How Patients Can Meet the Criteria for Insulin Pu...( Convincing health insurers of the b...),Health

Convincing health insurers of the benefit of pump technology is biggest

hurdle

PORTLAND, Ore., April 8, 2008 /PRNewswire/ -- While many health plan insurers will pay for patients with type 1 diabetes mellitus to have an insulin pump, the criteria for approval is not always clear.

"Continuous subcutaneous insulin infusion (CSII) or insulin pump therapy is an ideal tool for the patient in need of intensive insulin therapy and carbohydrate counting," explains Dr. Skip Freedman, Executive Medical Director at AllMed Healthcare Management, a leading independent review organization (IRO). "But only when they can also put in the time and effort needed to use a pump effectively. In general, patients need a pump when they cannot achieve acceptable control using a regimen of multiple daily injections or when they have frequent hypoglycemic episodes or hypoglycemic unawareness."

Accepted Guidelines

The American Association of Clinical Endocrinologists (AACE) current guidelines recommend insulin pump use for patients who are willing and able to comply with prescribed type 1 diabetes mellitus self-care behavior that includes frequent monitoring of blood sugars, carbohydrate counting and insulin adjustment. This implies that CSII is not only appropriate as a last-ditch effort when all else fails for the patient, but is also appropriate for any patient who is complying with the general recommendations for good type 1 diabetes care.

According to Freedman, patients who are unable to achieve acceptable control using a regimen of multiple daily injections and patients with frequent hypoglycemic episodes or hypoglycemic unawareness should discuss the value of an insulin pump with their doctors. Patients who are very insulin sensitive; those unable to sense when blood sugars are too low; and those with high morning blood sugars often can benefit from the ability of a pump to adjust their insulin rates hour by ho
'/>"/>