The national diabetes charity, Diabetes Ireland, has again criticised the Government's decision to restrict the availability of an innovative device, which helps people with type 1 diabetes to achieve better control on the condition.
The FreeStyle Libre consists of a small round sensor - about the size of a two euro coin - which is worn on the back of the upper arm for up to 14 days. A handheld reader is scanned over the sensor to upload glucose results. This takes less than one second and there is no need to draw blood. As a result, it does away with the need for finger pricking.
The device has been described as a 'game changer' by many, however, the cost can be prohibitive. The starter kit costs €169.90, which includes two 14-day sensors to cover the first month. After that, each 14-day sensor costs €59.90, so almost €120 per month.
There are around 20,000 people with type 1 diabetes in Ireland. Originally, anyone wishing to use the device had to pay privately for it.
In early 2018, the HSE announced that it would be reimbursing the device for those aged between four and 21 based on clinical need. Adults over the age of 21 would not be reimbursed at all.
Diabetes Ireland pointed out that as a result, many adults who might benefit from this device cannot access it, even if their diabetes team believes that they would benefit from it.
Ireland is currently the only country in the world to put an age restriction on free access to the device.
The charity highlighted the case of 22-year-old William D'arcy, who has been refused access due to his age.
His consultant endocrinologist, Dr Ronan Canavan, made an application for the device on his behalf, which was refused, and then refused again on appeal.
"We have this young person who, based on my clinical judgment, needs a Freestyle Libre as his current level of control is very worrying. He has a strong real fear of having low glucose levels that inhibit his ability to manage his diabetes.
"I recommend that he test his blood glucose level at least 10 times a day, but he cannot commit due to the finger pricking required. The Freestyle Libre would relieve him of that," Dr Canavan explained.
According to Dr Anna Clarke of Diabetes Ireland, there are many cases like this one in which the diabetes team believes the Freestyle Libre would benefit a person's diabetes management, "but the age barrier means they cannot get it".
She pointed out in April 2018, the HSE has said it was committed to reviewing this decision in a year, however "here we are 15 months later with no review".
Mr D'arcy voiced his frustrations with the decision, noting that if he was one year younger, he could obtain the device.
"Because I am over 21 years, my application is denied. I can't believe we are the only country who has an age barrier. I want to work with Dr Canavan's team to protect my health and manage my diabetes better but I can't commit to pricking my finger 10 times every day.
"I believe the Freestyle Libre would give me better quality of life immediately and help me protect my health and wellbeing going forward," Mr D'arcy said.
Diabetes control is measured by a HbA1c blood test, which reflects average blood glucose over the preceding three months. A raised HbA1c level reflects poor or bad diabetes control and increases the risk of health problems, such as heart attack, stroke, blindness or amputation.
Dr Canavan has said that he is concerned for Mr D'arcy's future health.
"This young man's continued current HbA1c levels means he is more likely to progress to advanced complications within five years, which will prove much more costly to the State," he explained.
Diabetes Ireland has called for the HSE to carry out its review of the device that was promised for April 2019.
"The future health of our people with type 1 diabetes must be the priority as this will improve their quality of life and limit future health expenditure," the charity said.
For more information on Diabetes Ireland, click here.