Uptake of publicly funded flash glucose monitoring systems: a population-based cohort study in Ontario, Canada

Objective — This study aimed to investigate the uptake of Flash Glucose Monitoring (FGM) among Ontario residents aged 66 and older, who are insulin-requiring and are eligible for Ontario’s universal drug coverage program (the Ontario Drug Benefit (ODB)), specifically examining differences based on immigrant status.

Methods — Using administrative data, we conducted a population-based, repeated cross-sectional study among Ontarians aged 66 and older 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, considering demographic, neighborhood, and healthcare utilization factors.

Results — We found a total of 14,151 immigrants and 85,710 long-term residents who received an FGM over the study period. In the first month of funding, the rate of new users was lower among immigrants (37.1 per 1000) compared to long-term residents (48.8 per 1000). Rates peaked at 94.3 and 91.3 per 1000, respectively, in October 2019, declining thereafter and stabilizing in April 2020. Immigrants receiving FGM were younger, more likely to reside in neighborhoods with greater racialized and newcomer populations, and more likely to have received non-insulin diabetes medications in the prior year, compared to long-term residents receiving the FGM.

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