What's the biggest challenge when it comes to diabetes?
Kyle opened the discussion by noting that there are sections of the diabetes population who might not have easy access to the technologies or devices being discussed today. “Whether that's because of financial reasons or the system problems that we know exist in the medical community in the form of health care inequity, particularly faced by those in the black and brown communities. Today, we'll be discussing some of the programs that have been developed to help people living with diabetes, but we know there's still a lot of work to be done.”
Nia Grant shared her diagnosis story, diagnosed with type 1 diabetes at the age of 21, when she was a senior in college. “The biggest challenge for me is maintaining consistency in life. I'm very much a get-up-and-go kind of girl … I need my keys, my wallet, my cell phone and I'm out the door. Diabetes requires slightly more planning ahead. For me, the biggest challenge is how to maintain that simplicity of 'it's time to go – keys, wallet phone, and out the door.' Now it's keys, wallet, phone … Dexcom, and out the door. It's trying to maintain that balance, and being able to do the things that I like without having to worry too much about what diabetes will do that day.”
What has been your personal experience with diabetes medical devices?
Nia took a “good, bad, and ugly” approach to describing her experience with diabetes medical devices. “Let's start with the ugly,” she said. She talked about her first CGM and how it met her needs at the time, but it was first generation, a little “rough around the edges.” She still felt blessed to have the technology, despite its shortcomings. The bad, she says, was in 2012, when she approached her doctor about getting a Dexcom CGM and her doctor said her A1C didn't warrant a CGM because she was well-controlled. She had to make her case for access. “I could have a better A1C and a better quality of life if I'm not constantly checking my blood sugar, not having to treat those lows in the middle of the night. If I knew what was happening [with blood sugars] at any given time, I can certainly manage my blood sugars better.” The good, from Nia's perspective, has been her experience with Dexcom. For the past five years, she's had access to a Dexcom product and “it has revolutionized” her life. She recommended that people looking to explore diabetes devices should reach out to people on the Internet who have used devices and have real-life experience that they can share.
What about coverage issues?
Keri Leone shared that one of the biggest challenges - from her vantage point as an employee at Dexcom - is coverage. “A lot of times, we hear from healthcare professionals and patients that CGM is 'covered.' I think that the definition of 'coverage' is what I always like to educate my patients with diabetes about.” Keri walked through some of the different insurance companies, commercial payers, and federal government coverage (like Medicare and Medicaid). “Overall, for our commercial coverage, for all non-settle channels, CGM is covered for type 1 patients … we're also seeing coverage for those who have type 2 diabetes with intensively insulin managed regiments … Medicare covers CGM for anyone with type 1 or type 2 diabetes and intensive insulin managed regiments.” She explained that Medicaid is more of an “uphill battle to climb” but cited that 37 states have CGM coverage, and of those 37, fourteen will cover through a pharmacy benefit.
Can someone start on a CGM during COVID-19, using remote training?
Keri shared that in clinic settings, clinicians have the facilities to train using their staff, and in a remote setting, Dexcom has an entire group of certified diabetes educators who are available Monday through Friday, 6 am – 5 pm pacific time to walk patients through the remote training for Dexcom G6.
She also recommended that, for patients who may be hesitant to try a CGM, that there are a lot of healthcare professionals who can provide a Dexcom G6 Professional System where patients can test wearability and comfort. She also cited Dexcom's 30-day return policy for patients who don't find the device to be a good fit for their diabetes care.
Is accessing CGM more challenging due to COVID-19?
Keri shared that Dexcom's US-based manufacturing facilities are in Arizona and California, and are considered essential during the pandemic, so there has not been any interruption in service that would cause back orders, etc. As a company, Dexcom had to shift to keep employees safe from a work environment perspective and how the company interacts with providers and patients (using Zoom to connect with patients, etc). “There's been a lot of creativity, but we've gotten through and we're looking forward to seeing people 'live,' soon.”
