Nearly 40 percent of insulin pump users who are covered by Medicare changed their insulin pump therapy-related behavior because they had difficulty obtaining insulin pump supplies under the program, according to a study published in The Journal of Diabetes Science and Technology. Furthermore, of those who reported changes in their insulin pump behavior, three in four respondents reported an adverse medical outcome as a result.
Those were some of the alarming findings of the study, which was conducted by endocrinologist Dr. Nicholas Argento of Maryland Endocrine and Diabetes and the Patient-Centered Research team at T1D Exchange.
The goal of the study was to determine whether current Medicare requirements for providing insulin pump coverage were a barrier to pump therapy. People with diabetes covered by Medicare are required to see an approved health care provider every 90 days to renew coverage for their insulin pump supplies. Many Medicare patients with diabetes have shared personal stories online about how this policy has created difficulty in blood sugar management, but there’s been little research on this topic.
For the study, researchers recruited 241 adults with type 1 diabetes from the T1D Exchange Glu online community who had been on insulin pump therapy and who received Medicare coverage for their pump supplies for at least six months. The researchers asked the participants to fill out a questionnaire about their experience with Medicare coverage, and analyzed the data.
Medicare requirements create barriers and impact treatment
Researchers found that most of those who received Medicare coverage for their insulin pump supplies reported problems with that coverage. For example, 72% of those who were on pump therapy when they began Medicare coverage reported problems with the transition from private insurance. Also, more than half (57.5 percent) of those who began insulin therapy while on Medicare reported problems with obtaining pump supplies. These issues included delays in obtaining supplies, difficulty getting paperwork completed, and difficulties seeing a health care provider every 90 days.
These obstacles could lead to adverse health consequences. Of those who said they changed their pump therapy behavior because of issues with Medicare coverage, 66% said they kept infusion set sites in place longer than three days, 34% said they reused pump supplies, and 18% temporarily stopped insulin therapy. More than 40% of respondents reported increased blood sugar variability or higher blood sugar levels because of this changed behavior, among other adverse medical outcomes.
The researchers argued that the Medicare requirement for a face-to-face visit every 90 days is not backed by scientific evidence. As such, these findings suggest that the bureaucratic requirement may pose an unnecessary barrier to diabetes care, leading to adverse outcomes for people with type 1 diabetes.
To read the full study, click here.