NewNowNext

CGM Reimbursement

If you’re a regular diaTribe reader, you probably know that we’re big fans of Continuous Glucose Monitoring (CGM)—devices that let you see your glucose levels in real-time and watch whether they’re going up, down, or remaining steady. We think that these devices can help people with type 1 and type 2 diabetes improve blood glucose control – even if it already appears to be really good!

However, truth be told, these are expensive devices and few people can afford to pay for them out-of-pocket. We thought it would be helpful to publish a list of insurance companies that have begun to offer favorable CGM coverage. Here’s the list, according to the Juvenile Diabetes Research Foundation (JDRF), strong proponents of CGM technology:

• Aetna—Will cover CGM for all patients with type 1 diabetes over age 25 or under 25 with severe hypoglycemia
• CIGNA—Will cover CGM for patients with type 1 diabetes with severe hypoglycemia AND for type 2 patients with recurrent severe hypoglycemia who meet a specific c-peptide threshold (talk to your doctor)
• Highmark Blue Cross Blue Shield and Humana—Will cover for type 1 patients with severe hypoglycemia or hypoglycemia unawareness (if you don’t notice when your blood sugar is severely low)
• Kaiser Permanente in CA—Will cover for all patients with type 1 diabetes who meet specific Kaiser coverage criteria
• United HealthCare—Will cover patients with type 1 diabetes who have not achieved optimum control (most people are probably eligible)
• Wellpoint/Anthem—Will cover patients with severe hypoglycemia or those who are pregnant

If your insurance company is on this list and you meet the criteria, you should ask your doctor about CGM, particularly if you have hypoglycemia unawareness or frequently unpredictable glucose levels. If your insurance company is not on the list, they should be, in our view, and the pressure is on, as all the big five “heavyweights” have approved CGM in some way. Now, there’s one clear thing missing – most of this coverage is for type 1, even though we’ve heard from a number of type 2 patients that CGM may be helpful for them as well. The reason coverage is more limited for type 2 patients is because not enough studies have been done, and the benefits of CGM in type 2s are not as certain. We think there’s a clear message to companies – please do some more type 2 studies to find out if CGM can be beneficial!. In the meantime, a growing number of healthcare providers are offering CGM rentals for their type 2 patients. This makes great sense to us. If your A1c is over 7%, it might really help you to get into better control, and even if you don’t have a high A1c, it might help you avoid serious highs and lows. For type 2s who have never tried CGM, we might recommend a physician-based system first - we will be writing about this more in diaTribe #16. If CGM isn’t available, of course, you can get some of this information from a few days of taking 12-24 fingersticks every day, but CGM might be a better bet – ask them and ask them again!

By the way, the JDRF is a great resource to find out if your insurance company covers CGM, even if it’s not on the list above.

We think it’s important to get the word out about this technology so that it can benefit the greatest number of people possible. We really appreciate the work of the JDRF, which has done critical research to help persuade insurance companies to cover CGM devices. You can also visit the Children With Diabetes Insurance forum and join discussions or learn about what strategies have worked well for others.

SugarDash PocketLog

Our frequent contributor, Dana Lewis, alerted us to this handy tool for recording blood glucose numbers during the day. SugarDash is a mini-logbook that you can download from the internet, print out and fold, and it has enough spaces to enter 19 different glucose values each day for a week. While you may not need all the spaces, the fact that they are already marked with time of day makes it easier to track when you tested. There’s also a space underneath the glucose values where you can record each day’s events (like exercise, meals, etc.). SugarDash is small enough to fit into your glucose meter case and may be easier to carry around than a regular logbook. The book and folding directions are freely available for download. Dana will be going to the American Diabetes Association (ADA) conference with us this summer and hopefully coming back with even more tips – parents, Dana is also a moderator of ADA's Planet D online community, a safe place for kids to explore, discover, and connect with other kids living with diabetes.

Tour de Cure Red Rider program

The Tour de Cure is a series of cycling races held by the ADA each year to fund diabetes research. As we pointed out in Issue 13’s NewNowNext, there are many ways for everyone to participate in the Tour de Cure (racing, tandem biking, unicycling, you name it) but if you have diabetes, there’s another way to ride…in style. The Red Rider program gives every person with diabetes who signs up for the race a free signature bright red jersey or T-shirt. The idea is to visibly recognize the strength it takes to live with diabetes, and to foster a sense of community between riders. In addition to the jersey, people with diabetes can join Team Red, made up of other Red Riders and their supporters. To sign up, all you have to do is tell your local Tour coordinator that you’d like to be registered as a Red Rider when you sign up. If there’s no Team Red in your area you can start one as a captain or join the diaTribe team! We’ll be riding June 14 in Silicon Valley and Novo Nordisk CEO Lars Sorensen will be riding that day as well – if you would like to meet him, let us know at kelly@diatribe.us as he promised to make time to meet the diaTribe riders when we asked him! Find out more information about the ride.

Haidee Merritt’s One Lump or Two?

Diabetes is generally a serious business…Haidee Merritt, on the other hand, has made a business out of its less-serious aspects. Her book One Lump or Two? is a collection of cartoons exploring the idiosyncrasies and frustrations of living with diabetes. Part comedy, part catharsis, part black humor, it’s a fascinating view through the eyes of someone coping with the disease on a daily basis—and laughing at the complexity of it all. We featured one of her cartoons in diaTribe 13’s Fingersticks, and the book is available for purchase online.

No more Cozmo

In case you haven’t heard, Smiths Medical recently decided to leave the insulin ppumping business and stop selling the Deltec Cozmo insulin pump. If you’re already a Cozmo customer, this probably won’t affect you immediately—Smiths has agreed to honor all existing warranties and provide customer service until the end of the warranty period. However, sooner or later you’ll need to change pumps. We’re sad to see the Deltec go, but there are plenty of other options available for pump users.

Medtronic has already started a new Medtronic Cares program to help make it easier for you to switch to a Medtronic pump. The program will give you a reduced price on a Paradigm REAL-Time pump with a two-year warranty, as well as 30 days of supplies. Animas and Insulet have just launched similar deals--Animas will lower the price of a OneTouch Ping to $900 and give you up to $700 for trading in your current pump, and Insulet has a special Omnipod starterkit for as little as $50.

Learn more from Smiths, or find out more about the Medtronic, Animas, and Insulet programs.

Onglyza…the next Januvia?

On April 1st diaTribe traveled to Washington DC to observe the regulatory discussions on a new diabetes drug that is waiting for approval in the US (it is also awaiting approval in Europe). The new drug, called saxagliptin, is a new kind of DPP-4 inhibitor, the same type, or class, of drug as Januvia. At the meeting, the FDA brought a panel of physician and research experts (called the Advisory Committee) to discuss the safety and efficacy of the drug and give recommendations about whether or not it should be approved. After a full day of sometimes-heated discussion, the panel voted overwhelmingly to recommend that the drug could be approved. The final decision is still in the hands of the FDA, but the agency almost always agrees with the panel in the end. That said, the FDA recently postponed its decision date by an additional three months, most likely for resource reasons. We think it would be great, with all the subsidies going on, if the FDA could get some funds to aid them in helping people with diabetes! Regardless, it seems likely that saxagliptin (which, if approved will be called Onglyza) will soon be available for your doctor to prescribe--so far it appears to be a safe drug with moderate efficacy that is very similar to Januvia.

The FDA and Liraglutide

On April 2nd, right after the saxagliptin meeting, the FDA Advisory Committee discussed liraglutide, a once-daily injectable medication for type 2 diabetes that works in a way similar to Byetta--it's a member of the GLP-1 class. We've been looking at this drug with anticipation for a long time now; convenient dosing may offer advantage for patients, all else equal. However, this time the Advisory Committee voted not to approve liraglutide, based on concerns about a specific cancer in laboratory animals--while no increased risk of that cancer has been seen in people taking liraglutide, the committee voted that they couldn't rule out the risk. There was a tie in the committee on whether or not liraglutide should be approved so the FDA has the next move. Because of the tie, we are now in the midst of a delay for liraglutide--we aren't sure yet what the FDA will do based on the Advisory Committee's recommendation, but we certainly hope they look to make more safe alternatives available for patients based on high need. Currently there are over 9 million patients in the US estimated to have A1c above the target range of 7% and many more globally. Liraglutide did recently receive a positive opinion from regulatory authorities in Europe, and we would expect to see it on the market there in the next couple of months. We don't know yet the details on regulatory agency differences in opinions on liraglutide, but we'll keep you updated…

Be inTouch with your diabetes management

We’d like to tell you about a new diabetes management program from J&J’s SymCare branch that has just received FDA approval this month. The program, called inTouch, is designed to help you and your doctor share information about your diabetes and help you maintain better control. It helps to promote education about diabetes, allows you to upload information from your glucose meter and get online coaching from nurses, and has a reward system that gives you Amazon gift cards when you meet diabetes management or educational goals. SymCare is designing trials using the inTouch program that will study whether it succeeds in improving diabetes management in the real world—we think the technology has promise, and we’re very curious to hear what they discover. In general, we think information technology has the potential to change diabetes care for the better, and inTouch seems like a first step in that direction. The inTouch program is currently being offered through employers, so ask your company about the new program. So far, inTouch only works with OneTouch meters, but the plan is to eventually open it up to other brands as well. If you sign up for the program and aren’t using a compatible meter, the SymCare team will give you a new meter free of charge. For more information, point your browser (and your boss) to the SymCare website.

DiabetesMine Design Challenge

Diabetes advocate Amy Tenderich is hosting her annual Diabetes Design Challenge, giving you a chance to win funding to help you develop your ideas for new diabetes products or web applications. There are three prizes to be won: a grand prize, an award for the most creative idea, and one for the best kid’s entry. The grand prize includes $10,000 in cash, a mini-workshop with experts at the global design and innovation firm IDEO, and one ticket to the Health 2.0 innovation conference held in San Francisco in October 2009. The most creative idea will receive $5,000 in cash and a consulting session with IDEO, and the best kid’s entry will receive $2,000 in cash. Entries will be accepted until May 1st, 2009, and can take the form of either a 2-minute video or a 2-3 page document describing your idea and showing a prototype with supporting graphics. The contest is now over, but you can look at the contest information here.