Why does insurance prioritize the pump over CGM?

[Diamattic]

I can see why the pumps get all of the attention - we need insulin to live.. I get that..

What i also understand is that all of the negative long term effects come from high glucose levels. Most pumps cant tell you what your sugars are doing so you still have to test manually, and its very easy to miss spikes or forget to check and run high for long periods. Pumps over amazing ability to delivery precise (and tiny) doses whenever requested, but without constant monitoring of glucose levels the user is not informed enough to make such changes. Even with a pump you can set your basal rate wrong, you can bolus wrong, and you can go low without knowing, all just like without a pump at all...
But with a CGM the patient would always be aware of their sugars can then adjust insulin appropriately.

Through my experience as a T1D (which is only about 8 months now) i find finger picks worse then injections, and carrying around a meter, strips and a lancet everywhere more of a hassle then an insulin pen and a couple needles.

If someone gave me a choice today, between a free pump, and a free CGM I would easily take the CGM - that way i would KNOW what my body is doing all time and act accordingly, but with a pump i would have the power to act but wouldn't always know what my body is doing all of the time.. which doesn't seem as beneficial.

Why is it that most insurance companies cover pump supplies, but seem to completely ignore the CGMs ?

What do you guys think on this topic?
(obv, the best situation is to have both)

 

[CarbsRok]

Slight problem the CGM is not 100% accurate as it lags by about 20 mins so you still need your meter

 

[noblehead]

Some pumps do come with a CGM such as the Animas Vibe so you can have the best of both, I'm sure insurance companies would cover a separate CGM at an additional cost to your home insurance or may even cover it in the policy.

 

[Diamattic]

I've called my insurance provider and here in Canada they don't recognize it, or it's supplies at all. They told me they can't do anything to help not even if I pay more or upgrade my coverage, they just don't cover it.

 

[CarbsRok]

I've called my insurance provider and here in Canada they don't recognize it, or it's supplies at all. They told me they can't do anything to help not even if I pay more or upgrade my coverage, they just don't cover it.

It's rare to get any funding in the UK, which is very sad considering the benefit of it. But then most health services/ins companies tend to shut the stable door after the horse has bolted.

 

[AlexMBrennan]

If someone gave me a choice today, between a free pump, and a free CGM I would easily take the CGM

With respect, that's because you don't need either technology. Since CGMs are more of a convenience option wheras pumps are absolutely required in certain situations (you can do a finger price BG test at any time, but no matter how hard you try you can't get a variable basal insulin profile with one lantus pen) I can sorta understand why pumps are prioritised.

It's rare to get any funding in the UK, which is very sad considering the benefit of it.

The NHS isn't stupid - if you pass on your research clearly showing that spending £1000/year on CGMs saves £10000/year per patient in complications they'll start handing them out immediately.

 

[Diamattic]

With respect, that's because you don't need either technology. Since CGMs are more of a convenience option wheras pumps are absolutely required in certain situations (you can do a finger price BG test at any time, but no matter how hard you try you can't get a variable basal insulin profile with one lantus pen) I can sorta understand why pumps are prioritised. .

Yeah thats true, I don't NEED either at this point. Maybe it would be better for insurance to look at a case by case basis and assess everyone's need based on the doctors opinion on what would benefit each patient the most. In cases that need a pump they should be allowed to have that covered, and in cases that would benefit from CGM they should have that covered.

I just think its strange that insurance companies recognize glucose monitors and test strips but not CGMs and supplies, i get that they aren't 100% accurate, but neither is every regular monitor haha The option would be nice at least.

 

[tomfalc]

It would be nice to think that both the NHS and insurance companies around the world would think that it was better for all Type 1's to have access to both pump and CGMS technology as early as possible in order to prevent complications from starting, but that's a lot of up front expense in buying the pumps and the transmitters, and in running costs in the sensors and the pump consumables, against a possible problem later. I hope their statisticians are working on it, but I guess the technology is still very new in their world view.

 

[tom58]

Finger pricking blood tests will become more comfortable over a period of time. For more than tweny years I've tested at least ten times a day and now I scarcely notice it. I seldom change the lancets either but new ones do seem to be kinder on the skin. I've been pumping for eight years and wouldn't want to go back to injections.

 

[ElyDave]

The way I look at it is this

on MDI, to exercise I have a choice either 1) reduce basal or bolus or both preceeding exercise and go high as a result or 2) keep basal and bolus the same and go low, resutling in a need to eat more carbs, even for short duration exercise

with the pump about 1-2 hours before exercising, I just turn the basal rate right down, get circualting insulin out of my system, slight upward drift in BG, but no crash during exercise.

The pump gives you the ability to better mimic the bodies own response to exercise, illness etc with more fine control. The CGM tells you exactly where your BG is +/- a bit. What the CGM cannot do though is take that insulin out of your system in response to a low, or add more in response to a high, the fine tuning of the pump can let you do that, given regular testing.

Of course in the perfect world we'd all have the closed loop artificial pancreas with both insulin and glucagon reservoirs and algorithms that can cope with increases in activity as well.