That’s a question, folks, not news of a new Medicare policy
on insurance coverage. The fact is: Medicare will still only cover a Continuous Glucose Monitor (CGM) for type 1s and
type 2s who inject meal-time insulin.
Current government policy is
designed to avoid hypos and is
cost-driven. Hypos from accidental overtreatment with insulin by the patient are acute and can be life threatening if not addressed
quickly. They frequently result in emergency room visits and hospitalizations.
Regrettably, for non-insulin dependent type 2s, Medicare does not foster a
long-term approach to blood glucose self-management (BGSM). They do not
consider the costly complications
from higher levels of glucose in the blood. And as the cost of treating the
complications and co-morbidities of T2D
soars, Medicare should cover CGMs for
non-insulin dependent T2s.
Diabetic complications take many
years to develop. Microvascular
complications include 1) nerve damage (peripheral neuropathy), the leading cause of amputations; 2) loss of sight (retinopathy), and 3) end-stage kidney
disease (nephropathy), requiring
dialysis. The co-morbidities of T2D are macrovascular: some cancers,
stroke, and heart disease; the ADA
"compliant" patients (with an A1c of
7.0%), have
TWICE the risk of
CVD.
Why does the government set such
a low standard for doctors and
patients? Because achieving the ADA’s modest ≤7.0% A1c control goal is still
difficult with the government’s one-size-fits-all Dietary Guidelines.
Type
2 diabetes is a DIETARY disease, but the Dietary Guidelines for all
Americans are still based on an eating pattern that is very high (55-60%)
carbohydrate. All carbs sooner or later become “sugar” (glucose) in
the blood. Eating so many carbs while
trying to manage your blood glucose requires increasingly more
meds. But the USDA/HHS, abetted by Big Agriculture and Big Pharma, are stuck in
the status quo.
So, if the patient understands this
and wants to lower their blood sugars on a day-to-day basis, they need to
know what foods (and other factors such as hormones) affect their blood sugar
(glucose). The best way to do that is to monitor your blood sugar frequently,
and “eat to the meter,” i. e., change what you eat.
As I am not an insulin-dependent
type 2 who injects meal-time insulin, my options for obtaining a CGM are
limited to cash-only, i.e., out-of-pocket. I recently looked into this and
learned the following:
For context, I treat my type 2
diabetes primarily with a Very Low Carb “Eating Pattern.” My only diabetes med
is Metformin, and I am assured by my
physician, “You can’t get hypoglycemia from just Metformin.” My own experience
since 2002 confirms this. I am in no
danger whatsoever of hypos, even with extended fasting. Metformin
works on the liver (and gut) and improves insulin sensitivity. It has no
effect on the pancreas.
So, if you are not able to use
insurance to cover the cost of purchasing a CGM system (sensors and readers, or
transmitters and receivers), you have 2 choices: Dexcom and Freestyle Libre.
If you don’t have or aren’t eligible to use insurance, cost is the main factor.
That eliminates one choice for me.
The new Dexcom G6 (3/18), at
about $5,000 US a year, is expensive. It is more accurate in hypos, includes
alarms and has an integrated mobile app. It automatically downloads results to
a Bluetooth-enabled device. The 10-day sensor is a little bulky, but if
you’re insurance eligible, and get hypos, it’s
definitely the way to go.
The new
Freestyle Libre 14-day (8/18) is much
less expensive, but still costly at $1,620 a year ($135/mo). The previous
Freestyle Libre included sensors good for 10 days, but the new FDA approved
14-day sensor should now be in pharmacies. It may be slightly less accurate
than a Dexcom, but it has a shorter “warmup” period (1 hr. vs. 2 hr.) for new
sensors. However, it has no alarms for hypos. It has a
90-day memory and an excellent suite of reports (daily reports and 14-day summaries). It does not have
its own integrated mobile app and must be “read” every 8 hours. However, a
startup, Ambrosia, has a workaround called BluCon. Given my needs, and the cost
disparity, it’s a no-brainer. If I decide to do it, I’ll opt for the Freestyle
Libre 14-day.
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