You see the small, handmade signs at the intersections of streets across the country, touting “CASH PAID FOR DIABETES TEST STRIPS.” Signs of the times? Perhaps, as ad hoc resellers of medical supplies provide a secondary market to someone in need of a few quick dollars while possibly flouting pesky safety laws. But it’s also an indicator of a larger-scale issue: the difficulty faced by federal policymakers in regulating a multifaceted industry crucial to the survival of many of the nation’s 29 million diabetes patients.
Diabetes is an indiscriminate disease that, if left untreated, can lead to stroke, cardiovascular disease, lower limb amputations, kidney failure, blindness and more. And glucose monitoring — the ongoing measurement of one’s blood sugar level — is essential to the treatment of those suffering from this “silent” disease. It is also big business involving many stakeholders; from physicians and patients to researchers, regulatory bodies, health care payers and manufacturers of glucose monitoring devices and products.
At issue is the assurance that the crucial glucose monitoring supplies patients need are available, safe and reliable. For instance, once the Food and Drug Administration approves glucose monitoring products for market, are there sufficient safeguards to ensure the quality of these meters and test strips has not diminished over time, whether on drugstore shelves, in medicine cabinets at home or in the questionable possession of the street-sign purveyor noted above? Does current Medicare policy balance the need to provide patient access to high-quality care and effective glucose monitoring while controlling program costs? And, if not, what policy changes need to be made?
Workable, informed answers and solutions won’t come from one segment alone. They will have to be the product of consensus, taking into consideration current available data and the points of view of everyone involved in the glucose monitoring arena. That is why the American Association of Clinical Endocrinologists is convening a Consensus Conference on Glucose Monitoring in Washington, D.C. ,in late September. This conference will bring together all relevant stakeholders including representatives from scientific, educational and medical societies; patient advocate groups; the FDA and Centers for Medicare and Medicaid Services; the insurance industry; large employers; and the medical device and supplies industry.
During the two day conference, this diverse group will present, listen, debate, interact and work to achieve compromise and consensus. A consensus statement will be drafted, reviewed and approved by a panel of experts and specific recommendations will be made to legislators during a congressional briefing immediately following the conference. These recommendations will provide an impetus for legislative or regulatory action to facilitate real improvements in diabetes care. The conference will also serve as a model for productive stakeholder-government partnerships and will demonstrate the value of enacting legislation pending in Congress that would establish a National Diabetes Clinical Care Commission (HR 1074/S 539).
The prevalence of diabetes in our country has risen dramatically in the past 20 years, along with the related cost of care. According to the most recent Centers for Disease Control and Prevention data, nearly 1 in 10 Americans have the disease and $1 out of every $3 of Medicare is spent on treating diabetes related conditions. Maintaining the status quo of care for diabetes patients is not an option. Inaction will only lead to more severe adverse outcomes and ratchet up the national price tag for care exponentially.
Solutions will be found when public and private stakeholders reach consensus for the greater good. Consensus is essential for good governance and we believe that the AACE Consensus Conference on Glucose Monitoring will provide the stimulus for constructive compromise to improve diabetes care for millions of Americans.
Dr. R. Mack Harrell is a practicing endocrinologist in Hollywood, Fla., and president of the American Association of Clinical Endocrinologists. Dr. George Grunberger is a practicing endocrinologist in Bloomfield Hills, Mich., and is president-elect of the AACE. Dr. Grunberger is the chairman of the AACE Consensus Conference on Glucose Monitoring.