Not all insurance plans will cover the monitoring devices and even when they do, other barriers keep patients from using them.
A continuous glucose monitor is a life-saving and revolutionary piece of technology: it collects much more useful data than other methods of measuring blood sugar levels.
“And you're prescribing the medication again without really addressing what the root cause of the noncompliance to treatment is. So at the end of the day, we engage in this vicious cycle where we're not really addressing the root cause and when the patient is progressively getting worse.” Arizona's Medicaid program insures 20% of all diabetes-related hospital visits for inpatient treatment in the state and nearly a quarter of all diabetes-related emergency hospitalizations, according to statewide hospitalization data.“CGM makes a large immediate difference in our patients' lives and is directly responsible for preventing hypoglycemic emergencies in several of my commercial patients.
Blair Butterfield, a doctor of osteopathic medicine who also submitted public testimony, acknowledged that the financial barrier extends beyond just AHCCCS patients. David Grigsby holds up the reader for his CGM outside a federally funded health clinic in Tucson on February 17, 2022.Grigsby, a longtime resident of Tucson, was 22 when he found out he had diabetes. He had awakened one day with extremely high blood glucose levels, though he didn’t know it. He crossed the street to the 7-Eleven to get a Big Gulp.He called his mother, and she took him to the hospital. There, he says, he fell into a coma for about four days.
David Grigsby discusses his latest CGM data with Lisa Beckett at a federally funded health clinic in Tucson on February 17, 2022.Grigsby was also skeptical of CGMs because he doesn’t use many electronics, and giving the CGM another try required the level of trust he had built up with his current practitioner, Beckett of El Rio.
“Time is a barrier, so it does take time to sit down and explain the devices how they work,” Beckett said. Administrative hangups as well as historical patterns of discrimination and bias continue to plague the world of CGMs. Those patterns were recently exposed in depth in a study published by a team at Medtronic, a medical device company that makes insulin pumps and CGMs.
Among physicians and in society at large, Heather Walker believes that unconscious bias may also be to blame. Walker, associate director of qualitative research at the University of Utah Health who has studied social elements of diabetes, said the stigma associated with diabetes, as well as weight-based stigma, intertwine with doctors’ expectations of their patients.
“In general, mental health issues really tend to be more prevalent in the populations that we serve. And if you're depressed, you know, you aren't going to have that motivation to make lifestyle changes,” she said. “For the same reason, you're probably not going to have that motivation to be taking your medication every day and checking your blood sugar every day, too.”
Andrade, a pharmacist and realtor whose family is originally from Morelia, Mexico, and who now lives in Chicago, said her father Dagoberto was diagnosed with Type 2 diabetes while she was still in pharmacy school in St. Louis. When she came home to Chicago to visit him, she found his blood glucose test strips unused, still stapled in the package from the pharmacy.
“When we were in Mexico, my whole family's telling him, ‘No, you eat all the tortillas you want,’” Andrade said. “And he was like, ‘No, I saw the numbers. I sat there and I ate and I’ll show you right now.’” Marrero wants to know why. “Is it issue with providers who don't want to prescribe it for whatever reasons? Or is it something that is a cultural-ideological issue for the Mexican-origin community? Is there something about this technology?”
“The problem is that most of these complications are long-term consequences. You know, so I have diabetes now, but it may be 20 years before my eyes get crappy. And that's a weird paradigm, especially for people trying to cover costs,” he said.
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