In an Instagram post sponsored by Abbott, the maker of a competing CGM system, the T1D nonprofit Beyond Type 1 asked its audience, “What is the main reason you’re NOT using a continuous glucose monitor?” Of the 213 who answered, 76% pointed to cost or availability. In a comment, Walt D. observed that “these kinds of technologies are prohibitively expensive for the vast majority of the people who could benefit most from them.” Cycling 1,000 miles through India this winter put a spotlight on my privilege: There, insulin pumps and CGM systems are rare, and diabetes is managed without the tools I’ve come to rely on.

Even if a type 1 diabetic can access a CGM system, they may have trouble managing the recurring expenses. Many of us send our expired Dexcom transmitter out to a member of our black-market community for refurbishment or attempt to do it ourselves. For years, I’ve relied on a popular underground technique that extends a sensor’s lifespan by tricking the app into thinking I am inserting a new one. Along with so many of my friends, I’ve risked infection to save money.

By virtue of the racial disparities in healthcare coverage, those risks are higher for diabetics of color. A study of more than 10,000 American children found that compared with white children, Black children with T1D are almost four times less likely to be using an insulin pump, a device that drastically improves quality of life with the disease. The study, recently brought to light by Jordan Hoese, MD, MPH, also points out that Black people with T1D under 25 have a mortality rate nine times higher than their white counterparts.

It doesn’t have to be this way. Buried inside my Dexcom CGM transmitter, for example, is a $1.35 watch battery. It could be replaceable if Dexcom engineered it that way, or went the route of swapping it with a rechargeable battery like the one in Medtronic’s MiniMed Guardian Link transmitter.

While keeping profit margins high, Dexcom has promoted its devices to higher-income groups via marketing tactics such as influencer-sponsored Instagram posts. Diabetes supply manufacturers are building and marketing their products to perpetuate a world where temporary cures are only available to those who can afford them.

Insulin, glucagon, CGM systems, blood glucose meter supplies, and insulin pumps are not accessories to advertise, taking advantage of the United States’ status as one of two countries in the world that allow direct-to-consumer advertising of prescription drugs. They are medications we should find out about from our doctors, not from our Instagram feeds.

At the start of the pandemic, when I was confronting my own insulin shortage, insulin manufacturer Novo Nordisk started running full-page ads in the New York Times, letting readers know that NovoCare, their patient assistance program, is here to help if you can’t afford your insulin. But band-aids like financial assistance programs, ads, limited-time copays, sponsorships, and coupons won’t change the fundamental inequalities perpetuated by profit-seeking pricing. These companies need to start lowering the cost of our oxygen so we don’t need a coupon to afford it.

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