September 17, 2013

Group Meeting on Internist Statement

Four diabetes support groups got together Saturday evening to discuss the latest “Choosing Wisely,” not, statement by the Society of General Internal Medicine (SGIM). "Don't recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin,” tops the list and became our topic for discussion. Even the doctor with the group we have been working with about testing was unhappy with this being the top choice for his own profession. With what his patients are doing to manage their diabetes, he sees the value of testing and was apologetic to those of us that had worked so diligently since our meeting together early this summer.

Tim welcomed everyone and passed out a printout of the Medscape article for everyone to read. Then he went to his projector and used the presentation slides he had taken time to pull together to help everyone see what we were talking about. Tim thanked Allen, Ben, and Barry for their help in developing a list of the possible problems this choice will create.  He thanked me for being watchful and having found this so quickly and posting it immediately. 

The first slide was the item for discussion and Max said now he understood my blog about the big guns fighting for Big Pharma. Even our local doctor commented that this is possibly the reason for this point being on the list. When Dr. Robert Ratner, chief scientific and medical officer for the ADA says, “Many people with type 2 diabetes who are on medications don't need to do home glucose monitoring at all," this may cause more fallout. Tim agreed and said I had a copy of the other Medscape article that may be cause for concern as well because of possible FDA and CMS inactions.

Tim then said this may require two meetings to cover all the discussion and make everything clear. The second slide laid out the fact that this applied to only those with prediabetes and type 2 diabetes for those on oral medications. Sue's husband, Bob, let out a low whistle and said they are kicking us in the teeth while we are down. Allen said wait until you see what else this will do to you. Even Jessie was saying what do they want us to do.

Tim moved to the next slide and we heard several more comments. The points included:
#1. No more test strips
#2. No education by doctors
#3. Only the A1c test, maybe quarterly, if that often
#4. Unknown if doctors will diagnose prediabetes
#5. Diabetes will be managed completely in the dark with possibly only the A1c's for little guidance, quarterly, or twice a year
#6. Probably an end of education by CDEs for people with prediabetes or type 2 diabetes, very little of that now as it is

Tim moved to the next slide. It included the following questions:
#1. Can we find doctors that will give those able to afford test strips a prescription?
#2. Will we be able to have the SGIM reverse their position before it becomes too late?
#3. Will you write your congress people to have them apply pressure to the Centers for Medicare and Medicaid Services to reimburse for test strips?
#4. How can we help those on oral medications to continue their education?

There were a lot of questions after this slide and both doctors stepped up to say they would do everything possible to help those that could afford test strips and write letters to insurance companies to get test strips reimbursed if they will allow this. Until Medicare and insurance companies close the door, they will do everything possible to encourage testing and maybe holding test strips until they get near expiration.

Tim said the next slide may shock a few people, but should be carefully considered if the worst does happen.
#1. Investigate the cost of insulin and what insurance will cover. Those using the VA need to know what their copay is. If they are eligible and have not applied, get it done.
Testing supplies through the VA cost nothing and the copay will only apply to medications.
#2. Consider moving to insulin
#3. Forget the insulin myths

Both doctors were somewhat surprised by this, but both agreed this was one possible solution if it became necessary. One of the group from our local doctor said he would find out what his copay would be and turn this over to the doctor since he had the name of his insurance. This caused several others to volunteer for two of the groups with the doctors present. A couple from both groups asked about applying to the VA and Ben, Allen, and Barry talked with them and then asked if there was anyone else needing the information; there was no one else.

This became a very good discussion and we spent quite a bit of time talking about this with the doctors answering most of the questions. Then Tim said that we needed to conclude for this meeting. He thanked both doctors for attending and this drew a round of applause. Our local doctor asked if we could have one more meeting in two weeks and the other doctor said that would be good and wanted a show of hands from his group to determine about how many would attend. All said they would and thanked Tim for putting together the slides.

With this, Tim asked everyone to write down questions for discussion and have someone in their group email them to him. He continued that we would continue to see if anything else developed in the next two weeks to add to the discussion. Since we had not gotten to the test strip discussion of the Diabetes Technology Society's discussion with the FDA, this would also be on the agenda. We concluded the meeting and said the next meeting would be here at the same time in two weeks.

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