Diabetes

This week, the top managed care news included courts rejecting multiple health initiatives from the Trump administration; Congress heard more about rising insulin prices; a new agreement seeks standards for reporting social determinants of health.

Based on recently published results of the REDUCE-IT study, pharmacuetical company Amarin has submitted a supplemental new drug application (sNDA) to the FDA for an expanded label for its leading drug Vascepa. Also, the American Diabetes Association has included the drug in a mid-year update to its 2019 Standards of Medical Care in Diabetes.

The authors determined whether Minnesota health systems responded to competitors’ publicly reported performance. Low performers fell further behind high performers, suggesting that reporting was not associated with quality competition.

A House of Representatives subcommittee heard from stakeholders about the impact of the rising cost of insulin.

The potential value of continuous monitoring of blood glucose and the enzyme-based electrode that underlies continuous glucose monitoring (CGM) in the subcutaneous tissue were described in the 1960s. In 1999, the FDA approved the first “professional” CGM system, which stored data over 3 days for later retrieval and analysis. However, many patients (even volunteers in CGM-based clinical trials) found early-generation systems uncomfortable and difficult to wear. By contrast, current systems are more accurate, provide customizable alerts and alarms, are easier to use and less likely to cause skin irritation, resist interference from acetaminophen, allow for real-time data to be shared and remotely monitored, and are stable enough so as not to require periodic calibrations with SMBG values.

Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.

When the FDA approved Abbott’s FreeStyle Libre Flash continuous glucose monitoring (CGM) system in September 2017, diabetes advocates hailed the move as long overdue and one that might lead to greater penetration of glucose monitoring technology for those with type 2 diabetes.

In 2017, as advocates and researchers discussed the potential for continuous glucose monitoring (CGM) to become a tool in clinical trials, most of the discussion involved testing in new therapies. The discussion culminated in an international consensus on CGM, published in December 2017, that included standards for assessing hypoglycemia in clinical trials.

Nearly 3 years after UnitedHealthcare set off a firestorm among the type 1 diabetes (T1D) community by naming Medtronic its preferred supplier of insulin pumps for adults, a fresh wave of protest has erupted after the payer extended the pact to youth, starting at age 7. The change was announced in a UnitedHealthcare bulletin February 1, 2019.

Even when things go well, managing diabetes is not easy. Keeping tabs on this disease 24/7 takes planning, commitment, support, and the right tools. For years, a chief complaint among those living with diabetes has been that managed care nickel-and-dimes people over basic supplies, which are comparatively cheap—things like test strips and sensors for a continuous glucose monitor—but will shell out thousands for dialysis and amputations. In the years ahead, if Congress wants to understand rising costs for end-stage renal disease or an increase in emergency department visits for hypoglycemia, it should look directly to CMS’ foray into competitive bidding for blood glucose test strips.

Three years after results from a study in Diabetes Care revealed how flaws in CMS’ Competitive Bidding Program endangered Medicare patients who rely on supplies to test their blood glucose, the federal government has allowed contracts to expire for the dwindling number of suppliers, raising fears that the program for seniors with diabetes has reached the point of collapse.

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Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Researchers found that a prescription for healthy food can improve health outcomes for beneficiaries in Medicare and Medicaid.

This week, the top managed care news included new primary prevention guidelines that could increase the use of some diabetes drugs; the FDA expanded criteria for which patients can take part in clinical trials; a summit on value-based insurance design showed the need for tough conversations with stakeholders.

For SGLT2 inhibitors and a fish oil capsule, there was plenty of good news; for aspirin, not so much. A recap of the American College of Cardiology's 68th Annual Scientific Session, held March 16-18, 2019, in New Orleans, Louisiana.

If approved the oral form of semaglutide would be the first pill in the GLP-1 receptor agonist class.

New findings show reduced hospitalizations for a wide group of patients with heart failure. For high-risk patients with reduced ejection fraction, the drug appears to cut deaths, but more studies will answer these questions.

The joint guidelines from the American College of Cardiology and the American Heart Association call on clinicians to pay more attention to social determinants of health. They were announced Sunday at the 68th Scientific Session of the American College of Cardiology in New Orleans, Louisiana.

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care news included the 2020 budget plan proposing a mix of healthcare spending cuts and increases; the FDA approving the first immunotherapy regimen for breast cancer; and researchers uncovering how sodium glucose co-transporter-2 inhibitors work.

The results come after the American Diabetes Association and the American College of Cardiology have recently issued guidelines calling for the use of GLP-1 receptor agonists for patients with type 2 diabetes and cardiovascular risk.

The change comes on the heels of hearings in Congress where insulin costs were held up for scrutiny.