Inside Pediatrics Summer 2022

ACCESS FOR ALL ADDRESSING BARRIERS TO HEALTH CARE DELIVERY THROUGH ADVOCACY

T he old saying goes, “an ounce of prevention is worth a pound of cure.” But sometimes it’s all about having access to the right tools. That was the driving force behind advocacy efforts that led to a change in Alabama Medicaid coverage requirements for continuous glucose monitors (CGM) for children with type 1 diabetes. “Our team caters to the majority of children with diabetes in Alabama,” said Ambika P. Ashraf, M.D., medical director of the Children’s of Alabama Pediatric Endocrinology Clinics and director, Division of Pediatric Endocrinology and Diabetes at the University of Alabama at Birmingham. The clinic treats about 2,500 children and adolescents with type 1 diabetes. Multiple studies in children with type 1 diabetes show that intensive glucose control reduces the rate of diabetes complications. Traditionally, patients with diabetes check blood sugars at least four times per day, with younger children often being checked up to eight times a day. Traditional glucometers require frequent, painful finger pricks to get a drop of blood for testing. In addition,

middle-of-the-night checks are often needed to catch dangerously low or high sugar levels.

Continuous glucose monitors provide real-time, numerical and graphical information every one to five minutes, allowing for blood glucose monitoring with reduced patient burden. CGM use can improve glucose control while reducing the frequency of hypoglycemia, lowering hemoglobin A1C, improving time in the range of goal blood glucose and ultimately helping to prevent acute and chronic complications related to diabetes. These devices can be especially helpful to patients with social determinants of health that prevent them from adequately self-monitoring their blood glucose. The monitors can also reduce patient and caregiver fear of low blood sugars, improving quality of life for patients and caregivers. Prior to 2021, Alabama Medicaid required patients to have “severe hypoglycemia” for coverage of CGM, which led to significant inequity between patients with private insurance and those with Medicaid.

Before CGMs were approved by AL Medicaid

Clinic’s baseline CGM access rate in 2019 for all patients with diabetes was

Approximately

CGM access among clinic patients: Commercial Insurance

45

%

48 %

of clinic’s type 1 diabetes population have Medicaid insurance

50 %

was the national average based on the Type 1 Diabetes Exchange Quality Collaborative

Medicaid

22 %

17 %

5