I've just come back from three days in South Korea with a group of nurse educators, as part of the Diabetes Exchange. It's an annual summit run by Spirit Health, and this year it was held in partnership with i-SENS, who make the CareSens Air CGM.

I went expecting to learn about the technology. I came back thinking much more about the system that sits around it.

Watching CGM being built

I've lived with diabetes for nearly 50 years. When I was diagnosed, checking my glucose meant urine tests and guesswork. So standing in a factory watching CGM sensors being made felt personal in a way I hadn't expected.

It also changed how I think about the devices we hand over in clinic. We spend a lot of time teaching people how to apply a sensor, read the data and act on it. We spend almost no time thinking about how much work, precision and quality control sits behind that small thing on someone's arm. Seeing it made me more patient with the frustrations people bring us, and more curious about why sensors sometimes fail.

Insurance and the NHS

The biggest thing I brought home was the difference between South Korea's national health insurance model and the NHS.

In South Korea, CGM is paid for in one of two ways: by insurance, once a C-peptide test shows someone qualifies, or out of the person's own pocket. Even with insurance, there's additional co-pay. A blood test decides who gets help, and everyone pays something. We're not as different as we like to think. On the NHS, NICE guidance (NG17 and NG28) sets out who qualifies for CGM, and anyone who doesn't meet the criteria potentially has to fund it themselves.

But it made me look at our own system more honestly. The real difference is the co-pay. If you meet the criteria here, CGM costs you nothing. But even for people who qualify, access still varies depending on where they live, which team they see and how hard they push. We don't ration with a bill, but we do ration by postcode, by waiting list and by who has the time and confidence to ask.
Neither system has it solved. Seeing them side by side stopped me treating our way as the default and made me ask what we'd change if we were designing it from scratch.

What this means for nurses

Talking to nurse educators from a different system was the best part of the trip. However, the money flows, the same problem keeps coming up: a device is only as good as the education that comes with it.

People don't just need a sensor. They need someone to show them what the numbers mean, when to act and when to leave things alone. That's nursing work, and in the UK it often falls to specialist nurses who are already stretched.

If we want fair access to diabetes technology, we have to count the education as part of the access. A sensor prescribed without the time to teach someone how to use it isn't equal care, however free it is.

What I'm bringing back

I've come home with a bit more gratitude for the NHS and a lot less patience with the gaps we've learned to live with. I'd love to hear from other nurses on the forum: where does access to diabetes technology fall down in your area, and what's helped close the gap?

My place on the Diabetes Exchange was hosted by Spirit Health in partnership with i-SENS.