Diabetes Treatment Is Becoming More Convenient, Less Painful and Less Expensive

by Rick Mendosa

We all know that talking to your doctor regularly about prescription medications for your type 2 diabetes is important if you require medication in addition to diet and exercise. New medications are introduced that may be right for your treatment plan. Other prescriptions are reformulated as combination drugs or extended-release drugs. Examples include GLUCOVANCE®, which is two medications (glyburide and metformin HCl) in one pill, and GLUCOPHAGE XR® (metformin HCl extended-release tablets), which can be taken once a day by most patients.

You and your doctor might be less likely to talk about issues such as testing devices and insurance coverage. However, just as prescription drugs are improving, monitoring devices are getting more advanced (and less painful!). There's even good news about diabetes and insurance in America.

Devices: Testing Easier to Manage

Fingerstick devices for testing blood sugar have been in wide use since the 1970s. If we consider these to be the first generation of blood glucose meters, a second generation of meters that test less painfully has finally established itself. These new meters require less blood and test on areas of the body that have fewer nerve endings, like your forearm. These meters have been available only for a short time, but there are already five different brands on the market.

First to be introduced, the AtLast (Amira Medical Inc.) became available in December 1999. Since then the OneTouch® FastTake® (LifeScan Inc.), which was previously available, incorporated new test strips that require less blood, thereby permitting forearm testing. The One Touch Ultra® (LifeScan Inc.) is a similar monitor, but works even faster, taking only 5 seconds to give a reading. The FreeStyle (TheraSense Inc.) takes the least blood of all available meters. The newest alternative site meter, the MediSense® Sof-Tact (Abbott Laboratories Inc.), hides the test strip, lancet, and blood drop internally.

Meanwhile, the third generation of blood glucose meters is about to arrive. These meters, which continuously test blood glucose, will help guard against hypoglycemia or low blood sugar by sounding an alarm. The first has passed Food and Drug Administration review. After daily calibration with a first or second-generation meter, the GlucoWatch® Biographer (Cygnus, Inc.) uses a low level of electric current to draw out and measure glucose through the skin at frequent intervals throughout the day and night. The watch is already available for limited distribution in the U.K., and received FDA market clearance in the United States in March 2001. However, the cost of the GlucoWatch may be significant, perhaps $400 to $500 for the hardware and $4 to $5 for each AutoSensor, which snaps into the back of the GlucoWatch and provides up to 12 hours of automatic readings.

Two other companies have continuous sensors in development. The SpectRx Inc. technology (not yet named) uses a proprietary method that is designed to painlessly create a tiny micropore in the outer, dead layer of skin. Interstitial fluid is collected through this micropore and measured for glucose. The initial version of the Continuous Glucose Monitoring System (MiniMed Inc.) is FDA-approved and uses a tiny sensor implanted just below the skin of your abdomen. After three days you return to your doctor, who removes the sensor and downloads the readings to a computer, where you can both get a complete look at where your glucose levels have been.

Health Insurance: Treatment Easier to Afford

Over the last five years, the American Diabetes Association (ADA) has made remarkable progress in lobbying for adequate healthcare coverage for diabetic supplies and training. The ADA argues that since diabetes is a self-managed condition, and that to stay healthy a person with diabetes needs equipment and supplies (test strips, meters, oral medication, insulin, syringes) and education to use such equipment and supplies, state and federal law should require insurance companies to provide coverage in these areas. Plus, in the long-term, adequate education, equipment, and supplies lead to fewer long-term complications from diabetes, which the insurance companies should see as a net positive.

In March 2001, Wyoming became the 44th state to enact a law that ensures insurance coverage for supplies and equipment that are prescribed or medically necessary, as well as for educational programs to help people control their diabetes. These laws also include broader programs aimed at diabetes prevention. Endocrinologist Eric Wedell, MD, who works with the ADA and lobbied for the Wyoming law, said, "This legislation is important because supplies, equipment, and education are necessary for better blood glucose control. And better blood glucose control translates into better health, fewer complications, and fewer dollars spent on healthcare for diabetes."

The District of Columbia and 43 other states now have similar laws. Only four states had protection laws before 1996, and only six currently lack such laws (Alabama, Idaho, Montana, North Dakota, Ohio, and Oregon). Companies with self-funded plans are exempt from the new laws (they are governed by a federal law called ERISA). Medicare has covered blood glucose test strips, lancets, and meters since July 1998. To find out more about what your health plan has to offer, talk to your employer or your insurance company's customer service department.

© Rick Mendosa

Rick Mendosa is a freelance journalist and consultant, and has written hundreds of magazine and online articles, columns, and Web pages about diabetes since his own diagnosis in 1994. Visit the author's web site at http://www.mendosa.com/diabetes.htm.