Initially published in Benefits and Pensions Monitor, February 2018 | Updated November 2022

Sponsoring an employee benefits plan can be a significant investment for any employer. As plan sponsors struggle to control rising benefits costs, they may be tempted to focus solely on the bottom line. As a result, preventative care plans with capped maximums promoting employee health through choice and flexibility have become an increasingly popular strategy among employers. But what about employees with health conditions for whom prevention is not an option?

The plan choices that employers make today can impact the lives of employees and their dependents far into the future.

One such condition is Type 1 Diabetes (T1D), an autoimmune disorder that attacks and permanently destroys insulin-producing beta cells in the pancreas. It’s estimated that 300,000 people in Canada live with T1D.1 The cause of the disease is unknown but believed to be triggered by a combination of genetic and environmental factors. Once referred to as ‘juvenile diabetes,’ the onset of T1D often (but not always) happens during childhood and is unrelated to diet or a sedentary lifestyle. Nothing can be done to prevent it, and there currently is no known cure. T1D is controlled with multiple daily insulin doses using syringes, pens, or pumps. Without insulin, high blood glucose levels cause cellular damage and an inability to metabolize sugar into energy, leading to organ damage, starvation, and death.

Similar name, different disease

In contrast, Type 2 Diabetes (T2D) is generally considered a lifestyle-related disease, although genetics and family history also affect its onset. Historically, T2D took decades to develop, which is why it was once referred to as ‘adult-onset diabetes.’ With T2D, the pancreas may still produce adequate insulin levels, but an individual’s cells become insulin resistant. Over the last 25 years, the incidence of T2D has not only exploded among adults, but it now affects a growing number of increasingly sedentary adolescents and children, who are also developing T2D, and it is expected to reach epidemic proportions. As a result, public health officials are aggressively preaching prevention to slow the ever-rising number of T2D cases.

The focus on preventing T2D runs the risk of cutting off essential care and support for those with T1D, for whom prevention is not the answer. Both T1D and T2D can result in high blood glucose levels that, if unmanaged, will lead to similar devastating complications and costs. But according to the Juvenile Diabetes Research Foundation (JDRF), only 5 to 10 percent of Canadians diagnosed with diabetes live with T1D; most Canadians with diabetes have T2D. Unfortunately, these two distinctly different types of diabetes are often grouped under a single classification of ‘diabetes’ in government statistics and within medical and insurance sectors, blurring the distinction between the two and leaving those with T1D in the shadows.

T1D looks like me

T1D Looks Like Me isn’t just a catchy slogan; it’s my life. Since my diagnosis at age six, I have had to deal with the relentless demands and effects of T1D. The burden of responsibility and fear of complications accompanying this disease can be overwhelming for an adult, let alone a child, and never more top of mind than over the past three years as the world scrambled to deal with COVID. As an adult over 40 living with T1D, statistics tell me that my chances of hospitalization and adverse outcomes from COVID are many times higher than average,2,3 and it’s been difficult to escape the constant reminders of that fact.

This year the world celebrated the 100th anniversary of the discovery of insulin. While I may not be overly fond of injections (an estimated 53,000 over the last 50 years and counting) or the idea of being continuously connected to an insulin pump, I am grateful that something is available to keep me alive until a cure is found. Had I been born 50 years earlier, I likely would not have survived into my teens4, so I consider myself lucky.

For employers considering implementing a healthcare spending account (HCSA) in place of a traditional insured benefits plan to promote choice and prevention, flexibility may come at a high cost.

T1D is always in the back of my mind. My insulin, blood glucose monitor (now a continuous glucose monitor, or CGM), and an emergency source of carbohydrates are always with me. The factors that can affect my blood sugar level are endless. Food, medication, and physical activity, as well as biological and environmental factors such as stress, illness, lack of sleep, or hormone fluctuations, can all impact my blood sugar levels, sometimes in the most unpredictable way. It is impossible to control or even account for some of these variables.

Preventing complications and preserving my quality of life often feels like a full-time job. T1D never takes a break, yet most people who interact with me daily never know I have the condition unless I disclose that information. With T1D, you have no choice but to integrate the disease into everyday life. You’re still dealing with the same home and work-life stress we all have. But you learn to do so while constantly monitoring glucose levels, administering insulin six or more times a day and carefully calculating each dose to balance against carbs consumed and activity levels. All of this is in the back of your mind while dealing with potentially extreme blood sugar spikes or drops.

With proper care and treatment, including access to insulin, people with T1D can live healthy and productive lives. What many people do not understand, however, is the amount of effort it takes to keep T1D well-controlled. There are no breaks and no vacations. It is constant, and it can be costly.

The high cost of trying to stay healthy

A 2012 report published by the Canadian Diabetes Association (CDA) notes that 57 percent of Canadians with diabetes say they do not comply with prescribed therapy because they cannot afford medication or supplies. Some reported estimating glucose levels and rationing insulin.5

If left undiagnosed or untreated, T1D can quickly kill an individual, so what should an individual who cannot afford to manage their condition efficiently do? Insurance carriers offer individual plans, but coverage is often limited and expensive, if not outright declined, for people with diabetes. Government coverage of diabetes medications and supplies can vary by location, leaving many with T1D to bear the costs directly. Mainly at risk are lower-income earners without social assistance; fixed-income seniors; and those with high drug and health care costs, who do not qualify for other aid forms and are not covered under a private health plan.

Diabetes Canada (formerly CDA) reports that, on average, Canadians with T1D can spend anywhere from $2,600 to $4,900 on out-of-pocket diabetes-related medical costs annually, depending on their method of insulin administration.6 However, a closer look at the references shows that these estimates date back to 2015. In reality, individuals with T1D using insulin pumps and glucose monitoring systems may face out-of-pocket costs of more than $15,000 per year.7

The argument can be made that the federal government should enhance financial assistance for people with T1D to ensure affordability and access to medications, devices, and supplies. However, as it stands, for Canadians who live with chronic conditions or autoimmune disorders, employer-sponsored benefits play a crucial role in their effort to remain healthy and productive and maintain a decent quality of life.

Business decisions have real-life implications

The plan choices that employers make today can impact the lives of employees and their dependents far into the future.

For employers considering implementing a healthcare spending account (HCSA) in place of a traditional insured benefits plan to promote choice and prevention, flexibility may come at a high cost.

Having lived with T1D for 50 years, I’ve dealt with my share of diabetic complications, but technology and research and diabetes care have advanced enough to minimize the impact and make diabetes management easier, allowing me to lead a healthy, full, and active life, pursuing my passions, which I’ve been able to do with the support of an insured employer-sponsored health benefits plan, both as an employee and a dependent.

I’ve learned that what’s most important in life is my health. Employers who come to the same conclusion may find that retaining a loyal, highly motivated, experienced, and productive workforce, supported by a robust employer-sponsored benefits plan, might be their best strategy for preserving and enhancing profitability.

Reach out to your Cowan consultant today to discuss benefits options.

1 JDRF (September 6, 2022). JDRF commissions cost effectiveness study to demonstrate real quality of life value of diabetes technologies. Retrieved from URL.
2 Campbell, D. (May 20, 2020). COVID-19: people with type 1 diabetes more likely to die than those with type 2 – study. Retrieved from URL.
3 Endocrine press release (September 28, 2021). People over 40 with type 1 diabetes and COVID-19 are more likely to be hospitalized. Retrieved from URL.
4 Delle Palme, R. (September 27, 2018). The Long Life of One of Banting’s First Patients. Retrieved from URL.
5 Canadian Diabetes Association (August 13, 2012). Paying for Rent or Medication: A Decision Canadians with Diabetes Should Not Have to Make. Retrieved from URL.
6 Canadian Diabetes Association (2022). Diabetes in Canada. Retrieved from URL.
7 Canadian Diabetes Association press release (June 24, 2022). Welcome news for Canadians living with type 1 diabetes. Retrieved from URL.