The Korean Diabetes Association (KDA) held a press conference on January 19th to address an important issue in regards to how type 1 diabetes is classified.
In Korea, type 2 diabetes is currently classified as a mild disease, and if there are complications, it can be treated as a serious disease. Type 1 however is currently neither classified as mild nor severe, instead it is treated as a ‘non-mild’ disease. This has several implications in terms of access and financial support. There is also a greater financial burden as cgms and insulin pumps are only partially covered by the national health insurance.
Diseases classified as a severe incurable disease are difficult to impossible to cure, require continuous treatment and can cause serious disability or death if treatment is discontinued. They also carry a significant social and economic burden.
Type 1 diabetes meets several of the criterias to be recognized as a severe incurable disease. While insulin prices themselves are reasonably affordable in Korea, adding in the costs of cgms and insulin pumps, the economic burden is high – so despite Korea being called an ‘IT Powerhouse’, it severly lacks behind other countries in regards to access and support for automatic insulin delivery.
Professor Sang Man Jin, from Samsung Seoul hospital and secretary of the Korean Diabetes Association also pointed out at the press conference that even the American Diabetes Association recommends automatic insulin delivery as the standard treatment for all types of diabetes that result in a lack of insulin secretion. He advised that the guidelines of the Korean Diabetes Association will therefore also change to follow the same direction, but he pointed out that while their guidelines may change, the actual medical field is not prepared at all to handle this yet.
While Korea does have some continuous glucose monitors and insulin pumps and even produces their own pump and cgm technology, access alone is not enough to help people living with diabetes to improve their glycemic control – it is important that people receive education, training and support to fully understand and apply their devices properly. This is an area that the Korean medical field still needs to address – how to provide support to patients at all hospitals.
Despite access to cgms, there is little to no support and education being offered by the hospitals, leading to patients being turned away, told to get the devices and learn to use them themselves. A professional medical team of doctors, nurses and diabetes educators is needed, however since there is currently no system for insulin pump or cgm training for medical professionals, they hardly understand how to use these devices themselves and are unable to provide training for their patients. Only large medical institutions with professionals dedicated to diabetes care can fully support their patients with both medical care and diabetes technology education.
However, currently larger hospitals in Korea are penalized for the number of ‘mild’ cases they treat, therefore they prioritize treating severe cases. If people decide to go to a bigger hospital due to lack of support at their smaller hospital, they also incur a higher out-of-pocket cost, as well as the penalty applied to the hospital. Since hospitals don’t want to be penalized either they have started to focus more on severe cases and gradually reduced the number of departments dealing with mild diseases. This has affected especially the endocrinology departments. Due to this system, many hospitals don’t want to see people with type 1 diabetes in their internal medicine departments.
If type 1 diabetes can be recognized as a severe incurable disease, tertiary general hospitals would be obliged to increase the ratio of severe incurable diseases to patients, which would in turn provide more access and support at hospitals for people living with type 1 diabetes.
One of the biggest reasons type 1 diabetes is not seen as a severe incurable disease in Korea is because it is considered to incur less than 1 million won in medical expenses a year, which is a requirement for severe incurable diseases to receive support from the national health insurance. However since neither test strips, diabetes consumables or cgms are considered under these medical expenses, let alone insulin pumps, the total cost of medical examinations and insulin rarely exceeds the 1 million threshold. As consumables, cgms and insulin pumps are considered under a different term, not actual medical expenses, the funding is not applied to all costs, so the economic burden is a lot higher for people living with type 1 diabetes.
If type 1 diabetes can be recognized as a severe incurable disease, and the Korean Diabetes Association officially recognizing diabetes technology as standard treatments, the conversation can begin to have more support and funding available at all levels – from hospital access and patient education to financial support to fully access the technology that is available nowadays.
Below are several articles in Korean that have covered the press conference. These can be translated as well if opened via google chrome. If you can, please leave a comment in support of these proposed changes.
- http://m.bokuennews.com/m/m_article.html?no=225112
- https://www.dailymedi.com/news/news_view.php?wr_id=893515
- https://biz.newdaily.co.kr/site/data/html/2023/01/19/2023011900111.html
- https://n.news.naver.com/article/018/0005409315?sid=102
- https://n.news.naver.com/article/032/0003200185?sid=102
- http://www.monews.co.kr/news/articleView.html?idxno=319080
- https://m.asiatoday.co.kr/kn/view.php?key=20230119010010478
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