On February 3, 2023, Congress renewed the Special Diabetes Program (SDP), increasing annual federal funding for Type 1 diabetes (T1D) research from $160 million to $200 million. This bipartisan initiative has led to a total investment exceeding $3.5 billion since the program’s inception in 1997. While this boost in funding is a significant step forward for T1D research, it raises critical questions about who will truly benefit from these advancements.
Living with T1D is a daily challenge that requires constant management. Individuals rely on health technologies such as Continuous Glucose Monitors (CGMs) to prevent life-threatening blood sugar fluctuations. These devices have become essential tools for over two million Americans diagnosed with T1D, as they help to reduce dangerous blood sugar swings and the risk of long-term complications. However, access to these technologies varies significantly across different regions and healthcare systems.
For instance, one individual with T1D highlighted the stark contrast in accessibility between Australia and the United States. In Australia, CGMs are fully subsidized under a centralized healthcare system, making them accessible as a standard care requirement. Conversely, in the U.S., the same supply of CGMs can cost as much as $1,599, a price tag that many cannot afford without significant insurance coverage. These disparities are not mere accidents of circumstance; they stem from existing healthcare policies that create barriers to access.
The SDP has played a pivotal role in funding vital innovations in diabetes care, leading to the development of technologies like CGMs and insulin pumps. These advancements have transformed daily life for those managing T1D. Nonetheless, as funding increases, it is essential to examine the distribution of these new technologies. The real question remains: who ultimately benefits from these federal investments?
Access to T1D care requires consistent attention and reliable medical support. Traditional treatment methods were labor-intensive and could be difficult to maintain alongside work or living situations. While new technologies offer the promise of enhanced care, their high costs present a significant hurdle. For example, a new insulin pump can exceed $8,000, with ongoing costs for supplies ranging from $2,000 to $6,000 annually.
Even those with insurance face a challenging landscape filled with administrative complexities, including prior authorizations and prescription renewals. Such obstacles can lead to rationing of essential supplies, forcing individuals to choose between critical health needs and other basic living expenses. This creates a situation where the choice between insulin and rent becomes a painful reality for many.
Furthermore, disparities in access persist even for FDA-approved technologies. The National Institutes of Health (NIH), which oversees SDP funding, cannot guarantee that the latest innovations will be widely distributed. Access is affected by numerous social determinants, including race, income, and geographic location. Research indicates that Black individuals with T1D are less likely to receive prescriptions for essential technologies like CGMs compared to their non-Black counterparts.
In California, a hub for biomedical innovation and technology, policymakers are positioned at the forefront of health advancements. Stanford University exemplifies the intersection of research and commercialization, benefiting from federal investments to drive breakthroughs in diabetes care. While lawmakers support increased research funding, they often overlook the pressing need for insurance reform and pricing strategies that ensure equitable access to these innovations.
The NIH plays a critical role in setting scientific priorities and fostering advancements in diabetes care. However, without a concerted effort to ensure that these innovations are available to all, the disparities that medical advancements aim to address may only widen. People living with T1D do not require the promise of future lower costs; they need access to affordable technologies now.
As a prominent research institution, Stanford holds a responsibility to evaluate how publicly funded scientific progress can benefit not only the private sector but also the general public. Taxpayer funding supports the SDP, and patients participate in clinical trials, yet the fruits of this investment should extend beyond those with comprehensive insurance plans.
While there is a bipartisan agreement on the importance of scientific discovery, it is crucial to address the complexities of distribution and access. If the goal is to achieve better health outcomes alongside scientific advancement, equitable access to new technologies must be prioritized as seriously as the research itself.
