type 1 diabetes<\/a> management and has made recent efforts to optimize workflow, he said.<\/p>\n\u201cIt\u2019s our area of passion. But imagine a general endocrinologist helping people with thyroid and pituitary conditions or a primary care provider managing every condition in the book. It makes perfect sense that prior authorizations are going to be a huge bottleneck for getting these supplies authorized,\u201d he said.<\/p>\n
Physicians should be able to individualize diabetes device prescribing, Welch said. \u201cInsurance companies should cover the quantities of diabetes supplies based on published failure rate data, and\/or based on physician-prescribed quantities, without hassle, prior authorization, or extra cost,\u201d he said during his ADA presentation.<\/p>\n
Access Gaps, Device Failures Common<\/p>\n
The online 64-question anonymous survey was distributed in December 2023. Access gaps were defined as the inability to obtain prescribed supplies for diabetes technology for any reason, leading to the individual going without that supply for any duration of time. The survey was sent to about 46,000 email addresses of people in the T1D Exchange, of whom 2475 responded and 506 were excluded.<\/p>\n
The respondents had a mean age of 48.8 years, diabetes duration 27.9 years, and mean A1c of 6.6%. Three quarters were female, 78% were college graduates, and only one quarter had annual incomes below $50,000. Two thirds (64%) had private insurance. Nearly all (96%) used CGMs and 80% used insulin pumps.<\/p>\n
\u201cThis is a very motivated group of people who are engaged with their diabetes,\u201d Welch noted.<\/p>\n
While 57% of CGM users reported having no CGM supply access gaps in the past year, 18% reported one gap, 12% two, and 7% three. Of those reporting gaps, the average CGM user reported 2.6 access gaps per year.<\/p>\n
Access gaps for CGM were significantly more common among those with lower incomes; those of a minority race\/ethnicity; and people on Medicaid or with no insurance vs those with private insurance, Medicare, or Department of Veterans Affairs (VA) benefits, and for females vs males.<\/p>\n
Gaps were less common with insulin pump supplies, with 72.7% reporting no gaps in the past year. However, 12.8% reported one gap, 7.2% two, and 2.5% three. Those with gaps reported an average of 2.4 gaps per year. Socioeconomic differences were similar to those seen with CGM access.<\/p>\n
While 87.3% of insulin users reported no gaps, 6.2% reported one gap, 3.3% two, and 3.3% three in the past year. The average was 2.2 gaps per year.<\/p>\n
\u201cFortunately, this was a smaller number and frequency, but it\u2019s still somewhat discouraging to consider,\u201d Welch said.\u00a0<\/p>\n
The differences in gaps in all supply types were significant for all socioeconomic groups (P < .05). For example, those on Medicaid had 2.1 annual CGM gaps per year, compared with 0.5 for those receiving VA health benefits.<\/p>\n
Asked what they did to avoid access gaps, patients reported calling the company to request replacements if a device fails early, extending use of the supply longer than recommended, and having their health care provider prescribe extra supplies. Some reported obtaining supplies from other people with diabetes who have extras.<\/p>\n
Access gaps were related to worse glycemic control. Individuals with A1c levels of 7.0% or less had approximately half as many gaps in access to all diabetes technology supplies and insulin compared to those with an A1c level > 7.0%. For CGM supplies specifically, the difference was 0.8 vs 1.5 gaps per year.<\/p>\n
Patients who receive 90-day supplies reported half as many gaps as those who reported receiving 30-day supplies. With CGM, the difference was 0.8 vs 1.6 annual gaps.<\/p>\n
The survey found that CGM sensor failure is very common, Welch said. Over half of respondents (50.8%) reported that their devices failed early or fell off 1%-10% of the time, another 21% reported early failures 11%-20% of the time, and only 7.3% reported zero failures.<\/p>\n
Failure rates of more than 10% of the time were seen among all CGM brands, ranging from 39% with the Dexcom G6 to 53% for Abbott\u2019s FreeStyle Libre 3. For insulin pump failures, those proportions ranged from 34% with Medtronic\u2019s MiniMed 780G to 53% for Insulet\u2019s Omnipod 5.<\/p>\n
The length of access gaps wasn\u2019t included in the T1D Exchange survey, but researchers gave patients at the University of Cincinnati Endocrinology Clinic pre-visit questionnaires that included the question. Here, 51% of 207 CGM users who responded reported at least one gap in the past 3 months, with an average duration of 16.5 days. The top reason reported was early CGM failure.<\/p>\n
For insulin pumps, 16.5% of 109 respondents reported at least one gap in the past month, with an average duration of 19.2 days.<\/p>\n
To inform his call for insurers to cover extra diabetes supplies, Welch presented published study data from the manufacturers of marketed CGMs. Reported early failure rates ranged from 13% to 23%. Using this data, he estimated the number of sensors that fail early per year ranges from 3.2 to 7.6, depending on the manufacturer.<\/p>\n
\u201cIf we know that this is happening, and even the studies that led to the approval show this, why is it so hard to get extras, and why are we always on the edge of running out, and why can\u2019t we make this better? That\u2019s my call to action,\u201d he concluded.<\/p>\n
Welch reported no relevant financial relationships. Ahn is a speaker for, advisor for, and\/or recipient of research grants from Abbott, Ascensia, Insulet, Lilly, MannKind, Novo Nordisk, Xeris, Sequel, Lilly, Honey Health, Medtronic, and Tandem.\u00a0<\/p>\n
Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR\u2019s Shots blog, and Diatribe. She is on X (formerly Twitter) @MiriamETucker and BlueSky @miriametucker.bsky.social<\/p>\n","protected":false},"excerpt":{"rendered":"Gaps in access to prescribed diabetes technology are common, often arise from early device failure, and lead to…\n","protected":false},"author":2,"featured_media":70803,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[64,63,55678,28754,55677,55681,55682,4384,137,44814,55680,55679],"class_list":["post-70802","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-au","tag-australia","tag-continuous-glucose-monitoring-continuous-glucose-monitoring-cgm-cgm-continuous-glucose-monitor","tag-diabetes-mellitus","tag-diabetes-mellitus-type-1-diabetes-mellitus-type-i-type-1-diabetes-type-1-dm-t1dm-t1d-type-1-diabetes-mellitus-type-1-diabetes-mellitus-t1dm-type-1-diabetes-t1d","tag-glycated-hemoglobin","tag-glycosylated-hemoglobin","tag-hba1c","tag-health","tag-hemoglobin-a1c","tag-hemoglobin-a1c-test","tag-insulin-therapy"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/70802","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=70802"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/70802\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/70803"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=70802"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=70802"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=70802"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}