BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) has numerous requirements for coverage of continuous subcutaneous insulin infusion (CSII; insulin pump). Due to recent improvements in diabetes treatment, people with type 1 diabetes are living longer, resulting in an increase in the number of individuals who are eligible for Medicare and are impacted by CMS policies regarding CSII. METHODS: Two hundred forty-one adults with type 1 diabetes who had been on CSII with CMS coverage for at least 6 months were surveyed. Median age was 67 years, mean A1c was 7.0%, 64% were women, 93% were white, and the median type 1 diabetes duration was 42 years. Participants reported median CSII use of 15 years and 82% were on CSII before starting CMS. RESULTS: Of those starting CSII while on CMS, challenges included cost of supplies (29%) or the insulin pump (24%). The majority (57.5%) reported issues with obtaining supplies, the most common problems being delays in release of supplies (29%), difficulty getting paperwork completed (23.5%), and seeing a health care provider every 90 days (18%). Participants reported changing their CSII behaviors because of supply delays (39%) including leaving site in place >3 days (64%), and reusing pump supplies (34%). Consequently, participants reported adverse outcomes including more erratic (48%) or higher (42%) blood glucose and pain or irritation at sites (34%). CONCLUSION: This study concluded that current CMS CSII policies promote adverse CSII behaviors and outcomes in type 1 diabetes and thus call for changes in the CMS CSII policies.
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) has numerous requirements for coverage of continuous subcutaneous insulin infusion (CSII; insulin pump). Due to recent improvements in diabetes treatment, people with type 1 diabetes are living longer, resulting in an increase in the number of individuals who are eligible for Medicare and are impacted by CMS policies regarding CSII. METHODS: Two hundred forty-one adults with type 1 diabetes who had been on CSII with CMS coverage for at least 6 months were surveyed. Median age was 67 years, mean A1c was 7.0%, 64% were women, 93% were white, and the median type 1 diabetes duration was 42 years. Participants reported median CSII use of 15 years and 82% were on CSII before starting CMS. RESULTS: Of those starting CSII while on CMS, challenges included cost of supplies (29%) or the insulin pump (24%). The majority (57.5%) reported issues with obtaining supplies, the most common problems being delays in release of supplies (29%), difficulty getting paperwork completed (23.5%), and seeing a health care provider every 90 days (18%). Participants reported changing their CSII behaviors because of supply delays (39%) including leaving site in place >3 days (64%), and reusing pump supplies (34%). Consequently, participants reported adverse outcomes including more erratic (48%) or higher (42%) blood glucose and pain or irritation at sites (34%). CONCLUSION: This study concluded that current CMS CSII policies promote adverse CSII behaviors and outcomes in type 1 diabetes and thus call for changes in the CMS CSII policies.
Entities:
Keywords:
Centers for Medicare and Medicaid Services (CMS); aging; continuous subcutaneous insulin infusion (CSII); insulin pump; type 1 diabetes
Authors: George Grunberger; Jill M Abelseth; Timothy S Bailey; Bruce W Bode; Yehuda Handelsman; Richard Hellman; Lois Jovanovič; Wendy S Lane; Philip Raskin; William V Tamborlane; Caitlin Rothermel Journal: Endocr Pract Date: 2014-05 Impact factor: 3.443
Authors: Anne L Peters; Andrew J Ahmann; Tadej Battelino; Alison Evert; Irl B Hirsch; M Hassan Murad; William E Winter; Howard Wolpert Journal: J Clin Endocrinol Metab Date: 2016-09-02 Impact factor: 5.958
Authors: Gary A Puckrein; Gail Nunlee-Bland; Farhad Zangeneh; Jaime A Davidson; Robert A Vigersky; Liou Xu; Christopher G Parkin; David G Marrero Journal: Diabetes Care Date: 2016-04 Impact factor: 19.112
Authors: Gina Agiostratidou; Henry Anhalt; Dana Ball; Lawrence Blonde; Evgenia Gourgari; Karen N Harriman; Aaron J Kowalski; Paul Madden; Alicia H McAuliffe-Fogarty; Molly McElwee-Malloy; Anne Peters; Sripriya Raman; Kent Reifschneider; Karen Rubin; Stuart A Weinzimer Journal: Diabetes Care Date: 2017-12 Impact factor: 19.112
Authors: Grazia Aleppo; Christopher G Parkin; Anders L Carlson; Rodolfo J Galindo; Davida F Kruger; Carol J Levy; Guillermo E Umpierrez; Gregory P Forlenza; Janet B McGill Journal: Diabetes Technol Ther Date: 2021-06-17 Impact factor: 6.118