Access to technologies for type 1 diabetes treatment such as insulins, insulin pumps, glucometers, and continuous glucose monitoring devices is varied because of reimbursement policies. This affects the clinical care of children, as they might not benefit from existent or new technologies to treat their diabetes if reimbursement is limited, according to study results published in Pediatric Diabetes.

Investigators from the SWEET project (Better control in Pediatric and Adolescent diabeteS: Working to crEate cEnTers of Reference) analyzed data from March to August 2017 in 29 European countries. Using a survey, the investigators collected information regarding the level of reimbursement for insulin preparations, personal glucometers, insulin pumps, continuous glucose monitoring devices, and flash glucose monitoring devices. The information was gathered from diabetes technology companies such as Medtronic, Dexcom, Roche, Abbott, and Lilly. The collected data were later validated using the same questionnaire with members of the SWEET consortium in each country. The 2017 status of the European diabetes technology reimbursement was compared with the results of a previous study of the SWEET consortium in 2009.

The investigators found that insulins were fully covered with a few exceptions, glucometer strips were fully reimbursed without limits in 18 of 29 European countries, insulin pumps had limited access in 5 countries, and flash glucose monitoring technology was reimbursed in 12 of 29 countries. The number of countries in which continuous glucose monitors had a partial refund increased at a constant rate from 2009 to 2017. Compared with the results from 2009, the investigators found a definite trend toward improved reimbursement and availability of modern technologies. However, a large proportion of children and adolescents with type 1 diabetes were not able to benefit from innovative diabetes technology because of limited reimbursement.

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Among the study limitations, the investigators recognized a difference between reimbursement policies and real-life scenarios, especially considering that insurance policies might vary greatly among countries.

The investigators concluded that to improve the life expectancy of children with type 1 diabetes, more research on the cost-effectiveness of diabetes technology is needed to increase reimbursement and the accessibility of such technologies.

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Sumnik Z, Szypowska A, Iotova V, et al; on behalf of the SWEET study group. Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: the SWEET perspective [published online February 17, 2019]. Pediatr Diabetes. doi:10.1111/pedi.12833