C-Peptide and Beta-Cell Autoantibody Testing Prior to Initiating Continuous Subcutaneous Insulin Infusion Pump Therapy Did Not Improve Utilization Or Medical Costs Among Older Adults With Diabetes Mellitus

Gill, Max; Chhabra, Harmeet; Shah, Mona; Zhu, Cyrus; Grunberger, George

doi:10.4158/ep-2017-0220

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…Well-designed studies that have shown no correlation between success of insulin pump use and C-peptide/beta cell autoantibody levels further support this position. 35,56,72,73 Second, although frequent glucose testing (BGM or CGM) is necessary for initiating and continuing use of insulin pump therapy, an individual's history of testing frequency before insulin pump initiation should not be a requirement for coverage eligibility. Allowing beneficiaries to choose their insulin-delivery method, in collaboration with their health care provider, is critical to supporting treatment satisfaction, a major driver of treatment adherence and subsequent outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, because the determination was made in 2004, the most recent and relevant studies were, by default, excluded from their assessment. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][56][57][58] As a result, the clinical efficacy of today's advanced insulin-delivery technologies integrated with continuous glucose sensor technology were not considered. Moreover, these outdated criteria do not reflect important current evidence that is unsupportive or clearly refutes many of the original criteria, such as documentation of insulinopenia, frequent blood glucose monitoring (BGM), and quarterly inperson health care provider evaluation.…”

Section: Current Eligibility Criteria Are Based On Outdated or No Scientific Evidencementioning

confidence: 99%

“…As demonstrated in numerous studies, the glycemic benefits of insulin pump therapy are not dependent on detection of C-peptide concentrations or detection of autoantibodies. [34][35][36]56,[72][73][74] In a retrospective study that assessed a propensity scorematched cohort of insulin pump and MDI users, Gill et al investigated the differences in health care resource utilization and costs between individuals with T1D and T2D treated with insulin pump or MDI therapy who met or did not meet the Medicare C-peptide/beta cell antibody eligibility criteria. 56 For these comparisons, investigators structured the study as three analyses.…”

Section: Proof Of Insulinopenia Is Irrelevant To Success With Insulin Pump Therapymentioning

confidence: 99%

“…[34][35][36]56,[72][73][74] In a retrospective study that assessed a propensity scorematched cohort of insulin pump and MDI users, Gill et al investigated the differences in health care resource utilization and costs between individuals with T1D and T2D treated with insulin pump or MDI therapy who met or did not meet the Medicare C-peptide/beta cell antibody eligibility criteria. 56 For these comparisons, investigators structured the study as three analyses. Results from the first analysis showed significantly slower growth in hospital admissions and average annual medical costs among insulin pump users who did not meet the C-peptide/beta cell antibody test criteria compared with those who did, although changes in total medical costs were similar.…”

Section: Proof Of Insulinopenia Is Irrelevant To Success With Insulin Pump Therapymentioning

confidence: 99%

“…However, because the determination was made in 2004, the most recent and relevant studies were, by default, excluded from their assessment. 24–43 , 56–58 …”

Section: Current Eligibility Criteria Are Based On Outdated or No Scientific Evidencementioning

confidence: 99%

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Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Parkin¹,

Carlson

Galindo

et al. 2021

Diabetes Technology & Therapeutics

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Numerous studies have demonstrated the clinical value and safety of insulin pump therapy in type 1 diabetes and type 2 diabetes populations. However, the eligibility criteria for insulin pump coverage required by the Centers for Medicare & Medicaid Services (CMS) discount conclusive evidence that supports insulin pump use in diabetes populations that are currently deemed ineligible. This article discusses the limitations and inconsistencies of the insulin pump eligibility criteria relative to current scientific evidence and proposes workable solutions to address this issue and improve the safety and care of all individuals with diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Current Eligibility Criteria Are Based On Outdated or No Scientific Evidencementioning

confidence: 99%

Section: Proof Of Insulinopenia Is Irrelevant To Success With Insulin Pump Therapymentioning

confidence: 99%

Section: Proof Of Insulinopenia Is Irrelevant To Success With Insulin Pump Therapymentioning

confidence: 99%

“…However, because the determination was made in 2004, the most recent and relevant studies were, by default, excluded from their assessment. 24–43 , 56–58 …”

Section: Current Eligibility Criteria Are Based On Outdated or No Scientific Evidencementioning

confidence: 99%

See 3 more Smart Citations

Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Parkin¹,

Carlson

Galindo

et al. 2021

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

show abstract

7. Diabetes Technology: Standards of Medical Care in Diabetes—2020

2019

Diabetes Care

213

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes .org/SOC.Diabetes technology is the term used to describe the hardware, devices, and software that people with diabetes use to help manage their condition, from lifestyle to blood glucose levels. Historically, diabetes technology has been divided into two main categories: insulin administered by syringe, pen, or pump, and blood glucose monitoring as assessed by meter or continuous glucose monitor. More recently, diabetes technology has expanded to include hybrid devices that both monitor glucose and deliver insulin, some automatically, as well as software that serves as a medical device, providing diabetes self-management support. Diabetes technology, when coupled with education and follow-up, can improve the lives and health of people with diabetes; however, the complexity and rapid change of the diabetes technology landscape can also be a barrier to patient and provider implementation. OVERALL STATEMENT Recommendation 7.1 Use of technology should be individualized based on a patient's needs, desires, skill level, and availability of devices. Nonprofit websites can offer advice for providers and patients to determine the suitability of various options. ETechnology is rapidly changing, but there is no "one-size-fits-all" approach to technology use in people with diabetes. Insurance coverage can lag behind device availability, patient interest in devices and willingness to change can vary, and providers may have trouble keeping up with newly released technology. Not-for-profit websites such as DiabetesWise.org (1) and others can help providers and patients make decisions as to the initial choice of devices. Other sources, including health care providers and device manufacturers, can help people troubleshoot when difficulties arise. SELF-MONITORING OF BLOOD GLUCOSERecommendations 7.2 Most patients using intensive insulin regimens (multiple daily injections or insulin pump therapy) should be encouraged to assess glucose levels using

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7. Diabetes Technology: Standards of Medical Care in Diabetes—2021

2020

Diabetes Care

182

View full text Add to dashboard Cite

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

show abstract

C-Peptide and Beta-Cell Autoantibody Testing Prior to Initiating Continuous Subcutaneous Insulin Infusion Pump Therapy Did Not Improve Utilization Or Medical Costs Among Older Adults With Diabetes Mellitus

Cited by 6 publications

References 12 publications

Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

7. Diabetes Technology: Standards of Medical Care in Diabetes—2020

7. Diabetes Technology: Standards of Medical Care in Diabetes—2021

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