Maryland Endocrine and Diabetes, Columbia, MD, USA.
T1D Exchange, Boston, MA, USA.
J Diabetes Sci Technol. 2020 Mar;14(2):257-261. doi: 10.1177/1932296819838292. Epub 2019 Mar 31.
The Centers for Medicare and Medicaid Services (CMS) has numerous requirements for coverage of continuous subcutaneous insulin infusion (CSII; insulin pump). Due to recent improvements in diabetes treatment, people with type 1 diabetes are living longer, resulting in an increase in the number of individuals who are eligible for Medicare and are impacted by CMS policies regarding CSII.
Two hundred forty-one adults with type 1 diabetes who had been on CSII with CMS coverage for at least 6 months were surveyed. Median age was 67 years, mean A1c was 7.0%, 64% were women, 93% were white, and the median type 1 diabetes duration was 42 years. Participants reported median CSII use of 15 years and 82% were on CSII before starting CMS.
Of those starting CSII while on CMS, challenges included cost of supplies (29%) or the insulin pump (24%). The majority (57.5%) reported issues with obtaining supplies, the most common problems being delays in release of supplies (29%), difficulty getting paperwork completed (23.5%), and seeing a health care provider every 90 days (18%). Participants reported changing their CSII behaviors because of supply delays (39%) including leaving site in place >3 days (64%), and reusing pump supplies (34%). Consequently, participants reported adverse outcomes including more erratic (48%) or higher (42%) blood glucose and pain or irritation at sites (34%).
This study concluded that current CMS CSII policies promote adverse CSII behaviors and outcomes in type 1 diabetes and thus call for changes in the CMS CSII policies.
医疗保险和医疗补助服务中心（CMS）对连续皮下胰岛素输注（CSII；胰岛素泵）的覆盖范围有多项要求。由于糖尿病治疗的最近进展，1 型糖尿病患者的寿命延长，这导致有资格享受医疗保险并受 CMS 有关 CSII 政策影响的人数增加。
对至少有 6 个月接受 CMS 覆盖的 CSII 的 241 名 1 型糖尿病成人进行了调查。中位年龄为 67 岁，平均 A1c 为 7.0%，64%为女性，93%为白人，中位 1 型糖尿病病程为 42 年。参与者报告 CSII 的中位使用时间为 15 年，82%在开始接受 CMS 之前就开始使用 CSII。
在开始接受 CMS 治疗的 CSII 中，面临的挑战包括耗材（29%）或胰岛素泵（24%）的费用问题。大多数（57.5%）报告在获得耗材方面存在问题，最常见的问题是耗材供应延迟（29%）、难以完成文书工作（23.5%）和每 90 天看一次医生（18%）。参与者报告由于供应延迟而改变了他们的 CSII 行为（39%），包括在原处停留超过 3 天（64%）和重复使用泵的耗材（34%）。因此，参与者报告了不良后果，包括血糖更不稳定（48%）或更高（42%）和注射部位疼痛或刺激（34%）。
本研究得出结论，当前 CMS 的 CSII 政策会促使 1 型糖尿病患者出现不良的 CSII 行为和后果，因此需要对 CMS 的 CSII 政策进行修改。
