CGM FOR EVERY PERSON WITH TYPE 1 DIABETES IN MACEDONIA

 TO:

Minister of Health, Dr Sasho Klekovski, Ministry of Health

Health Insurance Fund of the Republic of North Macedonia

We, people living with type 1 diabetes, parents, families and our supporters, call for every person with type 1 diabetes in Macedonia to have the right to continuous glucose monitoring (CGM) through an appropriate, high-quality sensor funded through the public health insurance system.

Type 1 diabetes requires constant management — 24 hours a day, 365 days a year.

CGM is not a luxury.

CGM is not a privilege.

CGM must not be a device provided only after severe complications have developed.

CGM is a modern medical tool for safer day-to-day diabetes management, better health outcomes, and the prevention or delay of complications.

International recommendations are clear

In its Standards of Care in Diabetes—2026, the American Diabetes Association (ADA) recommends initiating CGM at diagnosis and at any point thereafter for people using insulin when the technology can improve diabetes management. The United Kingdom's National Institute for Health and Care Excellence (NICE) recommends offering adults with type 1 diabetes a choice between real-time CGM (rtCGM) and intermittently scanned CGM (isCGM), based on their individual preferences, needs and characteristics, and the functionality of the available devices.

The question is no longer whether people with type 1 diabetes need CGM, but how to ensure equitable, continuous and clinically appropriate access.

The state should not wait until people's eyes, kidneys, heart or nerves have been damaged before providing technology that can support better diabetes management and reduce the risk of complications.

Prevention must begin before complications develop.

According to our community's working estimate, approximately 3,500 people live with type 1 diabetes in Macedonia, of whom around 2,650 still do not have CGM provided through the public healthcare system. Because comprehensive official data have not been made publicly available, one of our key demands is for the institutions to establish and publish an accurate picture of the current situation.

Our demands:

• We call on the Ministry of Health and the Health Insurance Fund to:
• establish the right to CGM for every person with type 1 diabetes without excluding anyone solely on the basis of age;
• revise the existing eligibility criteria that make access conditional upon the prior development of severe complications;
• establish and publicly disclose accurate figures for the number of people with type 1 diabetes, current CGM users, and those who remain without coverage;
• prepare and publish a budgetary and health-economic analysis for full nationwide CGM coverage;
• secure the necessary funding and publish a concrete plan, timeline and implementation phases to achieve full coverage of people with type 1 diabetes without unnecessary delay;
• ensure a continuous and timely supply of high-quality sensors with standards for accuracy, reliability, technical support and the replacement of defective sensors;
• provide a choice of clinically appropriate CGM systems based on individual needs and professional clinical assessment, whenever feasible;
• establish a participatory model for the design and monitoring of the new system involving endocrinologists, the Ministry of Health, the Health Insurance Fund, and representatives of people with type 1 diabetes and their organisations.
• Invest today — reduce tomorrow's costs

CGM has a cost. But so do hospitalisations, severe hypoglycaemia, ophthalmological treatment, dialysis, cardiovascular complications, amputations, sick leave, reduced working capacity and disability.

We therefore ask the state to answer not only: “How much do CGM sensors cost?”

but also: “What is the cost of leaving approximately 2,650 people with type 1 diabetes without access to CGM?”

After 35 years of independence, it is time for Macedonia to take a decisive step that will bring better health, greater safety and fairer treatment for current and future generations of people with type 1 diabetes.

DO NOT WAIT FOR COMPLICATIONS.

GIVE US THE MODERN TOOLS TO HELP PREVENT THEM.

CGM FOR EVERY PERSON WITH TYPE 1 DIABETES. NOW.