Yesterday, we shared our blog about the CMS Updates For CGM Coverage. These updates made us feel hopeful that people with diabetes would have fewer barriers and improved access to CGM devices.

After sharing this post, members of our community let us know that although CMS guidelines have been relaxed in writing, this hasn’t translated into better access on the ground.

What is your experience with accessing CGMs for people with diabetes?

We are hoping to open up a dialogue around this topic and hear from our community members about how these guidelines apply to real-life situations.

If you have information to share, please fill out our brief survey by clicking here.

We will send a follow-up post next week with updates.

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Disclaimer: We always strive to give accurate information with our blogs. For this article, we discovered we need to dig deeper into this topic to make sure we got it absolutely right. If you have any information on this content, please click here to visit our survey to update us.

We have positive news to share for people with diabetes who are on insulin and would like to use a CGM (Continuous Glucose Monitor)!

The Center for Medicare and Medicaid Services (CMS) is relaxing some of their stringent requirements for obtaining a CGM during the COVID-19 pandemic.

“CMS will not enforce certain clinical criteria in local coverage determinations that limit access to therapeutic continuous glucose monitors for beneficiaries with diabetes. As a result, clinicians will have greater flexibility to allow more of their diabetic patients to monitor their glucose and adjust insulin doses at home.”

CMS just announced they would not enforce certain clinical criteria for obtaining a CGM, insulin pump, or associated supplies during the pandemic. For example, in-clinic provider visits, certain lab tests like a C-peptide or antibody testing, and demonstrations of SMBG would not be mandatory.

This is huge for people with diabetes!

It would limit visits to hospitals, clinics, and labs and help reduce exposure to the coronavirus at these public facilities.

Since CGM’s and insulin pumps have the ability to transmit the collected data to a provider for a telehealth consult, providers can now use that data to review during telehealth visits. This can strengthen the relationship during COVID by allowing for data-driven insulin adjustments.

This is a win-win situation and we can hope that private insurance companies will follow the lead of CMS for the benefit of people with diabetes who use insulin.

To learn more read diaTribe’s article and visit CMS.gov.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

As Diabetes Specialists, we want to ensure the safety of patients and colleagues, while providing diabetes care to those who may be the most vulnerable and isolated during this pandemic.

According to the CARES Act, Diabetes Self-Management Training (DSMT) can be provided to patients via telehealth during the pandemic. Though the original regulations had many gaps.

Previously, the CARES Act required that telehealth visits must include both audio and video, while many hospital outpatient clinics were running into billing barriers. In addition, under the original guidelines, RNs and Pharmacists were not included in the approved list of telehealth DSMT Providers.

See: ADCES Summary Sheet of DSMT and Telehealth FAQ for more information.

Though as of April 23, 2020 the guidelines have been updated.

Good News – these updates to the CARES Act now expand blanket waivers under the 1135 waiver.

For any of the information below, please check with your compliance team for clarification and share the important resource links below with your billing department.

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How do CMS Updates Affect Our Ability to Provide DSMT Training?

DSMT Can Now be Audio-Only

DSMT services may be billed for audio-only, but only if the video is not available or possible. Make sure to document the mode of instruction and the rationale if using audio-only. 

See: COVID-19 Emergency Declaration Waiver for more information.

Can RNs & Pharmacists Now Provide Telehealth and Bill for DSMT?

The ADA and ADCES have been working hard to decipher the language and intent in the updated guidelines. It seems that RN and Pharmacists are now included based on an assessment of the wording in the new documents. CMS continues to expand the definition of providers eligible to furnish telehealth services during the COVID-19 public health emergency.

As DSMT programs bill as an entity, rather than at the individual provider level, the American Diabetes Association is seeking confirmation that DSMT programs that are eligible through Medicare Part B, are considered distant site practitioners approved to furnish telehealth services.

See: Blanket Waivers for HealthCare Providers Fact Sheet for more information.

Hospital-Based Programs Can Bill for Telehealth DSMT on the UB-04 (Medicare Claims) Form

Hospitals may now bill for education and management services (i.e. DSMT) as if they were furnished in the hospital and consistent with any specific requirements for billing Medicare in general, including any relevant modifications in effect during the COVID-19 PHE.

In summary:

• DSMT services can be provided in the hospital outpatient setting remotely to a patient in their home.
• The patient’s home can serve as a temporary provider-based department of the hospital (CMS’ Hospitals Without Walls initiative).
• If you previously billed using the UB-04, continue to bill the same way.
• The patient must be a registered outpatient of a hospital.
• DSMT and scope of practice requirements must be met.

See: CMS Hospitals Without Walls Initiative for more information.

Important to note: Please consult with your organization’s billing department and compliance team if you have questions.

Sources and Links

• CMS Press Release Summarizing April 30 Guidance.
• Hospitals CMS Flexibilities to Fight COVID Fact Sheet.
• Blanket Waivers for HealthCare Providers Fact Sheet
• Telehealth Information: List of billing codes are available here.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

Click here to read our entire May Newsletter

As a Diabetes Nurse Specialist in a local clinic, I am providing telehealth once a week. During these visits, I am checking in with people about their food and medications.

Do you have enough food and insulin to last? Most of them answer, “yes, for now”. 

Many of them may run out of insulin and supplies in the near future, some as a result of the costs that make essential medications in-affordable. If this is the case, what can we offer them?

We are excited to thank our guest contributor and Diabetes Educator of the Year, Dr. Diana Isaacs, who has provided us with helpful information and a multitude of resources for people in need of low-cost insulin.

In light of the COVID-19 emergency, the Centers for Medicare & Medicaid Services (CMS), has expanded opportunities to provide remote care to people with diabetes. We have highlighted some recent updates and provided links to helpful resources for your billing team.

Lastly, we are looking towards the future with salivary glucose testing and insights into a past Question of the Week.

I am grateful to be a part of this amazing community of diabetes specialists. Thank you for your care, concern and advocacy.

Be well! Coach Beverly

Click here to read our entire May Newsletter

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Virtual Course Insulin Therapy, Pumps, & CGM + CV Risk Reduction Strategies
Earn 4.0 CEs | $69

Join Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, and ADCES 2020 Diabetes Educator of the year as she reviews these important topics. As Diabetes Specialists, we are tasked with taking a leadership role in technology and cardiovascular risk reduction. Dr. Isaacs will address these topics with clinical insight and expert knowledge during these two virtual courses.

Session 1 | CV Risk Management with Pharmacology and Intensive Insulin Therapy | Recorded & Ready for Viewing!

Session 2 | Continuous Glucose Monitoring and Insulin Pump Therapy | Recorded & Ready for Viewing!

Objectives:

1. Describe critical teaching content before starting insulin pump therapy.
2. Describe appropriate candidates for insulin pump therapy.
3. Discuss strategies to determine and fine-tune insulin pump basal rates.
4. Discuss how to determine and fine-tune bolus rates including coverage for carbs and hyperglycemia.
5. State important safety measures to prevent hyperglycemic crises.
6. List inpatient considerations for insulin pump therapy and CGMs.
7. Discuss features of available professional and personal CGMs and insulin pumps.
8. Describe CV risk factors associated with diabetes and future event prediction.
9. List different pharmacologic approaches to mitigate CV events.

$69 | Earn 4 CEs

These sessions are also included in our Virtual Conference.

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

“Scientists have been in search of a more cost-effective, non-invasive, and accurate diabetes monitoring alternative to blood sugar testing.”

Is there a better way to check blood glucose than uncomfortable fingersticks?

For people with diabetes who use self-management of blood glucose (SMBG) to monitor diabetes progress, fingersticks can wear on one’s fingertips, emotional well-being, and bank account.

Even continuous glucose monitors (CGMs) that provide around-the-clock glucose information and reduce the need for fingersticks, help with finger fatigue. But for many, they are not an affordable option.

Is there another option to check one’s glucose that is less painful and accurate?

The answer could be saliva-based glucose readings.

“Lab tests of the saliva process have shown promising results with an accuracy rate of 95.2%. The research has been published in the journal PLOS ONE,” wrote Dr. Kamal Kant Kohli for Medical Dialogues.

Currently, companies like iQ Group Global and GBS inc. are developing Saliva Glucose Biosensors. This biosensor is a small strip that once matched with someone’s saliva offers an immediate glucose check and sends the results to an app on one’s phone.

Once these new systems are approved, it will be a game-changer.

Though saliva-based glucose testing has not yet hit the markets, for the millions of people that continue to perform finger sticks, we hope that saliva glucose testing will be available soon.

To read more, click here or visit iQ Group Global and GBS Inc websites.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and Commission on Dietetic Registration (CDR), Provider DI002. Since these programs are approved by the CDR it satisfies the CE requirements for the CDCES regardless of your profession.*  

The use of DES products does not guarantee the successful passage of the CDCES exam. CBDCE does not endorse any preparatory or review materials for the CDCES exam, except for those published by CBDCE.

What does it feel like to be ill with COVID-19 as a person with diabetes? Much of the novel virus COVID-19 is still a mystery that we learn more about every day.

Through the stories of those who have contracted COVID-19, we know that the impacts vary. Symptoms can appear mild with a slight fever and some coughing, like Andrew O’Dwyer from the UK experienced.

While for others symptoms can be more severe, like how a secondary-school teacher living with diabetes had. She had a much longer list of symptoms including difficulty breathing, dizziness, dehydration, and vomiting.

Though even with her more severe symptoms, she struggled with whether she should go to the hospital or not.

“I’m unsure whether to go to the hospital. I feel as though I’ll be wasting valuable resources and I may be an infection risk to vulnerable patients.

As many medical systems are overwhelmed and resources continue to be limited, it’s important to think of ways to reduce the risk of transmission so individuals can get the care they need. Because despite this wide range of impact, COVID-19 continues to emerge with very severe complications for people with or without diabetes.

Reduce the Risk: Glucose control is key!

For people with diabetes who are treating COVID-19, glucose control is key! Keeping BG levels as close to the target range as possible can help reduce the inflammatory response, caused by hyperglycemia. Following the basic guidelines of sick day management will assist the type 1 person who might be diagnosed with COVID-19.

To minimize the risk of transmission, hospitals are starting to use CGM’s for glucose checks in ICUs and in COVID-19 units.

“We knew we needed to get creative” states Carol Levy, MD, Clinical Director of the Mount Sinai Diabetes Center, while discussing “a new initiative to utilize CGM for critically ill patients with COVID-19 to reduce patient-provider contact, conserve PPE, and reduce risks for virus transmission.”

For more information, please see our Emergency Preparedness Blog Post.

There is an incredible amount of information regarding COVID-19 and diabetes. These articles show a glimmer of hope for all people with diabetes that might develop COVID-19.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

To read more Mount Sinai’s efforts click here. Click here for For Arthur’s full story, or for the secondary school’s story click here.

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*From ADA Treatment & Care Fact Sheet, “People with diabetes are not more likely to get COVID-19 than the general population. The problem people with diabetes face is primarily a problem of worse outcomes, not a greater chance of contracting the virus. In China, where most cases have occurred so far, people with diabetes had much higher rates of serious complications than people without diabetes.” To help friends and family keep safe, here is an excellent handout on Keeping Safe and Home and in the Workplace by the World Health Organization.

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COVID-19 & Diabetes: What Healthcare Professionals Need to Know
Free Webinar

As health care professionals and Diabetes Specialists, how do we prepare people with diabetes for the possibility of a COVID-19 infection and hospitalization?

What are the best practices to care for people with diabetes and COVID-19 in the outpatient and hospital setting?

Updates:

The Telehealth guidelines for providing DSMT have been updated since the streaming of this webinar.  Please see this blog, Telehealth and DSMT | Latest Updates from CMS, for updated information.

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Webinar Viewing Options:

Can’t make it live? Your webinar registration means you receive a link to the recorded version within hours of airing.

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Medtronic announces the launch of their Next-Gen Bluetooth automated insulin delivery (AID) and CGM systems!

At last year’s Advanced Technologies and Treatment for Diabetes (ATTD) Conference in Berlin, Germany, Medtronic announced that they will be launching their Next-Gen of AID and CGM systems while sharing the results of a recent study they conducted on children who use their 670G AID system.

The study conducted evaluated the efficiency of the 670G AID (automated insulin delivery) system in children from 2-6 years old. The results were positive. After 3 months, the participants:

• Reduced their A1c’s by 0.5% (from a baseline of 8.0%)
• Increased their “time in range” by 2 hours per day
• Had no change in time spent in less than 70 mg/dl
• No experiences of severe hypoglycemia or DKA 

This is exciting news for this age group of 2-6-year-old children and their caretakers as it provides a safe and convenient way of managing diabetes in young kids.

Next-Gen AIDs & CGMs

In addition to this great news for younger kids and their families, Medtronic shared several products that they plan to launch over the next several years, phased into “1 year” and “2+ year” timelines.

These products hope to offer a wide range of new features, including:

• An 85% or greater time-in-range and an average glucose of less than 130 mg/dl from their personalized closed loops
• 50% smaller CGM sensors & pumps at a lower cost
• Smartphone app
• All-in-one CGM sensor and insulin infusion set
• Infusion sets with up to seven days of wear

This is such positive information in the on-going advances of CGM and automated insulin delivery systems for children and adults with type 1 diabetes.

Click here for in-depth details of these advances.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

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The world’s first drone delivery of insulin may be a useful model in response to the COVID-19 pandemic.

For people in rural, remote and isolated urban areas, using a drone to deliver much-needed insulin supplies is an option under consideration. A test flight in Ireland used a drone to deliver insulin as a response to people who were stranded without insulin during Hurricane Ophelia and the post-winter storm Emma when people were snowed in.

“Drone delivery has endless possibilities and can help us connect with our patient communities even in the most remote areas during sentinel events such as hurricanes, earthquakes, and pandemics, which have unfortunately become more common,” Spyridoula Maraka, MD, MS told Healio/Endo.

Though drone delivery has endless possibilities, there are also significant regulatory challenges with “aviation, medication dispensing, pharmaceutical dispensing, and cold chain protocols,” that had to be accounted for during this test run. Markara explains that through each phase of the mission, they had to have backup procedures in place.

Even with the obstacles for drone delivery of insulin or life-saving medications, this is an innovative and exciting prospect for people living in remote or isolated areas.

During the current pandemic, endocrinologists and care providers encourage people that use insulin to have enough stores at home for prolonged “Stay At Home” orders. As stated in our recent Question of the Week people with diabetes are not necessarily at increased risk for contracting COVID-19, but are at risk for experiencing worse outcomes and series complications from the virus (click here to review ADA’s Treatment & Care Factsheet). People living with diabetes may also experience a compromised immune system if blood glucose levels are running above target for a prolonged amount of time.

For these reasons, it is of utmost importance to have the necessary supplies and insulin one needs for optimal glucose levels during periods of crisis, like a pandemic.

To read more, click here and here for more valuable information regarding staying prepared in the pandemic with your insulin and diabetes supplies.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer

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