Uptake of Publicly Funded Flash Glucose Monitoring Systems: A Population-based Cohort Study in Ontario, Canada

In this study we investigated uptake of flash glucose monitoring (FGM) among Ontario residents ≥66 years of age who require insulin and are eligible for Ontario's universal drug coverage program (the Ontario Drug Benefit [ODB]). Specifically, we assessed differences based on immigration status.

Using administrative data, we conducted a population-based, repeated cross-sectional study among Ontarians ≥66 years of age with insulin-requiring diabetes between September 1, 2019, and March 31, 2023. The primary outcome was the monthly rate of unique individuals receiving publicly funded FGM through the ODB program. We compared characteristics of FGM users based on immigration status by considering demographic, neighbourhood, and health-care use factors.

We found a total of 14,151 immigrants and 85,710 long-term residents who had FGM over the study period. In the first month of funding, the rate of new users was lower among immigrants (37.1 per 1,000) compared with long-term residents (48.8 per 1,000). Rates peaked at 98.0 and 96.0 per 1,000, for immigrants and long-term residents respectively, in October 2019, declining thereafter and stabilizing in April 2020. Immigrants receiving FGM were younger, more likely to reside in neighbourhoods with greater racialized and newcomer populations, and more likely to have received noninsulin diabetes medications in the prior year, when compared with long-term residents receiving FGM.

We observed significant FGM uptake in the first months after public funding among both immigrants and long-term residents. Although long-term residents showed slightly higher initial uptake, differences between groups were minimal after the first month of funding.