Joslin’s Dr. Wolpert helps set guidelines for CGM Use

Dr. Howard Wolpert

After two-and-a-half years of conference calls, meetings, and extensive literature review, a panel of doctors, including Howard Wolpert, M.D., Director of the Insulin Pump  and Continuous Glucose Monitoring Programs at Joslin, have compiled the findings of a number of studies on real-time continuous glucose monitors (RT-CGM) into a series of guidelines recommending the proper use of the devices.

“With RT-CGM, there’s that minute-by-minute decision making that gets enhanced,” said Dr. Wolpert. “Being able to review the data, see what the patterns are, and make changes in ones’ treatment approach helps as well.”

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5 Responses to Joslin’s Dr. Wolpert helps set guidelines for CGM Use

  1. Michael says:

    Dr. Wolpert, why were these guidelines limited to children over 8-years old?

  2. Hi, Michael,
    Here’s what Dr. Wolpert said in response to your question:

    ” The recommendations were limited to children over 8 year olds because there is no study data on younger children on which to base guidelines.”

  3. Jerry Smith says:

    Dr. Wolpert,

    Do you have any suggestions about how to obtain Medicare approval for CGM coverage? I am familiar with your testimony in a February 2010 Level 3 Appeal that was successful. NHIC Policy Artice A33614 denies coverage because CGM is precautionary. Medical necessity, such as hypoglycemia unawareness, is not recognized. CGM is cost effective, medically beneficial, and potentially life saving for many older Type I’s subject to severe hypoglycemia. ADA, JDRF, and AACE will not advocate for CGM coverage because of a lack of clinical evidence that support its effectiveness. I agree with you that CGM is not a panacea, but it has proven to be very beneficial for many. I believe that a common sense, cost effective policy will save money due to fewer complications (coma, seizures, cognitive impairment, and untimely death) when used correctly.

    I would appreciate any comments or suggestions that you can offer.

    Thank you very much.

    Jerrome F. Smith
    Rochester, NY (Rochester General Hospital: Patient of Dr. Robert Heinig)

    • Lynn Wickwire says:

      Mr. Smith -
      Dr. Wolpert’s office forwarded your CGM coverage comment to me and I thought I might be able to provide some additional information. By way of background, I have had diabetes for 67 years and have used a CGM for at least 5 years on a 24/7 basis. I also have had hypoglycemic unawareness for probably close to 10 years. When I requested CGM coverage (I initially purchased it out of my pocket) from my health plan (I also am on Medicare), they denied my request stating that the CGM wasn’t covered by Medicare. So I began the appeal process and went through 4 or 5 levels of denials and appeals, eventually getting to a hearing before an Administrative Law Judge, an independent department within CMS. I submitted testimony beforehand and my health plan (Harvard Pilgrim) filed testimony opposing my request. [They even went so far as to submit a brief that I received on a Friday evening with the hearing scheduled for the following Monday. My feeling has always been that they did this intentionally thinking that I would not have time to respond to their comments. I prepared a response over the weekend and emailed it to the Judge’s office Sunday evening so he would have my response prior to the hearing and made sure that he know the timing of the Harvard Pilgrim filing. At the teleconference hearing, Dr. Wolpert, my wife and I each made comments presenting specific circumstances about life prior to use of the CGM and the difference with the CGM. The Judge took all the testimony and written materials under advisement and about 3 weeks later issued a decision ordering Harvard Pilgrim to cover all costs associated with the CGM I was using. I have since changed insurers and will probably begin a new request for coverage and the appeal process again. There is absolutely no question in my wife’s or my mind that the CGM has made a tremendous difference in my quality of life and in my ability to not have to worry about driving or hurting someone else or myself because of the hypoglycemic unawareness.

      Lynn Wickwire

      • Jerry Smith says:

        Lynn,

        Thank you for your reply. I am familiar with your case as someone from Insulin-Pumpers sent me the FAVORABLE decision by Judge O’Leary. My case was very similar to yours but a different ALJ in Cleveland issued an UNFAVORABLE ruling that was sustained by an MAC judge (Level 4) in Washington, DC. I believe I have your telephone number and I would like to give you a call next week.

        I have been advocating for a change in the Medicare rules that will replace the NHIC Policy Artice (A33614) which denies CGM coverage because it is precautionary. I have proposed a common sense, cost effective Medicare regulation that recognizes medical necessity and the prevention of severe hypoglycemia and its complications.

        Jerry Smith
        jsmith93@rochester.rr.com.

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