‘Choosing Against Technology Because I Have to, Not Because I Don’t Want It’

Joanne has lived with type 1 diabetes since 2018. Since diagnosis, she has managed her diabetes with multiple daily injections (MDI). This is a method that demands constant attention, manual dosing and careful planning. 

She is proud of what she has achieved using MDI. Her most recent HbA1c was 7.2%, reflecting the time, skill and effort required to manage diabetes without automated support. At the same time, Joanne is keenly aware that access to diabetes technologies could significantly reduce the burden of constant monitoring, counting and manually calculating, and improve long-term health outcomes. 

Insulin pump therapy, or an Automated Insulin Delivery (AID) system, combines an insulin pump with a continuous glucose monitor (CGM) and smart insulin dosing algorithms to help smooth glucose levels during the day and night.  

Research shows these systems can significantly improve blood glucose management and quality of life.

The benefits include: 

• Increased Time in Range (TIR)
  • The proportion of time blood glucose is in the target range increases by around 10–11% when people transition from MDI to AID systems. For many people, that means spending more of the day in healthier glucose levels.  

Read more about Time in Range. 

• Lower HbA1c
  • A measure of average glucose over time, reduces by about 0.37–0.5 percentage points with AID use in real-world settings.  

In Australian studies specifically, AID has been associated with improvements in average HbA1c from around 8.6% to about 7.3%. Many people reach internationally recognised targets and significantly higher TIR.  

Early data in children shows lower hospitalisation rates for acute complications such as severe hypoglycaemia and ketoacidosis with AID compared with MDI.  

• Reduced Diabetes Distress
  • Diabetes distress or burnout refers to the physical and emotional fatigue that can develop from the day-to-day demands of managing a chronic illness such as diabetes. This can include:
    • continual monitoring
    • manual dosage calculations
    • fear of hypoglycaemia
    • interrupted sleep
    • the mental load of making hundreds of health decisions each day

Evidence shows that technologies such as AID systems and CGM can help reduce diabetes distress by easing decision fatigue, improving glucose TIR and offering greater confidence in diabetes management.

Clinical Measures

Better TIR and lower HbA1c are not just numbers, they are clinical measures linked to lower risk of long-term diabetes related health complications, fewer medical emergencies and improved physical and emotional wellbeing. 

Despite this, the reality for Joanne and families like hers is that access to these technologies is largely determined by affordability rather than clinical suitability. 

Without private hospital cover, the upfront and ongoing cost of insulin pumps and AID systems is substantial. 

AIHW states that in Australia, the pump device itself can cost several thousand dollars, and around 80% of people who acquire pumps do so through private health insurance rebates.  

On top of that, consumables for pumps are far more expensive than those for injections, and ongoing costs can add up. Data from AIHW indicates that pump consumables cost up to $29 per month as opposed to MDI which comes in at around $6 per month. 

Weighing up the cost

With three dependent children in a household of five, Joanne’s decisions about diabetes technology are not made in isolation. Like many families managing chronic health conditions, she must prioritise essentials like rent, bills, groceries, education, routine healthcare and the annual cycle of diabetes care. The entire family’s wellbeing must be considered.  

For now, she continues to manage her diabetes to the best of her ability, looking out for opportunities for subsidies or clinical trials, knowing the potential benefits this technology could offer her in the future. 

“I feel like I manage my diabetes well, but I do it at a significant mental cost. Technologies like AID could reduce that daily burden, yet access is shaped by affordability, not suitability. No one should have to trade their medical condition and mental health or long-term outcomes against groceries, rent or school costs.” 

Joanne has chosen to share her story to highlight that access to diabetes technology in Australia remains unequal, and that many families like hers are having to weigh health outcomes against everyday costs. This is not just a personal challenge, it’s a conversation about equity, prevention or delayed onset of diabetes related health conditions, and how our health system supports people to manage chronic conditions well, and over the long term. 

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