After a century of insulin discovery – access to care is still a challenge

Dr Kate Gajewska

Clinical Manager for Advocacy and Research, Diabetes Ireland

World Diabetes Day 2021 marks 100 years of insulin discovery. After a century of this life-saving medicine, we still need better access to diabetes care.

Thanks to the outstanding developments in medicine, people with diabetes can now live long and healthy lives. However, more than half a billion people with diabetes still face challenges in accessing best standards of diabetes care. As a result, the main theme of this year’s celebrations is access to care.

Access to education

In Ireland, despite the reimbursement of medicines, over 225,000 people living with diabetes still have unequal access to the best available treatments and care.

In many places across the country, there are shortages in diabetes specialists (nurses, dietitians, endocrinologists), therefore many aspects of the service (structured diabetes education, access to diabetes technology) are unavailable. Adults with type 1 diabetes are waiting years to access education programs, whereas education is key to self-manage diabetes and should be delivered within the first year after diagnosis.

For people with type 2 diabetes, HSE offers the Integrated Care Programme for the Prevention and Management of Chronic Disease. Recently implemented, it aims to reshape the delivery of specialist diabetes care for people with uncomplicated type 2 diabetes. Investment in more than 200 posts for the Community Chronic Disease Specialist Teams will surely improve access to education for many. However, this model is ‘free of charge’ for Medical Card holders only, meaning that approximately 40% of people with diabetes may have no access to this intervention.

In Ireland, despite the reimbursement of medicines, over 225,000 people living with diabetes still have unequal access to the best available treatments and care.

Access to support

Psychological support is instrumental in helping to deal with the burden associated with living with diabetes but it is almost inaccessible. It is not formally embedded as part of diabetes management and is not in line with diabetes-related health-services delivery in Ireland. Presently, there is a 95% deficit of diabetes psychologists in adult diabetes services in acute hospitals and there is no access to dedicated diabetes psychology services in primary care. 

Highlighting the gaps 

Ireland is also one of a few countries in Western Europe that does not have a National Diabetes Registry. We don’t really know how many people have diabetes, how many suffer from complications and what their clinical outcomes and needs are. The establishment of a registry would help with tracking the prevalence of the condition, measuring outcomes and cost of care and planning for future services. Highlighting all of the above, Diabetes Ireland has prepared pre-Budget submission 2022 and proposed eight immediate actions for implementation to improve access to and the quality of diabetes care in Ireland.