Immigration Status and Time to Accessing Publicly Funded Flash Glucose Monitoring Systems.

Importance: Ontario's public drug program (Ontario Drug Benefit [ODB]) announced coverage for flash glucose monitoring (FGM) systems effective September 16, 2019, for eligible patients with insulin-requiring diabetes. However, even within the context of a publicly funded program, access to benefits is complex and can be inequitable. Objective: To evaluate the association between immigration status and time to accessing the FGM system through the ODB program. Design, Setting, and Participants: This population-based cohort study used retrospective data on Ontario residents 66 years or older who were ODB eligible and insulin requiring as of September 15, 2019, and followed up with individuals until March 31, 2023. Statistical analysis was performed from August 2025 to April 2026. Exposure: Immigrants were propensity score matched with long-term residents on age (within 2 years) and sex. Main Outcome and Measure: Marginal Cox proportional hazards regression models were used to examine the association between immigration status and the main outcome, time to receipt of first FGM sensor. Secondary analyses stratified the exposure according to timing of immigration (recent immigrants arriving to Canada within 10 years vs long-term immigrants). Results: A total of 109 079 individuals (median age, 73 years [IQR, 70-79 years]; 59 649 male [54.7%]) met the inclusion criteria, most of whom were long-term residents (95 677 [87.7%]). Within this cohort, 13 257 of 13 402 immigrants (98.9%) were matched with an equal number of long-term residents. In the primary analysis, immigrants had a significantly lower hazard of initiating FGM compared with long-term residents (36.7 per 100 person-years vs 38.8 per 100 person-years; hazard ratio [HR], 0.95 [95% CI, 0.93-0.98]). In secondary analyses stratified by timing of immigration, recent immigration status was associated with a significantly longer time to FGM initiation compared with long-term residents (HR, 0.87 [95% CI, 0.80-0.94]); long-term immigrants also had a significantly lower hazard of initiating FGM compared with long-term residents (HR, 0.94 [95% CI, 0.91-0.98]). Conclusions and Relevance: In this population-based cohort study of older adults with insulin-requiring diabetes, immigrants faced a longer time to access to FGM systems compared with long-term residents, with the greatest disparity observed among people who immigrated to Canada in the past decade. Efforts are needed to address barriers that may hinder timely access to novel medications or devices, which may include health care system navigation, patient-clinician communication, and cultural or knowledge barriers.