Do you fill a prescription or put food on the table? Pay an overdue bill or visit the specialist?
These are the choices diabetics will struggle with when money is tight.
While cutting corners on care might seem a solution to immediate cash-flow problems, experts warn the long-term health impact is not worth it.
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A diabetes diagnosis can hit the hip pocket hard, forcing people to find on average an extra $4025 annually for people with type 2 diabetes without complications, rising to $9645 in people with both micro and macro-vascular complications.
For type 1 diabetes, the average financial outlay is $3468 for people without complications, although this can surge to $16,698 for people with both micro and macro-vascular complications, according to a Baker IDI report in 2012.
This could explain why 24 per cent of Australians with chronic conditions, including diabetes, report not receiving care or attending their doctor because of cost.
But Professor Merlin Thomas, head of biochemistry of diabetes complications at Baker IDI Heart and Diabetes Institute, said scrimping on equipment or doctors visits could leave a terrible legacy in terms of diabetes complications that can include cardiovascular disease and kidney problems.
Failing to keep specialist appointments could also mean people missed out on opportunities to try new drugs and devices that could deliver a better quality of life.
Every person diagnosed with diabetes is registered to the National Diabetes Services Scheme which provides subsidised syringes and needles, blood glucose test strips, urine ketone test strips and insulin pump consumables to people with diabetes but there are still significant out-of-pocket costs.
New technology such as insulin pumps and continuous glucose monitoring devices have the potential to save lives and make controlling diabetes far better and easier but for most diabetics they are financially out of reach.
For the 10 per cent of West Australians now using an insulin pump, which cost about $10,000, the full out-of-pocket costs of necessary consumables such as infusion sets and reservoirs/cartridges is around $270 per month. Although the cost of pumps can be covered by private health insurance or subsidised by some government programs depending on the patient, and there are programs to subsidise consumables for some people.
Continuous glucose monitors, which have been hailed a major breakthrough in diabetes self-management, cost about $5000 a year to operate and there are no rebates from Medicare or private health funds.
“Each additional chronic condition adds 46 per cent to the likelihood of a person facing severe financial difficulties”
The Federal Government has committed to subsidising CGMs for people aged under 21, although details of the program are yet to be finalised and rolled out.
Sophie McGough, Diabetes WA educator, said it was hard knowing technology was available but financially out of reach.
“The worst thing is to have someone sit in front of you saying ‘I can’t work out what is happening with my diabetes’ and they are struggling and you know that there is great technology that could help them to manage their diabetes and get it under control and yet they can’t afford it,” she said.
The financial burden for people with diabetes was high because it put them at risk of other chronic conditions.
“Each additional chronic condition adds 46 per cent to the likelihood of a person facing severe financial difficulties — hence early intervention with access to quality diabetes self-management programs that are proven to reduce the risk of diabetes complications is important,” she said.
Ms McGough said diabetes was one of the leading causes of chronic kidney disease. Once diagnosed with CKD consumers spend an average of $1400 every three months on out-of-pocket medical expenses such as medications, community services and transport.
Tammy Moran, WA’s young leader for diabetes, was diagnosed with type 1 diabetes when she was eight years old and gradually took on responsibility for covering the costs of its management when she became an adult.
Now 28, Ms Moran said she was vigilant about her diabetes care and would never compromise that to save money but admitted there were times, particularly while she was studying at university, that she’d had to scrape together the money to pay for her test strips.
Each month she spends $41.50 on test strips and just under $8 on insulin. Annually there are three to five visits to a private diabetes educator at around $80-$100 per visit, one visit to a private endocrinologist for $275, a visit to the GP which is $78, and a visit to her optometrist for $60, all of which are rebatable by Medicare.
Ms Moran said her parents had enrolled her in the private system when she was a child and she had continued with this as an adult because it offered better opportunity for one-on-one care than the public system.
Ms McGough people considering reducing their care to save money should discuss the long-term health implications if they don’t take their medications or keep up with regular doctor’s visits with their diabetes management team. “The real expenses happen with diabetes when you get the complications of diabetes — renal dialysis, eye problems or amputation — they require additional expense that are not always completely covered by the health system,” she said.
Tips to ease the financial blow of diabetes
* Ask your GP or pharmacist if there is a cheaper version of your medication available.
* Talk to your GP to see if there is a combined medication available for any of your multiple medications.
* Ensure you are registered on the National Diabetes Services Scheme to receive subsidised products and supplies.
* Access the free diabetes self-management services that are available for people with type 1 and type 2 diabetes through Diabetes WA.
* Call the Diabetes WA free helpline on 1300 001 880 to speak to a diabetes educator. For those in regional and remote areas telehealth services are available if you can’t access a local diabetes service.
* Talk to your GP about a care plan that can help you access allied health professionals under Medicare.
* Take part in myhealthybalance.com.au for motivation and free tools to help you to achieve your healthy lifestyle goals.
SOURCE: Diabetes WA
Lupins and diabetes
Most of WA’s lupin crop is eaten by sheep and cattle but it may be better in the stomachs of diabetics. Dr Natalie Ward, from the University of WA, says lupins are widely grown for crop rotation or stock feed but the underused grain can help people control their blood sugar levels.
She is looking for people with type 2 diabetes to join a new study, saying: “Lupin is a novel food ingredient that is high in fibre and protein and has a low glycemic index. We’ve previously seen some benefit of lupin foods in non-diabetics and are extending our investigation.”
In the study, volunteers will be given lupin-rich substitutes for common foods such as cereal, bread and pasta. Anyone interested in joining can email Natalie.firstname.lastname@example.org or call 9266 7520.