Improved Hba1c, Total Daily Insulin Dose, and Treatment Satisfaction With Insulin Pump Therapy Compared to Multiple Daily Insulin Injections in Patients With Type 2 Diabetes Irrespective of Baseline C-Peptide Levels

Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

“…Well-designed studies that have shown no correlation between success of insulin pump use and C-peptide/beta cell autoantibody levels further support this position. 35,56,72,73 Second, although frequent glucose testing (BGM or CGM) is necessary for initiating and continuing use of insulin pump therapy, an individual's history of testing frequency before insulin pump initiation should not be a requirement for coverage eligibility. Allowing beneficiaries to choose their insulin-delivery method, in collaboration with their health care provider, is critical to supporting treatment satisfaction, a major driver of treatment adherence and subsequent outcomes.…”

“…However, because the determination was made in 2004, the most recent and relevant studies were, by default, excluded from their assessment. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][56][57][58] As a result, the clinical efficacy of today's advanced insulin-delivery technologies integrated with continuous glucose sensor technology were not considered. Moreover, these outdated criteria do not reflect important current evidence that is unsupportive or clearly refutes many of the original criteria, such as documentation of insulinopenia, frequent blood glucose monitoring (BGM), and quarterly inperson health care provider evaluation.…”

“…As demonstrated in numerous studies, the glycemic benefits of insulin pump therapy are not dependent on detection of C-peptide concentrations or detection of autoantibodies. [34][35][36]56,[72][73][74] In a retrospective study that assessed a propensity scorematched cohort of insulin pump and MDI users, Gill et al investigated the differences in health care resource utilization and costs between individuals with T1D and T2D treated with insulin pump or MDI therapy who met or did not meet the Medicare C-peptide/beta cell antibody eligibility criteria. 56 For these comparisons, investigators structured the study as three analyses.…”

“…Vigersky et al showed similar improvements in HbA1c, total daily insulin dose, and treatment satisfaction among T2D patients ‡65 years using insulin pump therapy compared with MDI irrespective of baseline C-peptide level. 73 In a study of 331 T2D adults who were randomized to insulin pump or MDI therapy, participants were categorized into two groups according to baseline C-peptide level: Group A (£183 pmol/L) and Group B (>183 pmol/L). At 6 months, the MDI group crossed over to insulin pump therapy.…”

Wünsche, Sorgen und Bedürfnisse bezüglich der Insulinpumpentherapie im Alter: Ergebnisse einer Befragung bei Menschen mit Typ-1-Diabetes mellitus im höheren Lebensalter und von Diabetesfachkräften

“…B. neuen Insulinpumpen werden Menschen mit Diabetes mit einem Alter über 65 Jahre systematisch von einer Studienteilnahme ausgeschlossen. Die wenigen vorhandenen Daten deuten darauf hin, dass die Nutzung von CSII auch bei älteren Patientinnen und Patienten zu einer Verbesserung in der Glukosekontrolle führt: Es wird eine signifikante Absenkung des HbA 1c -Werts erreicht bei einer gleichzeitigen Absenkung der Zahl an Hypoglykämien und einem niedrigen basalen Insulinbedarf [20]. Ältere Menschen mit Diabetes scheinen also in einem vergleichbaren Ausmaß von einer CSII profitieren zu können wie jüngere Nutzer/-innen.…”