Diabetes Tech Discussion Guide

1

How can I get an insulin pump in Australia?

There are a range of insulin pumps available in Australia. When transitioning to an insulin pump, consult with a diabetes specialist1 (endocrinologist, credentialled diabetes educator (CDE), nurse practitioner) to assist you with this transition. Access requires specialist support to ensure you achieve the best possible outcomes.

Insulin Pump2 order forms are available from your chosen insulin pump supplier for your diabetes educator or endocrinologist to fill out. The insulin pump order form should be accompanied by a Letter of Clinical Need signed by your diabetes specialist healthcare professional (Diabetes Nurse Practitioner or Endocrinologist). Your chosen insulin pump supplier can assist you in navigating this process.

The cost of insulin pumps or insulin pump consumables in Australia is not covered by Medicare. Instead, Insulin Pumps are available either through Private Health Insurance or are privately funded. Alternatively, the Australian Federal Government's Insulin Pump Program3 provides access to subsidised insulin pumps for eligible individuals aged under 21 years with type 1 diabetes who meet specific criteria. This program, administered by the JDRF, aims to improve the quality of life for people with type 1 diabetes by providing access to advanced diabetes management technology.

Access to partially subsidised insulin pump consumables in Australia via the National Diabetes Services Scheme (NDSS4) is currently restricted to people with type 1 diabetes.

If you have private health insurance your hospital policy may cover some or all of the cost of an insulin pump5. Please check with your individual insurer for details and to see if you are covered. A waiting period may apply before private health insurance benefits are payable.

Some people prefer to pay for their insulin pumps themselves and not via private health insurance6. The Omnipod DASH® Insulin Management System is also available via a no lock in subscription6 giving access to the pump for the time it takes to use a box of consumables (usually a month). Insulin pumps can cost between $7,000 to $10,0007, not including monthly consumables, to purchase outright.

Type 1 diabetes

If a diabetes specialist team believes that someone meets the clinical criteria for a pump and would benefit from pump therapy, NHS funding must be made available. If you are not currently under a diabetes specialist team, or it has been more than a year since your last hospital appointment, ask your GP for a referral. 

England, Wales and Northern Ireland 

The National Institute of Health and Care Excellence (NICE) published a mandatory Technology Appraisal of Continuous Subcutaneous Insulin Infusion (CSII, the technical name for insulin pump therapy) in 2008. There are different criteria for children aged younger than 12 and people aged 12 and up. A summary is online here. 

Please note that the ‘Further information and support’ list on the back cover of that summary is out of date – see the list at the end of this document instead. 

Scotland 

The Scottish Intercollegiate Guidelines Network published a national guideline on the management of type 1 diabetes in 2010. The full guideline document is online here (see pages 33–34 for information on CSII).

Type 2 diabetes

Across the UK, insulin pump therapy is uncommon for people living with type 2 diabetes and NHS funding is possible only if a diabetes specialist team makes a special funding request, as there is no formal policy.

2

How can I get a continuous glucose monitoring (CGM) system on the NDSS in Australia?

In Australia, access for eligible people to subsidised continuous glucose monitoring (CGM) products is via the NDSS8.

All people with type 1 diabetes are eligible to apply for access to subsidised CGM through the NDSS8, as well as some people with other rare conditions that are similar to type 1 diabetes. Some people are eligible to access fully subsidised CGM (that is, free of charge), while other people can access with a co-payment.

To access CGM products through the NDSS, you will need to see a diabetes specialist to determine whether you meet the eligibility criteria and to ensure that you know how to best use CGM in the management of your diabetes. Your diabetes specialist can also help with completing any relevant order forms and submitting them to the NDSS8.

3

What are Automated Insulin Delivery (AID) or Hybrid Closed-Loop (HCL) systems?

About HCL systems

An HCL system has three components: an insulin pump, a CGM and an algorithm which adjusts how much insulin the pump delivers based on the CGM data. The pump, CGM sensor, and algorithm all need to be able to ‘talk’ to each other to make an HCL system. See the ‘Next Steps’ section below for tips on talking with your diabetes specialist team if you are interested in an HCL system.

Automated Insulin Delivery (AID) or Hybrid Closed-Loop (HCL) systems automatically adjust insulin delivery to help control blood glucose levels, reduce hypoglycaemia, and increase time in range9. AID systems are often called hybrid closed loop systems and allow for a complete circle of communication between a continuous glucose monitor (CGM) and insulin pump.

AID systems create a circle of constant communication between your diabetes devices, creating a hybrid closed loop.

Generally, every 5 minutes:

  • The CGM reports your glucose levels to the insulin pump.
  • The insulin pump then adjusts its insulin delivery using an insulin control algorithm. The algorithm software is the “brains” of the system, that crunches the numbers to predict where glucose levels are heading and tells the pump what to do. 
  • The CGM picks up on any changes to your glucose level, reports that to the insulin pump, and so on.

With AID systems, users still need to bolus for meals.

AID systems can lessen the burden of managing your diabetes10, helping you feel free from having to think about manually controlling it around the clock, especially during times of increased hypoglycaemia risk. 

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Next Steps

Preparing to share with the diabetes specialist team

Starting 3–4 weeks before your next diabetes appointment

Starting 2–3 weeks before the appointment

During and after the appointment

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Further information and support

NATIONWIDE

References:

  1. https://www.omnipod.com/en-au/find-a-certified-pod-trainer-omnipod-australia
  2. https://www.omnipod.com/en-au/about-omnipod-dash
  3. https://jdrf.org.au/living-with-t1d/insulin-pump-program/
  4. https://www.ndss.com.au/products/insulin-pump-consumables/
  5. https://www.omnipod.com/en-au/poddertalk/health-and-wellness/how-much-does-a-tubeless-insulin-pump-cost-in-australia
  6. https://www.omnipod.com/en-au/subsidy
  7. https://jdrf.org.au/all-about-insulin-pumps/
  8. https://www.ndss.com.au/about-the-ndss/cgm-access/#:~:text=If%20you%20are%20interested%20in,be%20registered%20with%20the%20NDSS.
  9. Moshe 2023 Consensus Recommendations for the Use of Automated Insulin Delivery Technologies in Clinical Practice, Endocrine Reviews, 2023, 44, 254–280 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985411/
  10. Polonsky WH, Hood KK, Levy CJ, et al. How introduction of automated insulin delivery systems may influence psychosocial outcomes in adults with type 1 diabetes: Findings from the first investigation with the Omnipod® 5 System. Diabetes Res Clin Pract. 2022;190:109998. doi:10.1016/j.diabres.2022.109998 Available at https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(22)00812-9/fulltext
  11. https://www.diabetesaustralia.com.au/wp-content/uploads/diabetes-structured-monitoring-manual-1.pdf