Diabetes

Some large employers and policy makers advocate for retail competition that relies on providers competing on healthcare performance. Using diabetes care in Minnesota as an example, researchers examined whether the public reporting of care measures encouraged health systems to improve their clinics’ diabetes care performance in the latest issue of The American Journal of Managed Care®.

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 CDC clarifying its opioid guidelines for chronic pain; pharmacy benefit managers testifying before a Senate committee; Sanofi expanding its insulin savings program starting in June.

The findings represent the first in a new wave of renal outcomes trials in the sodium glucose co-transporter 2 (SGLT2) inhibitor class, a game-changing group of type 2 diabetes drugs with many benefits beyond lowering blood glucose.

The program comes as Congress has singled out the cost of insulin in its scrutiny of drug prices. Patients with type 1 diabetes cannot survive without the hormone, and press reports have highlighted the plight of young adults who ration insulin after they reach age 26 and cannot stay on family insurance plans.

Today we’re speaking with Tom Milam, founder and president of TrueLifeCare. As a former chief operating officer for a national diabetes supply, education, and support company, Milam created programs for people with diabetes that served more than 100,000 members nationwide. His experience also includes a federal appointment providing advisory service to Medicare. His extensive experience and knowledge within the diabetes space allows Tom to offer us an expert view of CMS’ Competitive Bidding Program.

Previous research overstated the generalizability of the Exenatide Study of Cardiovascular Event Lowering trial results by omitting the restriction on the percentage of patients without a prior cardiovascular event.

The authors of the manuscript “Generalizability of Glucagon-Like Peptide-1 Receptor Agonist Cardiovascular Outcome Trials Enrollment Criteria to the US Type 2 Diabetes Population” respond to a letter to the editor.

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 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.

Coverage of our peer-reviewed research and news reporting in the healthcare and mainstream press.

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.