Major victory in the fight against diabetes complications

OPINION – Under Governor Gavin Newsom’s leadership, California has taken a significant step toward improving care for vulnerable residents living with diabetes. New guidelines issued today by the state’s Department of Health Care Services will increase access to essential medical devices called continuous glucose monitors (CGMs).

Advances in CGM technology has improved diabetes management and quality of life for many with the disease. By using a tiny sensor under the skin that constantly checks blood glucose levels, CGMs provide people with diabetes and their health care providers a fuller picture of their blood glucose levels, allowing them to see what their blood glucose levels are at any time and alerting when levels trend high or low so they can take critical, preventive measures against hypo and hyperglycemia.

Having this critical, continuous information helps those with diabetes make better decisions about food consumption and timing of medication, including insulin. It’s like having a co-pilot, making it easier for our loved ones to stay safe and healthy. Without CGMs, the risk of serious complications like severe hypoglycemia can be life-threatening. I know the importance of this all too well as I lost a brother to severe hypoglycemia – something I believe could have been prevented if CGMs had been available at that time. Unfortunately, the cost of CGMs and their supplies can be prohibitively expensive. Without adequate insurance coverage, accessing CGMs can be more of a financial burden than some can bear, particularly those living on the margins. Which is why access to CGMs for Californians with Medi-Cal is so important.

A national study commissioned by the American Diabetes Association recently found that Medicaid beneficiaries living with diabetes are the least likely to have access to a CGM. And, within this subset, people of color are even less likely to have access to the lifesaving device. Additionally, individuals enrolled in Medicaid who take insulin are two to five times less likely to get CGMs than those enrolled in commercial health insurance plans.

With more than 10% of the population in California living with diabetes, 29% of which are Native Hawaiian or Pacific Islander and 22% American Indian and Alaska Native, the new policy for CGM access is not just a win for people living with diabetes but a win for our entire healthcare system.

Because of my brother’s experience, I knew California had to step up to the plate to ensure our most vulnerable had access to these essential devices. Following years of discussions with patients, stakeholders, physicians, and more, the Department of Health Care Services issued revised guidelines to significantly improve access to CGMs for those who are older, blind, disabled, pregnant, or living in poverty. Prior guidelines were onerous, included pages of burdensome criteria, and even excluded Medi-Cal beneficiaries living with Type 2 diabetes. The new guidelines not only reduce the required coverage criteria, but they also enable a wide variety of providers to prescribe the devices, ensuring significantly improved access for those who stand to benefit the most.

In addition to the lifesaving capabilities of these devices for Californians living with diabetes, CGMs have other potential benefits for the Golden State. Putting these devices into the right hands and improving individual’s diabetes management will lead to savings for the state due to less emergency room visits to treat severe hypo and hyperglycemia and avoidance of costly to treat complications. CGMs can also reduce the strain on healthcare workers by enabling them to monitor blood glucose levels remotely instead of performing manual finger sticks tests.

With more than 10% of the population in California living with diabetes, 29% of which are Native Hawaiian and Pacific Islander and 22% are American Indian and Alaska Native, the new policy for CGM access is not just a win for people living with diabetes but a win for our entire healthcare system. The new, less restrictive coverage criteria will result in greater access for all Medi-Cal beneficiaries, particularly those who currently have the least access to these lifesaving medical devices.

Time will tell how successful this change will be, but we can absolutely be sure that this is a solid step forward and one that dramatically increases health equity among Californians with diabetes. As we celebrate this milestone, I can’t help but think of my late brother. His story serves as a poignant reminder of the lifesaving potential these devices hold, and I hope that many other Californians will now have the chance to avoid similar tragedies.

Lisa Murdock is the Chief of Advocacy for the American Diabetes Association