Help People with Diabetes Access Care Data; Medicare CGM Coverage.
There are advocacy tides rising this morning, and we have a chance to jump on board. There are two opportunities to raise our voices.
The FDA has proposed new guidance for Medical Device Data Systems (MDDS) and the diabetes community has the opportunity to comment on that guidance document. There are more details on the StripSafely website as to what that means and why we should care. We have until August 25th to leave our feedback.
Here’s what you can do:
Leave Your Comment on the FDA Draft Guidance.
1. Highlight and copy the text in red below:
Support:
I am encouraged by the FDA’s draft guidance on MDDS. I support the FDA’s position that technologies that transport data, without changing values, are low risk. I believe that access to medical data should be available on multiple platforms that are accessible to both medical professionals and patients. Access to this type of data is becoming increasingly essential in healthcare, with the potential to reduce costs and improve outcomes – in fact, not having timely access to needed data poses a far greater risk. I strongly support access to this type of data and am pleased to see FDA recognizing its importance.
Diabetes:
People living with diabetes depend on data in order to minimize the chance of life-threatening complications that can arise with very little warning. I am happy to see that in his blog post Bakul Patel specifically mentions diabetes devices. I support this guidance’s decision to not mandate the PMA process for MDDS that include diabetes information.
Suggestions:
The draft guidance seems to be focused on data provided by MDDS to healthcare professionals. It should be modified to also explicitly state the value of access by patients, particularly for chronic conditions like diabetes where patients need access to their own data to manage their own care as safely as possible.
Real Time:
The draft in section V-B seems to precludes active patient monitoring. Specifically how or if this impacts diabetes is unclear. A clear definition of active monitoring should be included in the guidance. I strongly suggest that real-time access by patients to their own data *not* be defined as active patient monitoring. I strongly support including in this guidance more open access to information from continuous blood glucose monitoring for patients with diabetes. The appropriate risk of device performance is regulated through the device PMA, and shifting CGM data to secondary screens does not in any way increase risk. From a patient perspective, secondary screens significantly decrease risk by making information more readily accessible to the patient. This is particularly relevant for those of us who may be unaware of early stages of hypoglycemia.
ER and Hospitalizations:
Geller et al estimate in JAMA (JAMA Intern Med. 2014;174(5):678-686. doi:10.1001/jamainternmed.2014.136.) that almost one hundred thousand Americans a year are treated in the Emergency Room for insulin related hypoglycemia and that about one third of those are admitted. Timely access to real time sensing data may help prevent many of these ER visits. This suggest real opportunity to mitigate risk through secondary device display of CGM information.
Multiple Data Sources:
Existing regulations state that ‘Accessories to classified devices take on the same classification as the “parent” device. An accessory such as software that accepts input from multiple devices usually takes on the classification of the “parent” device with the highest risk, i.e., class.’ (http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/HowtoMarketYourDevice/PremarketSubmissions/PremarketNotification510k/ucm142651.htm ) People managing diabetes often use multiple devices to provide the data needed to follow care instructions. Bringing that data into a single application would improve patient understanding. For example finger stick measured blood sugar, CGM trends, amount of insulin infused, and the time of each are all information that patients juggle. A dashboard displaying all relevant diabetes data would improve safety and reduce risk, compared to forcing the patient to consult multiple devices and displays.
FDA’s Dr. Courtney Lias offered promising comments on diabetes and mobile devices at the Keystone 2014, “Practical Ways to Achieve Targets in Diabetes Care” sessions. Closer Look reports that Dr Lias, in comments on artificial pancreas, spoke of a strong FDA interest in consolidating devices through mobile technology to facilitate better diabetes care. She reportedly spoke of “component artificial pancreas system,” where patients could choose component devices of a system. I fully support the vision Dr Lias shared. This proposed MDDS guidance can encourage logical, safe and incremental steps towards that future by opening multiple diabetes devices to display on a mobile devices.
Conclusion:
Diabetes patients implement the individualized care programs created by our doctors based on real-time data from multiple FDA-approved medical devices. Easing the accessibility of data from those devices improves our ability to follow our care team’s instructions. I support the FDA’s adoption of MDDS guidance that incorporates a nuanced appreciation of the low risk and incredible value in using MDDS to transmit and display diabetes data.
2. Click here and paste the text you copied into the comment box.
3. Fill out your information. (Note: You’re commenting as an individual so be sure to uncheck the box that says: “I am submitting on behalf of a third party.”)
4. Click the Category “Individual Consumer.”
5. Click continue.
6. Review, check the confirmation box, and submit your comments.
Sign the “Tell Medicare to Cover Continuous Glucose Monitors for People with Diabetes” petition from the JDRF.
People with diabetes live longer, healthier lives these days. (Celebrate!) As a result, so many of us have the privilege of aging well. Bottom line? We’re getting older. And when we enter the Medicare age bracket, continuous glucose monitors will not be covered by our insurance. But we have a chance to change things. Here’s something you can do in less than 1 minute that will make a difference:
- Click here for the petition.
- Sign it.
- Share it.
- Pat yourself on the back and carry on.
Oh, this is a real thing with an actual patent pending. (source)
Thank you for giving these issues your attention. The community is lucky to have you. And you. But especially you.
We only had ten options to choose from, so the answers unfortunately couldn’t get too weird. (Unless you’re old school and remember testing earlobes. I learned that at diabetes camp.) The finger-most-favored, by far, was the ring finger, with the middle finger as a distant second place. Pinkies had their own fan base, and thumbs were the only fingers that received a “Oh, heavens no! Never my thumb!” sort of response. (As a community, we are somewhat ambivalent about our index fingers. Except maybe to point and say, “Can you grab me those glucose tabs?” or “Yes, I can eat THAT.”)
carbohydrates are the enemy. In fact, they’re my best molecular friend when my blood sugar is hanging out in the trenches. (See also: 
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