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Immigration Status and Time to Accessing Publicly Funded Flash Glucose Monitoring Systems
Mary N Elias1, Sara Allin1,2, Joanna Yang3
1Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
JAMA Network Open
|June 2, 2026
Summary
Immigrants with insulin-requiring diabetes experienced delays in accessing flash glucose monitoring (FGM) systems through Ontario
Area of Science:
- Health Services Research
- Diabetes Management Technology
- Health Equity
Background:
- Ontario's public drug program (Ontario Drug Benefit [ODB]) began covering flash glucose monitoring (FGM) systems in September 2019 for eligible individuals with insulin-requiring diabetes.
- Despite public funding, access to such benefits can be complex and inequitable, particularly for immigrant populations.
- Understanding disparities in access is crucial for ensuring equitable healthcare delivery.
Purpose of the Study:
- To investigate the association between immigration status and the time taken to access FGM systems via the ODB program.
- To identify potential inequities in the uptake of diabetes management technology among different patient groups.
Main Methods:
- A population-based cohort study utilizing retrospective data from Ontario residents aged 66 years or older, eligible for ODB and requiring insulin as of September 15, 2019.
- Immigrants were propensity score matched with long-term residents based on age and sex.
- Marginal Cox proportional hazards regression models were employed to analyze the time to receipt of the first FGM sensor, with secondary analyses stratifying by immigration timing.
Main Results:
- The study included 109,079 individuals, with immigrants comprising 12.3% of the cohort.
- Immigrants demonstrated a significantly lower hazard of initiating FGM compared to long-term residents (Hazard Ratio [HR], 0.95; 95% Confidence Interval [CI], 0.93-0.98).
- Recent immigrants (arrived within 10 years) faced the longest delays in FGM initiation (HR, 0.87; 95% CI, 0.80-0.94) compared to long-term residents.
Conclusions:
- Immigrant populations, especially recent arrivals, experience longer wait times for accessing FGM systems compared to long-term residents in Ontario.
- These findings highlight significant access disparities in diabetes technology adoption.
- Addressing systemic barriers related to healthcare navigation, patient-clinician communication, and cultural factors is essential to improve equitable access to novel diabetes devices.
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