March 9, 2016
AACE Consensus Statement on Glucose Monitoring
This is one consensus statement I don't expect to go far. The insurance companies don't listen to the American Association of Clinical Endocrinologists (AACE) and the Centers for Medicare and Medicaid Services (CMS) certainly does not pay attention to the AACE.
In addition, the AACE statement is not sincere. Why else would they ignore some of the prime issues and not direct their statement to Congress and others that could possibly address some of the problems. The American Diabetes Association stands in their way and the leaders of the ADA do not want to be outdone on testing supplies, CGMs, and other programs.
The AACE consensus statement does not address the need for testing supplies and CGMs for people over the age of 65 and this means that people that need CGMs will continued to be denied them as Medicare does not authorize or pay for them. With the numbers of the “baby boom” generation growing, it would have seemed that these issues should have been addressed.
As a result, I say that the consensus statement on glucose monitoring by the AACE is all but laughable. There is not hope of the ADA approving anything like this and with the current chief scientific and medical officer for the ADA, don't expect any improvements. If it even looks like the AACE is gaining any traction, you can bet that the ADA will find a way to bring insurance companies back in line and negate every advance by the AACE.
The statement, according to an AACE press release, incorporates new information that reflects evolving technology and provides clinicians with “detailed analyses to support precise recommendations for the type of system and frequency of use for either self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM) to reduce short- and long-term complications of diabetes.”2.
Yes, the statement is there, but it is just a statement with no enforcement and opposition by the ADA, CMS, and even the AMA. “In the past, glucose monitoring, which we now refer to as GM, was synonymous with fingerstick capillary glucose testing (SMBG or self-monitoring of blood glucose), which we now call BGM.” Why they found the need to rename some terms is also a puzzle and only serves to confuse people that are newly diagnosed.
While technology has already had a significant effect on GM, more changes are coming down the pike. For instance, data sharing via the Internet, which has already been started by Nightscout, Dexcom Share, and Medtronic, will alter management, the authors note. The use of smart watches and new mobile phones may enable patients to monitor and adjust their lifestyle and therapy on a continuing real-time basis. Also, CGM devices are now available with a longer duration of use (2 weeks) and some devices are factory calibrated, eliminating additional calibrations by the end user.
All this is great, but what percentage of patients are actually using the technology. I have met several people recently that have refused to use the new technology and have disabled what they have as they do not want the information available to their insurance companies or even their employers. Some are even willing to see their doctors on a weekly basis rather than use the new technology.