Inequity in Adoption of Advanced Diabetes Technologies Among Medicare Fee-for-Service Beneficiaries

2021 ◽  
Author(s):  
Kael Wherry ◽  
Cyrus Zhu ◽  
Robert A Vigersky
Keyword(s):  
Technology Use ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Fee For Service ◽  
Eligibility Criteria ◽  
Pump Therapy ◽  
Race Ethnicity ◽  
Technology Users ◽  
White Patients

Abstract Context Health inequity is often associated with race-ethnicity. Objective To determine the prevalence of insulin pump therapy and continuous glucose monitoring (CGM) among Medicare beneficiaries with Type 1 diabetes (T1D) by race-ethnicity, and to compare diabetes-related technology users to non-users. Design The prevalence of technology use (pump, CGM) was determined by race-ethnicity for enrollees in coverage years (CY) 2017-2019 in the Medicare fee-for-service database. Using CY2019 data, technology users were compared to non-users by race-ethnicity, sex, average age, Medicare eligibility criteria, and visit to an endocrinologist. Setting Community Patients or Other Participants Beneficiaries with T1D and at least one inpatient or two outpatient claims in a CY Intervention(s) Pump or CGM therapy, visit to an endocrinologist Main Outcome Measure(s) Diabetes-related technology use by race-ethnicity groups Results Between 2017 and 2019 CGM and insulin pump use increased among all groups. Prevalence of insulin pump use was <5% for Black and Other beneficiaries yet increased from 14% to 18% among White beneficiaries. In CY2019 57% of White patients used a pump compared to 33.1% of Black and 30.3% of Other patients (P<0.001). Black patients were more likely than White patients to be eligible due to disability/end-stage renal disease or to be Medicare/Medicaid eligible (both P<0.001), whether using technology or not. Significant race-ethnicity differences (P<0.001) existed between technology users and non-users for all evaluated factors except visiting an endocrinologist. Conclusions Significant race-ethnicity associated differences existed in T1D management. The gap in diabetic technology adoption between Black and White beneficiaries grew between 2017 and 2019.

The Use of Technology in Managing Diabetes in Youth Part 2—Insulin Pump Technologies: Information and Tips for the School Nurse

2020 ◽  
Vol 35 (4) ◽  
pp. 188-195
Author(s):  
Cari Berget ◽  
Leah Wyckoff
Keyword(s):  
Technology Use ◽  
Insulin Pump ◽  
School Setting ◽  
Glucose Monitoring ◽  
School Nurses ◽  
Insulin Pump Therapy ◽  
Control School ◽  
Pump Therapy ◽  
Use Of Technology ◽  
Diabetes In Youth

Insulin pump technologies are commonly used by youth with type 1 diabetes (T1D) for intensive insulin therapy, the gold standard for T1D care. Insulin pump technologies are advancing rapidly, with new insulin pumps becoming available every year offering improvements in glycemic control. School nurses must understand the basics of insulin pump therapy and distinguish between advanced pump technologies to best support their students with T1D. This is the second article in a three-part series on the use of technology in managing diabetes in youth. The first article described continuous glucose monitoring (CGM) devices and provided tips for the school nurses in incorporating CGM into the student’s individualized healthcare plan. The purpose of this article is to summarize insulin pump technologies, from conventional insulin pump therapy to advanced automated insulin delivery systems and to describe keys to success with insulin pump technologies. Part 3 will focus on special considerations and problem solving related to technology use in the school setting.

Modern technologies in diabetes management - continuous glucose monitoring and insulin pump therapy

2021 ◽  
Vol 87 (1) ◽  
pp. 50-55
Author(s):  
E.Yu. Pyankova ◽  
◽  
L.A. Anshakova ◽  
I.A. Pyankov ◽  
S.V. Yegorova ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Individual ◽  
Glucose Lowering Therapy

The problems of complications of diabetes mellitus cannot be solved without constant monitoring of blood glucose levels. The evolution of additional technologies for the determination of glucose in the blood of the last decades makes it possible to more accurately predict the risks of complications, both in the individual and in the patient population as a whole. The article provides an overview of the methods used in modern diabetology, facilitating control over the variability of blood glucose levels and helping in a more accurate selection of glucose-lowering therapy. All presented methods are currently working in real clinical practice in the Khabarovsk Krai

scholarly journals Glycemic Control and Hypoglycemia in Patients Treated with Insulin Pump Therapy: An Observational Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Guillermo Guzmán ◽  
Veline Martínez ◽  
Julián David Yara ◽  
Miguel Angel Mina ◽  
Juan Sebastian Solarte ◽  
...  
Keyword(s):  
Insulin Pump ◽  
Glycosylated Hemoglobin ◽  
Clinical Status ◽  
Life Quality ◽  
Glucose Monitoring ◽  
Severe Hypoglycemia ◽  
University Hospital ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Clinically Significant

Introduction. Diabetes mellitus (DM) is a highly prevalent disease worldwide. It has been associated with an important morbimortality due to its complications and sometimes as a result of adverse events related to treatment. Insulin pump therapy (IPT) is one of the options used to control this disease and reduces one of the most frequent complication associated with treatment: hypoglycemia, which has also a great impact on life quality and clinical status of patients. Materials and Methods. A descriptive and retrospective study was performed including patients treated and followed by the department of endocrinology from a high-complexity university hospital in Cali, Colombia, between 2012 and 2017. Patients were on IPT and continuous glucose monitoring (CGM): MiniMed Paradigm® Veo™ Insulin Pump (Medtronic®) and MiniMed 640G Insulin Pump-Enlite™ Sensor (Medtronic®). Presentation of hypoglycemia and variables associated with its development were evaluated. Results. 51 patients were included. The main indication for IPT initiation was the report of hypoglycemic episodes and inappropriate metabolic control. Initiation of IPT was related with a decrease in glycosylated hemoglobin (HbA1c) and also a decrease in severe hypoglycemic events and hospitalization due to hypoglycemia. The risk factors linked with clinically significant hypoglycemia were male gender, and standard deviation of glucose measures calculated by CGM. A diminished glomerular filtration rate (GFR) (<60 mL/min/1.73 m2) was correlated with higher risk of severe hypoglycemia. Conclusion. IPT with CGM is a useful strategy in the management of patients with DM; it is associated with a reduction of adverse hypoglycemic events and hospitalizations due to hypoglycemia.

scholarly journals Integrated insulin pump therapy with continuous glucose monitoring for improved adherence: technology update

2015 ◽  
pp. 1263 ◽  
Author(s):  
Andrea Tumminia ◽  
Laura Sciacca ◽  
Lucia Frittitta ◽  
Sebastiano Squatrito ◽  
Riccardo Vigneri ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Pump Therapy

Russian national guidelines on insulin pump therapy and continuous glucose monitoring for diabetes mellitus patients. DRAFT

2015 ◽  
Vol 61 (6) ◽  
pp. 55-78 ◽  
Author(s):  
Marina Vladimirovna Shestakova ◽  
Aleksandr Yuryevich Mayorov ◽  
Yury Ivanovich Philippov ◽  
Lyudmila Ibragimovna Ibragimova ◽  
Elena Vladimirovna Pekareva ◽  
...  
Keyword(s):  
Continuous Glucose Monitoring ◽  
Health Care Professionals ◽  
Clinical Guidelines ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Insulin Pump Therapy ◽  
Diagnostic Tools ◽  
High Tech ◽  
Pump Therapy ◽  
Diabetes Patients

Insulin pump therapy (continuous subcutaneous insulin infusion, CSII) and continuous glucose monitoring (CGM) are high-tech treatment and diagnostic tools for diabetes patients management which are actively used worldwide. CSII initiation and pump-users supervision became a part of routine clinical practice in Russia along with the CGM. Present project of clinical guidelines is based on international and domestic experience in CSII and CGM for diabetes treatment. Guidelines should ensure uniformity of CGM and CSII usage in Russia by health care professionals and diabetes patients and provide them an international experience to guarantee height performance of the technology. This article contains a preliminary version of the guidelines (draft) prepared for further expert’s discussion and review. The final version of the clinical guidelines will be sent to the Ministry of Health of the Russian Federation for approval.

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