Adrienne Prashar, who was diagnosed with Type 1 diabetes on the eve of her 13th birthday, took a break from her tumbling warmups to check her blood sugar. She had stored her diabetes supplies across the gym and had to cross over to retrieve them. Prashar mentioned that tumbling typically causes her blood sugar levels to decrease.
Prashar, now 14, did a finger stick, saw her blood sugar was 127, and went back to the mat. For most people with diabetes, the target range is about 80-130, and up to 180 two hours after meals.
Prashar is not required to frequently monitor her blood sugar levels as she relies on a continuous glucose monitor (CGM). This device provides her with blood glucose readings on her phone every five minutes. However, if Prashar ever experiences symptoms that conflict with the CGM readings, such as the incident that occurred at the gym in March, she verifies her blood sugar level by performing a finger stick.
According to her, rather than continuously pricking her finger, she prefers to glance at her phone to check if her numbers are trending low or high.
“It’s such a pain and it becomes more challenging to identify trends,” Prashar expressed, emphasizing his strong aversion towards it.
Montana lawmakers are considering a bill that would require insurance companies to cover CGMs for people with Type 1 and Type 2 diabetes. Multiple studies and experts back up the effectiveness of the devices, showing better blood test results, fewer long-term complications, and a reduction in health care costs.
House Bill 758 has broad support from lawmakers, but it faces opposition from insurance companies and some providers. That opposition focuses on the cost, whether a CGM is medically necessary at all stages of diabetes, and the possibility that CGM manufacturers will raise their prices if there is an insurance mandate.
Continuous Glucose Monitors (CGMs) have the flexibility to be worn on various body parts such as the legs, stomach, or arms, and they securely adhere to the skin using an adhesive patch. These devices feature a thin tube that is inserted beneath the skin to accurately measure blood glucose levels from tissue fluid. The collected data is then wirelessly transmitted through Bluetooth technology to a phone or any compatible device. Unlike the traditional method of a finger prick, which only provides a single-time reading, CGMs offer wearers a constant and uninterrupted flow of valuable glucose data.
According to GoodRx Health, CGMs can cost between $1,000 and $3,000 each year out-of-pocket.
According to spokesperson John Doran, Blue Cross and Blue Shield of Montana, which is the largest insurer in the state, projects that if the bill is approved, it would result in an annual expense of almost $5 million for the organization.
Doran emphasized that CGMs may not always be medically necessary, and determining their necessity should involve collaboration between the healthcare provider and the payer. However, he acknowledged that there are situations where a CGM is indeed required, and in such cases, Blue Cross already provides coverage for them.
“These items offer convenience,” Doran stated. “They deliver real-time information and can significantly enhance one’s lifestyle.”
Lawmakers in several states are considering bills to regulate coverage of CGMs, and Illinois’ governor signed one such bill into law last year.
A study published in the Journal of Diabetes Science and Technology in 2022 says about 30 million Americans have diabetes, a condition in which a person’s body can’t make enough insulin (as in Type 1) or use it effectively (as in Type 2). By 2030, the study estimated, 55 million people in the U.S. will have diabetes, with total medical and societal costs of more than $622 billion — a 53% increase from 2015. According to the American Diabetes Association, nearly 78,000 Montanans have been diagnosed with diabetes.
According to multiple studies, diabetes educators, and healthcare providers, Continuous Glucose Monitors (CGMs) have the potential to assist individuals with diabetes in lowering their A1C levels. A1C levels are widely used in diabetes management to measure blood sugar levels. Effective management of diabetes can significantly decrease the occurrence of complications such as retinopathy, heart attacks, and nerve damage. These complications often result in increased healthcare costs due to emergency room visits and hospitalizations.
Studies show CGMs can greatly benefit people with Type 1 diabetes. There are also promising results for people with Type 2 diabetes, the more prevalent of the two types, but the research is limited compared with that on Type 1.
Dr. Brian Robinson, an endocrinologist at St. Peter’s Health in Helena, said supplies for people with Type 1 diabetes are generally covered by insurance. When he considers recommending a glucose monitor for a patient, he said, the decision is driven by insurance rules that are informed by the American Diabetes Association’s standards of care.
Robinson stated, “There’s no doubt that CGMs have improved the condition of my patients.” However, he acknowledged that the current scientific evidence does not fully endorse his belief that CGMs should be universally provided to all individuals with diabetes.
Robinson explained that while not all physicians, particularly those in the field of endocrinology, concur on the necessity of a continuous glucose monitor for individuals with Type 2 diabetes, he believes that if a patient requires a daily shot to control their diabetes, they should be granted the opportunity to utilize a CGM.
According to Lisa Ranes, the manager of the diabetes, endocrinology, and metabolism center at Billings Clinic, individuals with both Type 1 and Type 2 diabetes can experience similar advantages from using a CGM.
Many studies have shown that CGMs are just as effective for patients on lower quantities of insulin, like some people with Type 2 diabetes, as for people with Type 1 diabetes, who rely on insulin throughout the day.
Ranes explained that this information empowers patients to make informed choices about managing their blood sugar levels, such as adjusting their insulin dosage or frequency, consuming a meal, or engaging in physical activity.
According to Ranes, continuous glucose monitors (CGMs) could be beneficial in the early detection of Type 2 diabetes for individuals. Ranes emphasized that Type 2 diabetes is a progressive condition, hence the importance of achieving control as early as possible for optimal outcomes.
Cass Mitchell, aged 76, received a diagnosis of Type 2 diabetes more than three decades ago. At that time, her doctor conveyed the unfortunate belief that individuals with Type 2 diabetes often struggle to effectively manage their care, resulting in shorter lifespans.
Mitchell, a resident of Helena, developed a tolerance for finger pricks. However, she mentioned that the test strips were quite costly, approximately $1 per strip at that time.
Around a decade ago, she acquired a CGM. Mitchell’s routine of testing her blood sugar twice daily transitioned to monitoring it through an app, doing so approximately 20 to 25 times per day. This change allowed her to develop a deeper understanding of her diabetes, and she now relies on her device’s time-in-range reports, which indicate how frequently her blood glucose levels remain within a specific range. These reports enable her to make necessary adjustments to her lifestyle.
Mitchell has lowered her A1C from around 11% to 7%. According to the ADA, the target for most adults with diabetes is less than 7%.
Mitchell’s device is currently eligible for coverage under Medicare and supplemental insurance. This coverage would continue if HB 758 is passed. Mitchell expressed concern about being unable to afford her CGM if she had to pay for it herself. However, she also expressed optimism about the bill’s ability to broaden access to CGMs for more individuals.
At first, Dr. Hayley Miller, the medical director of Mountain States Diabetes in Missoula, was optimistic about HB 758. However, her confidence in the bill has wavered, primarily due to concerns about potential increases in CGM prices if it were to pass.
Miller expressed that while it may appear as though they are opposed, the involvement of insurance adds complexity to the situation.
According to Emma Peterson, who previously served as a diabetes educator at St. Vincent Healthcare in Billings and Providence Endocrinology in Missoula, the majority of individuals involved in diabetes care believe that every person diagnosed with the condition should utilize a continuous glucose monitor.
According to Peterson, irrespective of the various types of diabetes, they all share the same complications and challenges in maintaining stable blood sugar levels.
