Yukon Legislative Assembly
Box 2703
Whitehorse, Yukon
Y1A 2C6
Dear Hon. Silver,
Thank you for your commitment to provide permanent funding of Continuous Glucose Monitors for Yukon citizens up to eighteen years of age. We trust that any child with Type 1 diabetes, including eligible infants, will be enveloped within this permanent coverage.
It is unfortunate, however, that in your March 19, 2020 letter to the Leader of the Official Opposition, Stacey Hassard, you opted to leave out the word ‘Continuous’ in your description of the glucose monitoring project for adults. Whether this was intentional or not is beyond the scope of this letter. The effect it has, however, is profound. Expulsion of the word ‘continuous’ means that the reader, or the individual(s) tasked with actualizing this project, can supplant flash glucose monitoring in lieu of Continuous Glucose Monitoring as the coverage of choice. Flash monitoring is not the same as Continuous Glucose Monitoring; the former requires the wearer to be alert enough to place a receiver against a transmitter, while the latter sends alarms to alert the wearer to impending glucose changes.
The difference between the two is vast and Yukon Party, in responding to Yukon Government’s haste to pass the 2020 budget, explicitly requested Continuous Glucose Monitors be available to all. Note that the request, the spirit of negotiations, and the ‘closed door’ agreements were always assumed to be within the realm of ‘Continuous’. Also note that all Continuous Glucose Monitor correspondence in the passing of the budget had nothing to do with COVID-19.
The Yukon T1D Support Network has provided a thoroughly researched, 30-page document on the efficacy of Continuous Glucose Monitors to Yukon Government. We have also advocated tirelessly to ensure those with Type 1 diabetes are receiving these monitors, whether that is through government provisions, private insurance, or through fundraising efforts. The Official Opposition, the Yukon Party, has continuously advocated on the behalf of those who have this disease and have gone so far as to make Continuous Glucose Monitor coverage for all those with Type 1 diabetes their central request in the spring 2020 budget. In April of 2019, The Third Party, the New Democratic Party, also introduced a motion to introduce permanent funding of Continuous Glucose Monitors for all Yukoners with Type 1 diabetes. In follow-up to this motion, members of your own government stated that “parents and citizens need to be an essential part of this conversation”, that “it is clear that CGM devices have the potential to make it easier to manage type 1 diabetes”, and that there does not need to be “any further evidence of continuous glucose monitors.” (Yukon Legislative Assembly, April 24, 2019. Hansard. 147, Number 147, 2nd Session, 34th Legislature). Not only did the sole-sourced pilot project provide recommendations on Continuous Glucose Monitor coverage in spite of the evaluator’s admittance that they were not in position to determine efficacy of the devices, the pilot was also conducted by persons with no history of working with individuals with Type 1 diabetes. Further, the Yukon T1D support Network was only involved by degrees through the draft submission. The final submission, which is what insured health is allegedly basing its adult project on, is fundamentally different from the draft that we were provided. We were assured full cooperative engagement with the pilot from commencement through submission, yet our feedback was not included in the final. This is not simply disappointing, this is unethical; as the only society that works solely with persons with Type 1 diabetes in Yukon, we are in a strong position in which to provide person-centered evidence on the efficacy of CGMs and our exclusion, whether whole or in part, is improper.
Honourable Silver, your March 19 letter to Stacey Hassard contained a fundamental flaw in its impression. Please instruct your staff to amend the letter to read “We are committed to permanently funding Continuous Glucose Monitors for Yukoners up to 18 years of age. We are also committed to introducing a Continuous Glucose Monitor project for those over 18 who choose to participate.”
Further, please consider the following:
- Jurisdictions within Canada carry a range of capacities. Yukon’s insured health must consider that Yukon does not have an adult endocrinologist, does not have a full roster of primary physicians that are trained in Type 1 diabetes management, and the population carries a higher-than-average load of insured persons.
- The Yukon T1D Support Network estimates an adult range of between 10-25 persons, with an outlier of 45 persons, who will actually request a Continuous Glucose Monitor immediately.
- Continuous Glucose Monitors in their most current form (Dexcom G6) is more accurate than standard finger-poke methods, and it is cheaper.
Thank you for your time and attention to this matter. Please feel free to reach out to us at any time.
Yukon T1D Support Network
April 6, 2020 Response from Pauline Frost, Minister of Health and Social Services