February 18, 2013

AADE Blog on BG Monitoring

If only this could be true! This blog by Carla Cox on the American Association of Diabetes Educators (AADE) website is the most positive blog about the supposed changes made by the American Diabetes Association (ADA) 2013 Guidelines. As research has shown by my blog here, 2013 may not be the year for much change, but maybe some of the results will be heard by the people at ADA and maybe for 2014, we will see some real change in the language and action by the insurance companies.

This quote from her blog is somewhat gratifying, “Benefits of monitoring have not been consistently demonstrated when patients with type 2 diabetes are on lifestyle-controlled regimens or oral medications (The Diabetes Educator, 2007; Health Technology Assess, 2009). Data aside, I believe all of us have seen how much patients learn about their BG response to meals, exercise and environmental pressure when checking BG values throughout the day, regardless of whether it’s controlled via lifestyle or medication. This is with the caveat, of course, that they understand how to interpret the results.”

It seems that the author is calling for more testing by type 2 people and education is what is needed. I could almost believe the good intentions, if certified diabetes educators (CDEs) were working heavily with type 2 patients. We know this isn't happening because there are not enough CDEs for this to become a reality. CDEs currently have no incentive to work with type 2 patients, as being reimbursed is a problem.

Even their own practice advisories from 2010 found at this link under 2010 says the following - “Shared medical appointments (SMA) are a healthcare practice approach that provides more access to patients while using existing resources. SMA are a recognized approach that have been shown to provide high quality care at reduce costs. While insurers may recognize these as separately reimbursable appointments, Medicare has yet to provide guidance on the topic.”  You will need to download the "Shared medical appointment" advisory with Adobe Reader (or another PDF viewer) to view it.

With many type 2 patients being under Medicare, I can understand that they do not wish to take on groups of people with type 2 diabetes as part of SMAs. Not all insurance companies are on board with reimbursing for patients not yet on Medicare. Therefore, in the meantime they will need to contact providers to see if they cover this. Most CDEs are not interested in contacting a variety of providers, as they would prefer a one on one situation. Yet, with the current shortage of CDEs, something needs to change. This says nothing about the needs of people in the “at risk” category (prediabetes) that receive no help.

Another factor that makes me question the sincerity of statements made by CDEs if the fact that Medicare is moving to more preventive medicine and this would seem to be the time for AADE to lobby the Centers for Medicare and Medicaid Services (CMS) to reimburse for SMAs as this could be a giant step forward to educating groups of people with type 2 diabetes and even many in the “at risk” group. Then for the enterprising CDEs, telemedicine may open up doors for education as well. Unless AADE attempts to open these avenues and pressure CMS to reimburse for these avenues, all I can say is the “feel good” hype is worse than BS, and I'm not talking blood sugar.

I sincerely wish this statement could be relied on and trusted - “Blood glucose monitoring is a cornerstone of diabetes education. Blood sugars shift throughout the day and often get progressively higher over time even in the “best” patient with type 2 diabetes.” The bold is my emphasis. I know from experience that this statement sounds good, but when mandates take place instead of education, it ruins the experience for most patients with type 2 diabetes.

This statement in the last paragraph of her blog gets my hackles up, “As diabetes educators, we are the “go to” persons to help guide patients to understand their BG results and to learn to act on the results to help normalize blood sugars and reduce risks associated with frequent BG values that are out of range.” But, how can we “go to” CDEs when they are not available and most don’t deal with type 2 diabetes people. I have to question where the CDEs are and why I should not consider statements like this, “feel good” hype?

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