How to Advocate for Yourself: Making Employer-Sponsored Health Plans Work for Your Diabetes Care

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney

The therapies, devices, and care that people with diabetes need can be expensive without adequate insurance coverage. For those with employer-sponsored health insurance, there are steps you can take to improve your insurance options and advocate for yourself.

Over 45 percent of Americans have diabetes or prediabetes and roughly half of US adults receive health insurance through their employer. Unfortunately, not all employer-sponsored health plans meet the needs of people with diabetes. According to a study of 65,000 people with type 1 diabetes on employer-sponsored health insurance, the average annual out-of-pocket cost of diabetes care was $2,500. Eight percent of study participants had annual costs well over $5,000. Since diabetes is most prevalent in low- and middle-income households, these costs, in addition to paying for premiums and non-diabetes healthcare, are unaffordable for many people.

If your health insurance does not cover a component of your diabetes healthcare, or if your diabetes care is covered but still unaffordable, you can work with your employer to get better coverage. Here is an overview of the different types of health insurance, who to go to for help, and how to advocate for better diabetes health coverage.

What are the different types of health insurance?

You will have expenses no matter what health insurance you have, but some plans can be more affordable for diabetes care. These are the expenses you will typically encounter with your health insurance plan:

  • Premium – Similar to paying rent, a premium is a fixed amount that you pay every month to keep your health insurance active. It’s common for employers to pay about half of your monthly premium, and sometimes more. In 2019, people with employer-sponsored insurance paid an annual average of $1,242 for health insurance premiums.
  • Deductible – The deductible is the amount you pay out-of-pocket before your insurance provider covers expenses. For example, if you have a $1,000 deductible, your insurance coverage will not kick in until you’ve paid $1,000 in healthcare expenses for that year.
  • Copays – Copays are a fixed amount that you pay for a health service or medication, and your insurance provider covers the rest of the cost. Copays are a helpful way to pay for diabetes care because they are fixed, predictable costs that people can plan for.
  • Coinsurance – Unlike fixed-price copays, coinsurance costs are a percentage of the total price of a health service or medication. These expenses are less predictable because medication prices can fluctuate.

There are three main types of health insurance – health maintenance organizations (HMO), preferred provider organizations (PPO), and high deductible health plans (HDHP). Here is an overview of the different types of health plans and what they might cost:

  • HMO – Health maintenance organizations have high premiums and low deductibles. An HMO plan covers healthcare within a network of hospitals and healthcare professionals. Your providers must be in-network in order to get your diabetes care covered. If your diabetes care professionals are in-network, this is often the most cost-effective healthcare option for people with diabetes.
  • PPO – Preferred provider organizations also have high premiums and low deductibles than HDHPs. PPOs are more flexible than HMOs because you are able to see providers out-of-network and you can see specialists without a referral. Because of this, PPOs typically have higher premiums and out-of-pocket costs than HMO plans.
  • HDHP – High deductible health plans typically have low monthly premiums and high deductibles. In 2020, the IRS defined a HDHP as any plan with a deductible of at least $1,400 for an individual and $2,800 for a family. If you have a high deductible health plan, you can open a health savings account where you set aside money to pay for medical expenses tax-free. These health plans are good for people who don’t anticipate needing regular healthcare; paying for diabetes care can be difficult with this type of plan because you will have high out-of-pocket costs upfront before you meet your deductible.
Advocacy

Image source: iStock Photo

Keeping these different types of health insurance and related expenses in mind, here are some things people with diabetes should think about when reviewing an employer-sponsored health plan:

  • What are my diabetes-related costs? Make a list of your diabetes healthcare costs including medications, devices, supplies, healthcare visits, and lab tests.
  • What are the health insurance costs? Look at the premium, deductible, and whatever cost sharing method (copay or coinsurance) is used for the health plan.
  • Are my medications and devices covered? Refer to your health plan’s Summary of Benefits and Coverage to see what is included in your insurance coverage. If a therapy or device is not covered, you may have to switch to one that is or submit a request to get it covered. Getting a new medication or device covered under your health plan can be a challenging and time-consuming process.
  • Is insulin covered pre-deductible? Some health plans cover insulin before you reach your deductible because it is considered preventive medicine. This can make insulin considerably more affordable, especially for people on high deductible health plans.
  • Are my healthcare professionals in-network? Accessing in-network healthcare is more affordable than out-of-network care. You should choose a health plan where your current providers are in-network or one that has good in-network options.
  • Can I access a flexible spending account (FSA) or health savings account (HSA) to save money? FSAs and HSAs are used to put aside money that is not taxed to help pay for medical expenses. HSAs are paired with high deductible health plans. FSAs can be used for any kind of health insurance and all FSA funds must be used in the same calendar year. Learn more about FSAs and HSAs here.

If I have a problem with my insurance, who do I go to for help?

Your employer’s human resources (HR) department should be able to address many of your insurance-related questions, since it likely helped select the health plan(s) available to you. Your HR department is your first resource for health insurance questions. If you need help selecting an insurance plan, want to see if your diabetes care is covered, need to file a claim, or are having trouble navigating your plan and understanding the costs, the HR department will support you.

For further questions, your HR department can refer you to a representative with the health insurance company or to a third-party administrator. A third-party administrator will help you understand your health plan, file health insurance claims, and navigate the appeals process if your insurance company denies coverage for a diabetes treatment. You can also apply for an exception to get treatments, medications, and devices covered if recommended by your doctor. A third-party administrator will guide you through these steps for getting important diabetes treatments covered.

Advocacy

Image source: iStock Photo

How can I make my employer-sponsored health coverage better for people with diabetes?

People with diabetes typically require expensive medications, devices, and regular visits with healthcare professionals to stay healthy. Robust employer-sponsored health insurance plans should make these expenses affordable and predictable. If you are trying to make permanent changes to your employer-sponsored health plan, your HR department can help you advocate for future health plans that better support diabetes needs. Employers have the power to make changes to their health coverage options every year. Here are some changes you can advocate for:

  • Add insulin and other diabetes care to the preventive medicine list.

In 2019, the IRS ruled that expenses for chronic disease management can be covered before you meet your deductible under a high deductible health plan. HMOs and PPOs also have preventive medicine lists. Diabetes care such as insulin, A1C testing, blood glucose meters, and eye screening – which are all considered preventive medicine – can be added to the preventive medicine list to reduce the copay or coinsurance costs for diabetes care. This saves employees money instead of paying full price before meeting their deductible.

  • Request to get a medication or device covered under your health plan.

If a device or medication you currently use (or want to try) is not covered under your health plan, you can ask for coverage in next year’s health plan. Diabetes devices, such as continuous glucose monitors (CGM) and insulin pumps, can help people with diabetes manage their glucose levels and increase their Time in Range, but are expensive without insurance coverage. Employers can typically negotiate to cover essential diabetes care, so request coverage for your medications and devices. Your diabetes treatment should be determined by your healthcare professional, not by what’s included in your health plan.

  • Share discounts and rebates with employees.

While list prices for diabetes medications may be high, your employer’s pharmacy benefit manager (PBM) can negotiate discounts and rebates on drug prices on behalf of the insurance plan and employer. The list price minus the negotiated discounts is called the net price. Sometimes PBMs and employers will keep the money saved; however, employers can pass discounts on to their employees to lower their out-of-pocket costs.

  • Use copayments for cost sharing instead of unpredictable coinsurance.

Coinsurance costs are unpredictable because they fluctuate as a drug’s net price changes. You can advocate for your employer to choose health plans that use copayments for healthcare cost sharing, instead of coinsurance.

More resources for accessing diabetes healthcare with your employer-sponsored health plan:

Feel free to share this article with your employer or your HR department. All people with diabetes deserve access to affordable, high-quality care. To learn more about health insurance and affording diabetes treatment, visit diaTribe.org/access.

Diabetes Series

Image source: iStock Photo

This article is part of a series on access that was made possible by support from Insulet. The diaTribe Foundation retains strict editorial independence for all content. 

Source: diabetesdaily.com

Real Stories, Real Data, Real Results – Using Your CGM to Improve Time in Range

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza

In this video on understanding your ambulatory glucose profile (AGP) report, pediatric endocrinologist, Dr. Amy Criego from the International Diabetes Center, uses real-world AGP examples to show how small steps and manageable goals can lead to more Time in Range. 

Continuous glucose monitors (CGM) are an amazing tool; the data they provide can help you learn more about your diabetes and dramatically improve your diabetes management. You can work with your care team to improve your Time in Range (TIR) based on data from your CGM. The International Diabetes Center’s Ambulatory Glucose Profile (AGP) report is a standardized, single-page report included in your CGM software that is based on your last 14 days of glucose data. It shows key measurements – including TIR, a summary glucose profile, and daily glucose graphs – that can be used to assess your diabetes management and outcomes and inform any changes you should make.

In this video, Dr. Criego shares real-world AGP reports from three people with diabetes:

  • Lee is a 20-year-old who has had type 1 diabetes for seven years. He currently uses a blood glucose monitor and insulin injections and his A1C is usually high. He struggles with consistent monitoring of his glucose levels, especially due to an unpredictable schedule.
  • Joe is a 17-year-old who has had type 1 diabetes for 11 years. He has been using a CGM for a long time and is working to increase his independence with his diabetes management.
  • Jill is a 10-year-old who has lived with type 1 diabetes since the age of two. She uses a CGM, and though her parents currently give her insulin injections, the family is interested in exploring insulin pumps to see how they could help her diabetes management.

Dr. Criego discusses how each individual’s care team used data from their AGP report to set attainable goals that could be achieved by making small adjustments to their diabetes management. Even though these examples focus on people with type 1 diabetes, you can definitely still learn from them if you have type 2 diabetes – and be sure to watch Dr. Anders Carlson’s video which includes examples for people with type 2 diabetes.

To learn more about the AGP, check out “Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile.

Watch our other videos in the “Shedding Light on the AGP Report” series:


Listen to this video at your leisure or fast forward to the section that most intrigues you!

  • 0:00 Introduction
  • 0:33 Analyze Your Report and Improve Your TIR
  • 0:56 The Different Parts of the AGP Report
  • 2:00 What is Going Well and Where are You Now?
  • 2:37 Learning from Lee – How seeing your glucose data can help improve issues caused by inconsistent monitoring by taking small steps towards achievable goals
  • 7:00 Learning from Joe – How understanding your TIR metrics can help teens gain confidence in independent diabetes management
  • 11:33 Learning from Jill – Looking at your AGP report to see how an insulin pump can help with hypoglycemia unawareness and TIR
  • 15:09 When Should You Call Your Care Team?
  • 16:42 Closing Remarks

This article is part of a series on Time in Range.

The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand Time in Range to maximize patients’ health. Learn more about the Time in Range Coalition here.

Source: diabetesdaily.com

Are CGM Users Aware of Time in Range?

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler and Rebecca Gowen

dQ&A surveyed 2,540 CGM users with type 1 or type 2 diabetes to find out how aware they are of their own time in range: 87% of respondents knew how much time they spend in range daily

Time in range is the percentage of time that a person spends in their target blood glucose range (70-180 mg/dl). This measurement of diabetes management along with time below range and time above range helps people assess patterns and trends throughout the day to inform daily treatment decisions in a way that A1C cannot. It is also becoming more well-known and accepted in the world of diabetes as a good indicator of diabetes management.

dQ&A, a market research company, wanted to measure people’s awareness of their own time in range. They surveyed 2,540 people with type 1 or type 2 diabetes who use continuous glucose monitors (CGM). The following question was posed to respondents: “Do you know roughly what percentage of your day (on average) you typically spend with your blood sugar between 70-180 mg/dl?” For those people who answered yes, dQ&A then asked them what percentage of time they typically spend in the target range (70-180 mg/dl) each day. It is important to note that the majority of people included in this survey were White, had type 1 diabetes, and were using an insulin pump.

Important survey results included:

  • 87% of all respondents knew roughly how much time they spent in range each day, while 13% did not. These results were generally consistent across several factors including people with type 1 and type 2 diabetes, adults and children, and people with type 2 diabetes who were or were not taking insulin.
  • 29% of respondents reported that they typically spend 71-80% of their day in range. 30% of the people surveyed reported a time in range above 80% while 41% of respondents reported a time in range lower than 71%.
  • People with type 2 diabetes who are not taking insulin are significantly more likely to report spending 91-100% of their day in range (36%), compared to adults with type 1 diabetes or people with type 2 diabetes on insulin (9% and 11%, respectively).
  • Time in range was higher in older age groups. The group with the lowest self-reported time in range was people under the age of 18: only 44% of people 18 years or younger spent more than 70% of the day in range, compared to 56% of people ages 18-44, 62% of people ages 45-65, and 68% of people over the age of 65.

Our takeaways from this data:

  • Among people who use CGM, the majority acknowledge time in range as a measurement of their glucose control. However, we believe more people can be educated on how to understand and act on their time in range data.
  • The majority of people with type 1 and type 2 diabetes report achieving the  time in range target of more than 70% and this was particularly true for those in older age groups.
  • An important focus should be placed on helping young people find strategies to improve their time in range and incorporate it into their self-management.

To learn more about time in range click here.

Source: diabetesdaily.com

Control-IQ: The Good, the Challenges, and Tips

This content originally appeared on diaTribe. Republished with permission.

After a month of her daughter using Control-IQ, Katie Bacon reviews the pros and cons of the algorithm and shares her family’s tips and takeaways

When the email came through in early April that our daughter, Bisi, could now download the software to run Control-IQ on her t:slim insulin pump, the timing seemed perfect. After all, our family was staying at home due to COVID-19, so we had plenty of time together to do the training and figure out the new system and how it worked for Bisi and her blood glucose levels. Plus, from everything I’d read about COVID, keeping blood sugars as stable as possible was more important than ever, and it seemed like Control-IQ could help us with that. (The Control-IQ algorithm uses data from Dexcom’s CGM to lower insulin delivery when a low is predicted and to increase insulin when a high is predicted – learn more about Control-IQ here.)

Bisi has now been on the new system for about a month, and while it hasn’t been a magic bullet and we’re still learning, Control-IQ has improved Bisi’s time in range by about 5% (and we’re hopeful that her time in range will continue to improve). Also, even more importantly, it’s improved her quality of life – and ours, as the parents who watch out for her. When I sat down with Bisi recently to ask her about the change, I got her perspective on the burden she feels diabetes has placed on her ­– and the power of Control-IQ to lighten that load. She told me that before using Control-IQ, at any given time 30-40% of her focus was on diabetes. I was taken aback by this percentage, since Mark (my husband) and I have always tried to take some of the weight for her. As she told me, “It feels demanding, like a lot of pressure, as if someone’s poking my head.” But with Control-IQ, she says, she doesn’t need to worry about much except bolusing insulin at mealtime. She has fewer highs, fewer lows, and she says she feels better physically than she did before. “For as long as I can remember, diabetes has been a main focus of my life, but it really shouldn’t be that way. So it’s been nice not to focus on it as much,” she said.

In terms of what Bisi has experienced over the past few weeks since switching to Control-IQ, I’ve divided my thoughts into the pros and cons of the system as we’ve experienced it; I’ve also included tips drawn from what we’ve learned from Bisi’s endocrinologist and DCES.

Pros of Control-IQ:

  • Graph

    Image source: diaTribe

    We’ve found that Control-IQ works particularly well at night, when Bisi isn’t eating anything or bolusing. While our nights had already improved with Basal-IQ (which did a good job minimizing Bisi’s lows), Control-IQ brings down any highs as well (see the graph on the right). I’d say that when Bisi’s pump only dealt with the lows, we still had to wake up maybe six to eight nights a month, on average – and sometimes multiple times in one night. But in the month since Bisi started on Control-IQ, we’ve only had to wake up three times. This is a big change in our quality of sleep (and quality of life).

  • Control-IQ helps keep blood sugars down during the day. As before, Bisi’s blood sugars are less stable during the day, when her activity is variable and when she’s eating meals and snacks. But now, Control-IQ raises her basal rate when she’s headed high and gives modified boluses (60% of what’s called for) if the highs are sustained. We’ve found that her blood sugar does not rise as steeply, according to her CGM, and also that it often tops out at a lower number than it used to.

Cons of Control-IQ:

  • There were a few instances where Bisi had sustained lows that were more difficult than usual to counteract with carbohydrates. These instances have all been when she’s started exercising with a lot of active insulin on board, due to Control-IQ turning up her basal rate in response to a high. Before using Control-IQ, if Bisi’s blood sugar was high, she (maybe with a reminder from me) would have to make a decision to either turn up her basal or give a correction. If she knew that she was going to get exercise in the near future, she wouldn’t do either of those things. But now they happen automatically, so she’s sometimes stuck with too much active insulin on board. It requires a different kind of thinking and a different kind of planning than before.
  • Both Bisi and I wish there were a little more flexibility in Control-IQ so she could set her own target. Bisi used to set her target at 100 day and night, and would often run at 80 or 90 while she was sleeping. With Control-IQ’s built in Sleep Mode target of 110, Bisi runs a little higher than she is used to, especially at night.

Thoughts and Tips for using Control-IQ:

  • We have found that being consistent about pre-meal bolusing is even more important with Control-IQ than it was before. If Bisi waits too long to bolus, her blood sugar goes too high, she gets more basal and an extra 60% bolus from Control-IQ, and then her blood sugar goes too low later on.
  • While it might seem like Control-IQ could enable people to be a little freer in what they eat, so far it has emphasized the benefits of eating low carb as the best way to avoid food-related spikes and insulin-related dips. No matter how good an algorithm is, it’s always going to be reactive rather than proactive, and we’ve found that the smaller the inputs in terms of number of carbs eaten, the more smoothly Control-IQ works. (I think this is partly why it tends to work better for Bisi at night, when she’s not eating anything, than during the day.)
  • Bisi’s endocrinologist validated our sense that exercise-related lows can be steeper with Control-IQ, since you tend to have more active insulin on board. Because you can’t do a temporary basal rate with Control-IQ, she suggested that we set up an alternate program with basal rates cut by 50%. If Bisi knows she’s going to exercise, she can turn on this alternate program 90 minutes to 2 hours before. Or, if she’s eating beforehand, she can put in fewer carbs/give less insulin. Either way, the trick is remembering.
  • During Bisi’s most recent appointment, her endocrinologist pointed us to a feature of Bisi’s Tandem reports that’s helpful to look at as a way to adjust settings. She told us to focus on the difference in the Logbook section between the Basal Total Delivered and the Basal Profile Setting, as a way to tell whether her basal rate at any given time should be raised or lowered; the closer the settings are to the amount of insulin that’s being delivered, the more smoothly the Control-IQ algorithm will work. She also suggested that we “Marie Kondo” (streamline and declutter) Bisi’s basal rates, which had proliferated over time, to help us see more easily where adjustments need to be made.
  • We realized that if Bisi has a random high blood sugar, particularly at night, we should assume that something has gone wrong with her pump site. Before Control-IQ, pump site failure was only one of several reasons – including the dawn phenomenon and the meal she’d eaten the night before – that her blood sugar might have gone high. This realization has helped us reduce that middle of the night detective work, when your brain is at its foggiest. If Bisi has a persistent high, the problem is most likely the pump site, not the algorithm.
  • One adjustment that Bisi has struggled with is remembering to turn off her insulin when she takes off her pump to shower or play sports. (The Control-IQ algorithm is thrown off when the system doesn’t have an accurate sense of how much insulin you have on board.) This is a work in progress for us.

Even though we still feel like we have more work to do in terms of getting the best out of the new algorithm, Control-IQ has improved Bisi’s life in important ways. As Bisi’s endocrinologist told us, “It’s not perfect, and you need to think more about active insulin than you did before. But the goal with this is to have diabetes interrupt your life less than it did before.” For Bisi, the important aim of staying in range now requires less mental effort. As she said recently when looking at her CGM graph after 24 hours of Control-IQ: “This is pure gold.”

This article is part of a series on time in range made possible by support from the Time in Range Coalition. The diaTribe Foundation retains strict editorial independence for all content.

About Katie

Katie Bacon is a writer and editor based in Boston. Her daughter, Bisi, was diagnosed with type 1 diabetes in August, 2012, when she was six. Katie’s writing about diabetes has appeared on TheAtlantic.com and ASweetLife. Katie has also written for The New York Times, The Boston Globe, and other publications. 

Source: diabetesdaily.com

Working with Your Healthcare Team to Achieve Your Time in Range Goals: An Interview with Cleveland Clinic’s Dr. Diana Isaacs

This content originally appeared on diaTribe. Republished with permission.

By Frida Velcani

Dr. Diana Isaacs on improving time in range, making the most of your data, and the barriers facing people with diabetes and their healthcare teams

Dr. Diana Isaacs is a Clinical Pharmacist and Diabetes Care and Education Specialist at the Cleveland Clinic. She works with people with diabetes on a range of issues, including medications, technology, and lifestyle changes. She also educates people every day about the benefits of time in range.

In addition, Dr. Isaacs is the coordinator for the Cleveland Clinic’s continuous glucose monitor (CGM) program. You can find more information on how to choose a CGM here. We continue to think that CGM is of the utmost importance for helping people keep their blood glucose levels in-range, assuming they have access. Dr. Isaacs meets with 200 people every month, through individual appointments, classes, phone follow-ups, and virtual visits. She also works with other healthcare providers, including nurses, nurse practitioners, dietitians, and physicians.

For this article, we spoke with her to better understand her views on the importance of time in range for people with diabetes. Here are her insights on how we can shift away from using A1C and move everyone toward better health.

Dr. Isaacs on Ways to Improve Time in Range, Setting Target Goals, and Celebrating the “Wins” 

We asked Dr. Isaacs to pinpoint the most important things that people can do to improve their time in range. “Work with your diabetes care and education specialist and healthcare team to interpret CGM data, understand patterns, and optimize medication doses,” she said. When reviewing data, it’s important to keep a positive attitude and focus on the successes. Repeat what worked well on the days when your time in range was the highest. Figure out what is causing the lows (which often lead to rebound highs) and work to prevent them.

Dr. Isaacs wants people to know that having high glucose variability is completely normal. Many people have the misconception that they should be spending 100% time in range. In reality, time-in-range goals are different for each individual depending on factors such as medication, age, and type of diabetes. Experts recommend that people with type 1 and type 2 diabetes aim to spend at least 70% of the day within 70 to 180 mg/dl, less than 4% of the day below 70 mg/dl, and less than 25% above 180 mg/dl. However, experts emphasize that even a 5% change in time in range – for example, going from 60% to 65% – is meaningful, as that translates to one more hour per day spent in-range.

“I’ve seen everything from 0% to 100% time in range,” she said. “There are differences when comparing someone who is new to our clinic compared to someone working with us for a year. It’s so individualized, and people have different challenges. The goal is to improve your personal time in range, and any increase in time in range is a win.”

Measuring Time in Range using Blood Glucose Meters, CGM, and Professional CGM

If you are using a blood glucose meter (BGM) or CGM, talk with your healthcare team about your glucose targets. The data will be more meaningful if you are working toward a specific goal.

For BGM users, paired testing can help you see the direct impact of food on your blood glucose – all you have to do is check your glucose before a meal and again two hours after the meal. To check that your basal insulin is working well, check your glucose levels before bed and first thing in the morning.

At the Cleveland Clinic, people are required to attend a two-part shared appointment to get access to professional CGM. The classes are usually two diabetes care and education specialists (pharmacist and dietitian or nurse) and 4-6 people with diabetes.

In part one, you go over glucose targets, time in range, and how to treat high and low blood sugars. In part two, you download the data and review it with your diabetes care and education specialists. You discuss what it means, find patterns, and make medication adjustments as needed. This class is offered five times per month. Dr. Isaacs says that this program has helped many people improve their A1C (an average 0.8% reduction) and diabetes self-management.

How can we make time in range accessible to people with diabetes and their healthcare teams?

Dr. Isaacs believes that everyone should have access to affordable medications, affordable technology, and a great support system. She says, “I’ve seen so much rationing of insulin and medications, especially in the Medicare and uninsured populations.” There are many people that have diabetes and haven’t connected with their healthcare team in years. We need to do a better job to help these people.

According to Dr. Isaacs, the average healthcare professional is not prepared to talk about time in range. A1C has been and continues to be widely used by most healthcare teams. While she is excited about the growing use of CGM, there are “still some hurdles to get all practices up to speed with how to download the devices and interpret the data.”

Her advice is to tackle these barriers from multiple angles:

  • In research, we need to make sure that time in range is an outcome in all clinical trials that measure glycemic management, so that we can directly measure the effect of time in range on clinical outcomes.
  • We need targeted education for busy healthcare professionals, including podcasts, webinars, and continuing education.
  • We need targeted education for people with diabetes who are often the ones bringing information to their healthcare team.
  • In practice, healthcare professionals should discuss time in range with every person with diabetes that is using CGM.
  • People with diabetes using CGM should be encouraged to bring their reports to their healthcare provider and discuss time in range.
  • Instead of only marketing CGM as a convenient way to reduce finger sticks (which is true), the real benefit is that it lets the person with diabetes be the driver, and time in range is their roadmap.

Dr. Isaacs recently spoke on a panel at the ADA post-graduate sessions about the power of time in range and CGM for all people with diabetes. She was joined by diaTribe’s medical advisory board member, Dr. Irl Hirsch, our editor-in-chief, Kelly Close, and Jane Kadohiro as the moderator, who herself has had diabetes for over 50 years. If you or your healthcare provider are interested in learning more about time in range and downloading CGM data, you can make an account and watch the session here!

Source: diabetesdaily.com

Benefits of Time in Range: New Study Shows Cost Savings

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler and Albert Cai

A new paper suggests that as people with diabetes increase their time in range, healthcare costs decrease

IQVIA, a healthcare consulting firm, published a 22-page paper describing the limitations of A1C and the potential financial benefits of improving time in range, the time a person spends with blood glucose levels between 70-180 mg/dl. The paper was sponsored by Lilly Diabetes.

The paper predicts that if the average time in range for people with diabetes in the US increases to 70% or 80%, healthcare costs will be reduced. The savings could be up to $9.7 billion for the US healthcare system over ten years if the average time in range for people with diabetes is increased to 80%.

The graphic below shows how much money is saved over ten years just by reducing hypoglycemic (low blood sugar) events in people with type 1 diabetes. Other costs saving would likely come from a reduction in diabetes-related complications. Studies (Diabetes Care 2019, Diabetes Care 2018) have suggested that greater time in range is associated with a lower risk of health complications.

Stat

Image source: diaTribe

Unsurprisingly, the biggest reductions in healthcare costs were seen in people with high baseline A1C. While a 5% increase in time in range for a person with an A1C under 7% would save only $20 over ten years, the same 5% increase in time in range for a person with an A1C over 8% would lead to $1,470 in savings over ten years – mostly due to a greater reduction in the risk of diabetes-related complications. This means that to get the greatest health and cost benefits, it is essential to bring time in range practices to people who are most struggling to manage their blood glucose.

To calculate the effects of improving time in range, the study assumed an average time in range for people in the US of 58% (type 1 and type 2 diabetes). This 58% came from a 2019 review of four major CGM studies. However, these four studies were done at top diabetes centers and the participants had relatively low A1Cs (~7.5%). Additionally, the majority of people with type 1 diabetes and almost everyone with type 2 diabetes still don’t have access to CGMs. In other words, the actual population average is likely much lower than 58% time in range and the $9.7 billion calculated in cost savings would actually be much higher if the population’s time in range reached 80%.

IQVIA provides several reasons why CGM should be used to support blood glucose management in people with diabetes:

  • A person with diabetes can understand how variables like food, exercise, and sleep habits affect blood glucose and can use that information to improve decisions and outcomes.
  • Healthcare professionals can provide more individualized care to support people with diabetes.
  • The healthcare system will save money on diabetes care.

The illustration below outlines how CGM can be used to monitor blood glucose and guide shared decision making for a healthcare professional (HCP) and person with diabetes (PwD).

Stat

Image source: diaTribe

The last eight pages of the paper discuss how time in range can become more commonly used, asking policymakers, healthcare professionals, and people with diabetes to drive the time in range movement forward. IQVIA’s ideas include:

  • promoting CGM to help people measure and understand time in range;
  • educating healthcare professionals and people with diabetes about the health benefits of time in range; and,
  • tackling affordability and access issues to make sure all people with diabetes (or even prediabetes) can use CGM.

This paper not only emphasizes the importance of time in range for well-being but also highlights time in range as a public policy matter. While there is clearly much work to be done, this study is an important step in underscoring the need to bring CGM and time in range to more people.

Source: diabetesdaily.com

Search

+