critical as Diabetes Treatments Advance

By Calli Barker Schmidt

More than 38 million Americans—over 11% of the population—are living with type 1 or type 2 diabetes, according to the American Diabetes Association. Millions more have been diagnosed with prediabetes. Yet despite the current treatments and helpful technologies available, diabetes advocates say too many individuals have limited access to the care they need.

“Everyone impacted by diabetes has a right to the best care possible for their unique situation,” says Todd Boudreaux, former vice president of strategic partnerships for Beyond Type 1, a nonprofit focused on raising money and awareness for diabetes research and advocacy. “But diabetes does not impact everyone equally. African Americans, Hispanic and Latino Americans, Native Americans, and Pacific Islanders are all more likely to develop type 2 diabetes than white Americans.”

In addition, “there are just not enough diabetes professionals to take care of the needs of people with diabetes,” says Osagie Ebekozien, MD, MPH, executive vice president and chief medical officer for T1D Exchange, which facilitates diabetes research and quality improvement. “We don’t have enough endocrinologists or diabetologists, and for some people, it can take as much as a year to see a specialist.”

And even when the appointment draws near, he points out, patients may have to balance work, school, transportation, childcare, and more in order to get there.

Inequities in technology access

T1D Exchange is collaborating with about 60 diabetes centers throughout the country to gather data related to patient experiences and outcomes—and then help make improvements by setting goals for better patient care and tracking their success.

“In diabetes care today, there is a lot of variation from center to center on how you are treated,” says Ebekozien. Insurance can play a major role—for instance, the therapies that individuals on Medicaid can access vary from state to state.

Health literacy and how much support is available to an individual with diabetes both play into care as well. For example, continuous glucose monitors can monitor the blood glucose level of a person with diabetes, and insulin pumps immediately deliver insulin, if needed. These technologies can be extremely important for those managing diabetes who need insulin, but these systems are not as commonly used as advocates and diabetes care professionals would like to see, Ebekozien says. Sometimes it’s because of the cost, but in many cases it’s because the provider is concerned that patients’ noncompliance with their care plan would lead to the need for too-frequent professional intervention.

A survey of individuals living with diabetes who are low-income, conducted by the American Diabetes Association, found that 31% said they do not monitor their own blood glucose levels because the test strips to do so are too expensive.

The survey results indicate that an individual’s socioeconomic status has a notable correlation to the care received. Surveyed patients reported that they did not often see their health care providers, and when they did, they felt that the providers did not take them seriously.

“The urgency of addressing disparate outcomes for underserved communities with diabetes is abundantly clear in data we see emerging regarding the COVID-19 pandemic and further highlights systemic and pervasive health inequalities within the U.S.,” surveyors concluded.

While many hoped telemedicine would make diabetes care more accessible to the masses, technological issues held some individuals back from accessing that care. In order for individuals to have productive conversations with their health care team, data from a continuous glucose monitor and other vitals needed to be shared electronically. “We learned telemedicine requires a lot of support staff,” explains Ebekozien. “Someone has to help a patient learn how to upload data and walk them through it a few times.”

Then there’s the elephant in the room—how will patients pay for their care?

Ensuring affordable coverage

Ebekozien is optimistic about new therapies that identify and treat individuals with prediabetes before their symptoms progress into full-blown diabetes. One example is glucagon-like peptide 1 receptor agonists (GLP-1 RA), a class of weight-loss drugs that can help prevent the onset of type 2 diabetes.

There are also new ways to screen for emerging type 1 diabetes in children. The FDA recently approved teplizumab-mzwv, an infusion medication that can delay the onset of type 1 diabetes for two or more years. “If you can delay it in a child, that child at least in their young days doesn’t have to deal with the challenges of managing diabetes,” Ebekozien says.

As treatments continue to advance, making sure they are affordable and accessible to as many people as possible—in addition to continuing to make sure insulin and other existing treatments are affordable—remains crucial.

One significant change that affected insulin prices was the Inflation Reduction Act in January 2023, which included a provision capping the cost of insulin at $35 a month for Medicare recipients.

“Any measure that helps bring out-of-pocket costs down for people living with diabetes is a step in the right direction, and the $35 monthly cap on insulin for Medicare recipients is making a difference for some,” says Boudreaux. “But it is not enough.”

Beyond Type 1 has worked with major insulin manufacturers to create, designed to connect people with diabetes to the insulin access and affordability options that best match their needs.

“High-quality, modern insulin needs to be available to people with diabetes regardless of employment or insurance status, across all demographics, without barriers, and at an affordable and predictable price point,” Boudreaux says.