The promise of sensors for children with Type 1 diabetes was not kept

Known colloquially as “sugar disease,” Type 1 diabetes is a lifelong health condition where the insulin hormone must be taken externally via injections or an insulin pump. There are approximately 30 thousand children under the age of 18 living with Type 1 diabetes in Turkey. In recent years, children with Type 1 diabetes and their families have been in the spotlight due to their struggle to have blood glucose monitoring sensors provided free of charge.

The mention of domestic sensor development efforts by former Minister of Health Fahrettin Koca during his farewell speech, where he stated that they would be made available to diabetics in a very short time, has brought the issue back to our attention.

Precise adjustment of insulin dosage is essential for people with Type 1 diabetes to lead a healthy life. For this reason, blood glucose levels must be measured regularly to detect changes in blood sugar. For many years, blood sugar measurement has been performed using a glucometer by taking a drop of blood from a finger.

In opposition to this laborious method that shows only instantaneous sugar levels, awareness and solidarity campaigns such as “Let the state pay for the sensors, let us keep our fingertips!” and “Raise a finger for the sensor” have been carried out for several years.

SENSORS HAVE BEEN A MILESTONE IN THE LIVES OF DIABETICS

Sensors play a major role in facilitating the daily lives of people with Type 1 diabetes and preventing potential complications. The impact of sensors, which have come to the fore in the last 10 years and can show glucose levels 24 hours a day without pricking a finger, is seen as a milestone in the life of a diabetic.

So, what kind of difference do sensors make in the lives of diabetics?

Sensors placed on the body can take painless measurements from the interstitial fluid 288 times a day, every five minutes. Thanks to sensors, it is possible to monitor glucose trends, predict highs and lows in advance and act accordingly, receive warnings through alarms, and allow families to monitor their children's blood sugar remotely via smartphones.

COST HINDERS ACCESS TO SENSORS

On the other hand, the majority of families with children with Type 1 diabetes are low-income families living on minimum wage. Therefore, very few families can afford the cost of sensors, which ranges between 3 thousand and 4 thousand 500 liras per month. In many provinces, the rate of children with Type 1 diabetes using sensors does not exceed 5-10 percent. For this reason, it is expected that the Social Security Institution (SGK) will cover the full price of the cheapest sensor.

Prof. Dr. Şükrü Hatun, Head of the Department of Pediatric Endocrinology and Diabetes at Koç University, one of the first names that comes to mind when it comes to the treatment of Type 1 diabetes in Turkey, has been fighting alongside families for years for sensors, which he sees as the most important advancement in the last 30 years.

He states that some of his patients describe the process they went through after their Type 1 diabetes diagnosis as “before the sensor” and “after the sensor.”

WE ARE THE ONLY COUNTRY IN EUROPE THAT DOES NOT COVER THEM FOR FREE

Stating that sensors are a right for people with Type 1 diabetes, Prof. Dr. Şükrü Hatun reminds us that Turkey is the only country in the European region where sensors are not covered by the state.

When I asked Prof. Dr. Şükrü Hatun about the struggle they have been waging for free sensors for years, he complained that they have been unable to get results from the long-standing meetings they have held with SGK officials and the Ministry of Finance.

He explained that although the Ministry of Labor and Social Security launched a new initiative last year and gave a positive opinion on including sensor-based glucose monitoring devices in the reimbursement scope, the proposal was not accepted by the Ministry of Finance. Prof. Dr. Hatun stated that they last met with the Deputy Minister of Finance 1.5 months ago as 5 professional associations dealing with diabetes, and provided the following information:

“There is no news yet regarding sensors, which are one of the most important medical advancements that change the fate of children with Type 1 diabetes. Because of this, we are sad, disappointed, and even angry.

Sensors are devices we request for the necessity of treatment and the comfort of diabetics. As the Turkish Diabetes Foundation, Turkish Diabetes Association, Foundation for Children with Diabetes, Pediatric Endocrinology and Diabetes Association, and Turkish Society of Endocrinology and Metabolism, we explained the issue comprehensively to the deputy ministers. Mehmet Şimşek is also aware of the issue. However, the final step is never taken.

Unfortunately, the promises made were not kept. I reiterate our call to the authorities, especially Minister of Finance Mehmet Şimşek, for sensors to be provided free of charge.”

WE HAVE BEEN GOING BACK AND FORTH FOR 7 YEARS WITH NO RESULTS!

Saying, “It is unacceptable for a country that builds its own aircraft and is involved in projects to send astronauts into space to withhold sensors from 30 thousand children,” Prof. Dr. Şükrü Hatun continued:

“We have been going back and forth for 7 years, we have left no stone unturned. The SGK and the Ministry of Finance say, 'We agree with you, we think sensors are necessary,' but there has been no progress in allocating resources and taking the necessary steps.

A budget of around 1 billion liras per year needs to be allocated. We see that Turkey allocates resources for so many things, but we do not understand why this money is withheld from 30 thousand diabetic children. When we consider the resources in the country, it is not an amount that cannot be allocated. We are already suggesting that the state cover the most basic, cheapest sensor on the market.

Although there seems to be no problem when we talk to decision-makers, it is very sad that the state is so indifferent to sensor support. Many diabetic families are disappointed. Mothers and fathers do everything for their children day and night. There are mothers who work a second job to buy sensors for their children, who do not sleep at night, and who wait at school doors.”

DOCTORS DEALING WITH DIABETES HAVE NO INFORMATION ABOUT THE DOMESTIC SENSOR

Thinking that the statements of the former Minister of Health, who left office, regarding the domestic sensor also affected the process, Prof. Dr. Şükrü Hatun made the following assessment:

“Those at the Ministry of Finance tended to wait for this initiative from the Ministry of Health. Fahrettin Koca said it could be used soon, but it is unknown who is behind the work. We told them that producing sensors is not as easy as it is thought, that we are not against domestic sensors, but that it is wrong to put children with Type 1 diabetes, who have been waiting for a long time, into a stage of waiting for domestic sensors as well. If there is to be a domestic sensor, it could be an alternative. Therefore, the Ministry of Social Security should start providing support equal to the price of the cheapest sensor as soon as possible.

It is as important for the domestic sensor to receive approval according to international criteria as it is to be made. For this, some research needs to be done. However, unfortunately, physicians like us who deal with diabetes have no information about the domestic sensor process. Neither I nor any of the association presidents who visited that day have any information. Since insulin doses are decided based on sensors, the precision of these devices is very important. They are produced by certain companies with very high standards all over the world.”

WE EXPECT ATTENTION FROM THE NEW MINISTER AND THE IMM (ISTANBUL METROPOLITAN MUNICIPALITY)!

Stating that they expect the support of the newly appointed Minister of Health, Kemal Memişoğlu, regarding sensors, which increase the quality of life of children and families and prevent organ damage related to diabetes in the long term, Prof. Dr. Şükrü Hatun made the following call:

“Our new minister is a general surgeon himself, and his wife is a pediatrician. Actually, we would like him to be interested in this issue as well. If he provides sensor support, he will have made a huge contribution. Children with diabetes have a characteristic; the smallest support makes a huge difference in their lives. Sensor support is very important to increase the quality of life and life expectancy of children, to prevent complications, and most importantly, for them to live like everyone else.”

Noting that although some governorships and municipalities are making efforts, what is done is not sustainable or permanent, Prof. Dr. Hatun said, “For example, recently the Ankara Metropolitan Municipality only gave sensors to children taking exams. We also reached out to IMM President Ekrem İmamoğlu, and he knows about the issue. We called on him to provide support in Istanbul. But this is actually the duty of the SGK. We know that the IMM looks favorably on it, but no steps have been taken yet. I would like to call on Mr. İmamoğlu again from here. There is no sound coming from the SGK, I think if it comes from Istanbul, it might have an effect on the whole of Turkey.”

IT PAYS FOR ITSELF IN 10 YEARS

Emphasizing that sensors are a real necessity, according to Prof. Dr. Şükrü Hatun, these devices can pay for themselves in 10 years by both preventing hospitalizations and reducing the costs arising from many complications that may develop.