According to an update I just got from DiaTribe, Oregon is considering severely limiting access to glucose test strips for people with Type 2 diabetes. This is one of a series of recent examples of an extremely worrisome trend toward lowering test strip coverage for people with Type 2 diabetes, and I want to encourage everyone who has diabetes or who knows someone who does (or who cares about it at all!) to sign this petition asking Oregon’s legislature to, if I may be blunt, not be idiots.
To quote from DiaTribe,
“At a recent meeting of Oregon’s Health Evidence Review Commission (HERC), the state panel recommended reducing access to test strips for people with type 2 diabetes on the Medicaid-funded Oregon Health Plan (OHP). A new plan would severely restrict access to strips for type 2 patients unless they are newly diagnosed, take insulin, or meet a few other special requirements. For people not taking insulin – which covers the vast majority, about 70% of all type 2 patients – those with an A1c above 8.0% would be entitled to one test strip per week, while those with an A1c below 8.0% would not be provided with any test strips at all.
This recommendation would severly limit test strips and set a dangerous precedent for other states looking to cut overall health care costs. It’s difficult to understand how the HERC imagines people with an A1c below 8.0% will manage their diabetes without test strips, and a test strip every week is hardly meaningful for patients or providers. Furthermore, any cost reductions will likely be more than canceled out in the long-term due to increased complications, hospital visits, and operations that inevitably follow poor control.
The decision is currently scheduled for December 5. If you are a person with diabetes or a caregiver, we encourage you to sign this petition and write to Oregon Health Authority’s Director Dr. Bruce Goldberg and the members of the HERC about the importance of having access to test strips and self-monitoring blood glucose.”
This particular coverage decision has to do with Medicare — i.e. the government health insurance for poor people — but this potential decision is no doubt partially inspired by Medicare’s (that is, gov’t healthcare for older people) approach toward blood glucose control in Type 2 diabetics who are not insulin — which is to say, they think that blood glucose control does not matter. (If you are interested in learning more, contact me directly and I can send you the papers they use to justify this attitude.) Why should you care about this if you’re not on Medicaid or Medicare? Well, first, it’s upsetting to think that the poorest people in the country may be even further restricted in terms of access to care. And second, anything that MediCARE does is incredibly important for the private health insurance market, since its coverage decisions are often used by private insurers as well. (They’re required to cover what Medicare covers, but don’t necessarily have to do more.)
Putting aside the potentially harmful trickle-down effects to other people with diabetes, I am continually shocked when I hear of things like this, since it does not address the fact that having an extremely high A1c, regardless of potential long-term consequences, can make you a near-term menace (and a potentially expensive one) to public health.
For example: when I was diagnosed with Type 1 at the age of 22, my initial HbA1c was 11.4%. In addition to being unable to sit through a 40-minute class without a bathroom break, my eyesight changed (due to the changing shape of my eyeballs), I was uncontrollably tired, my short-term memory was impaired, I began throwing up and was restricted to bed for a few days, and — the day before I finally went to the health clinic — I was so dizzy and confused that I was unable to walk down the street without help from a friend. I was not able to work; I was not able to think; I was not able to see properly; I was barely able to walk.
And yet in the eyes of Medicare (and presumably the people considering this test strip decision), an A1c of 11.4 percent is totally fine for people with Type 2. (Again, I can send you the paper that states this.) I am not going to get into Medicare’s firm belief that the path toward complications is different for Type 2s than it is for Type 1s, and thus tight control is less important for people with Type 2. Instead, for now I will simply emphasize the near term dangers of having people incapacitated by high blood glucose levels on the streets. Can you imagine what might have happened if I’d attempted to drive a car? Forget the possible human tragedy that could have ensued — it would have been *expensive* to the healthcare system if I’d hit someone or run into a wall. Blood glucose matters.
And then there’s the point that diabetes educator Gary Scheiner likes to make, but that few people ever consider in the argument over control: having high blood glucose makes you feel bad. It makes you sleepy and cranky and prevents you from thinking clearly (therefore making you less productive at work). There’s the obvious economic cost to employers and society of a loss of productivity — but there’s also an emotional cost to high blood sugar. Doesn’t it matter, at least a little, that having high blood glucose makes you feel like crap?
I find this entire issue terrifying, because it seems that the people in charge of making coverage decisions do not truly understand the experience of living with any form of diabetes or the importance of regular testing, let alone the issues about test strip quality (visit StripSafely.com for more info on that very important issue and how recent Medicare coverage decisions may have catastrophic effects on quality and safety). I encourage everyone to read the petition and consider signing it. Without patient pushback, this type of poorly considered cost-cutting has the potential to hurt us all.