How many people with diabetes are using HSE-Funded Devices?
This is a question I asked a couple of years ago while messaging back and forth with a friend about access to CGMs in Ireland and if it was possible to get a number. I drafted a Parliamentary Question for my friend to submit, thinking why not, but it couldn’t be that simple, could it? Yes, it could.
Last year, I wrote a document based on the replies to those PQs, which indicated that in 2021 over 11,000 people with diabetes were using HSE-funded flash and CGMs. I decided to continue to update these numbers and produce a similar but simpler document for 2022 and have summarised the main points below. The full version can be read here, where you will find more details.
The purpose of the document is to provide an estimate of the number of people who are using HSE-funded Flash and CGMs in Ireland and to prompt a discussion around access equality. I believe we need to talk about how fair it is that so many are approved for HSE funding and why some people are still being made to pay.
I also wonder about how well people with diabetes are doing. Access to these devices is based on clinical criteria, which include frequency of hypers and hypos as well as HbA1c and with the number of people being funded for these devices so high, I wonder if we are doing terribly in terms of our health. This is a bit scary to think about.
Summary of the Numbers
This document does contain the numbers for four of the devices available the Dexcom G6, Dexcom G7 and Medtronic Guardian CGMs and the Flash glucose monitor, Freestyle Libre. However, the figures for Dexcom G7 are not included in the overall total number, as it was suspected that some of these numbers would be Dexcom G6 renewals.
Before you read any further, there were some things to consider in how accurate these figures might be, which includes not knowing the criteria that the HSE used to collect the data. The second unknown is that the number of people with type 1 diabetes in Ireland is an estimate, as we don’t have a national diabetes registry, and the percentage is calculated on this estimate. The third unknown is also related to the lack of a register; we have no idea how many people with type 2 diabetes are insulin-dependent, so we don’t know if the numbers are only for people with type 1 diabetes or if they include people living with other types of diabetes.
Key points:
15,384 people were using HSE-funded Flash and CGMs in Ireland in 2022
This represents 53% of the estimated T1D population in Ireland, provided by Diabetes Ireland in 2022
This number has increased by 10% (3,624n) on 2021
5,074 users are aged Under 21 years
10,310 users are aged Over 21 years
According to figures provided by the HSE, there were 15,384 people using HSE-funded Flash and CGMs in Ireland at the end of 2022. This represents an estimated 53% of the type 1 diabetes population. Dexcom G6 is the most widely used system, and Medtronic is the least-used system, probably because it’s mostly used by people on insulin pumps. The uptake of Libre has been in decline since 2019, while the uptake of Dexcom and Medtronic continues to increase significantly.
Difference between brands
The section looks at how many people are using the different brands of devices and focuses on the main three and how uptake is spread across them.
Of the number of people using HSE-Funded Flash or CGM:
56% use Dexcom G6 and is the most widely used system
29% use Libre
16% use Medtronic; is the least-used system
Uptake between the Devices Within age groups
Under 21s
43% Dexcom G6
42% Libre
15% Medtronic
Over 21s
62% Dexcom G6
22% Medtronic
16% Libre
Uptake between 2018 and 2022
The number of people using HSE-funded Flash and CGM was 2,852. This number has increased to 15,384 by the end of 2022. Each of the five years between 2018 and 2022 has seen the total number increase by an annual average of 50%.
Uptake of HSE-Funded Flash & CGM in the Irish Type 1 Diabetes Population from 2018-2022
At the end of 2018, most of the uptake was in the Libre, which is the year it was included in the HSE reimbursement scheme. However, by 2022, this completely changed, with both Medtronic and Dexcom numbers effectively doubling year-on-year, while Libre’s uptake trend has slowed considerably with an annual increase in the number of users per year between 250 to 600.
Uptake Between 2018 and 2022 within Age Groups
Under 21 years
From 2,461 in 2018 → To 5,074 in 2022
The number of HSE-funded users Increased in this age group by an average of 750 people per year from 2018 until 2021 but only increased by 373 in 2022. This indicates that maybe the percentage of people using these devices in this age group is very close to 100%.
Over 21 years
From 391 in 2018 → To 10,310 in 2022
The number of users is increasing by an average of 2,300 people annually in this age group and looks set to continue.
In this group, Medtronic and Libre’s annual increase in uptake was marginal up to 2021, and they both still lag behind Dexcom G6 uptake significantly. This may warrant further investigation, especially if the trend in uptake in this group continues to be significant.
I have lots more questions about these numbers, especially about why some people have to pay for their devices, and others do not. I haven’t shared this document as widely as my previous one, but I have gotten really useful and constructive feedback from Diabetes Ireland. I would love to know if you have any thoughts on access to Flash or cgm devices; please do share them in the comments below.