The ethical problem with denying diabetics no-prick glucose monitors

In the past few years, science has produced a few truly wonderful devices capable of monitoring diabetics’ blood-sugar levels 24/7 in real-time, with the power to help the afflicted self-manage very protective eating strategies.

Unfortunately, even though I’m diabetic, I simply can’t afford all but one of these devices even if my doctor were willing to prescribe them (or insurers to authorize it), and neither can tens of millions of other blood-sugar challenged Americans who would greatly benefit from them, according to American Diabetes Association data. No matter how trailblazing, the devices are priced well beyond most folks’ means.

That’s a travesty, as I’ll explain later.

Using the old finger-stick glucose monitoring systems is like trying to understand climate by periodically looking out the window.

The problem is the expensive devices—the brand names Dexcom and Freestyle Libre are probably the best known—are generally only covered by private insurance and Medicare/Medicaid if a patient’s diabetes is severe enough to require regular insulin injections.

But I don’t need insulin at this point, as don’t many only moderately afflicted diabetics and many more who are inadvertently flirting with diabetes diagnoses.

What is ‘pre-diabetes’?

My diabetes had hovered for years in what’s clinically termed the “pre-diabetic” range before a couple of years ago it quietly drifted into full-fledged diabetes, though in my case it’s still relatively mild. Thus far, without insulin or pills, I have been able to shift my glucose numbers back to pre-diabetic levels by losing a few pounds and shedding some carbs and sugar from my heretofore bread- and sweets-laden diet.

But when first diagnosed with diabetes and initially using my doctor-prescribed and insurance-covered finger-prick type blood-glucose tracking device—which only provides one reading per prick—I decided to try one of the new 24/7 monitoring devices.

To get a full understanding of what my blood sugar levels were doing throughout each day, I figured I’d have had to stick my fingers 50 or more times every 24 hours. So the innovative continuous glucose monitoring (CGM) systems seemed a no-brainer.

But, yikes! Most are prohibitively expensive unless you’re a one-percenter.

The Dexcom system, which I once used temporarily, costs roughly $500 per month if you have a smartphone to monitor continuous blood-glucose readings (add an extra one-time cost of $500-$800 for a Dexcom receiver if you only have a “dumb” phone), according to Healthline.com.

That’s a car payment.

One more affordable than others

I found the Freestyle Libre system to be the cheapest option out there by far, costing only about $160 per month for a couple of two-week sensors. Recently, I just purchased a two-week trial because it is the most affordable CGM system, and although previously users needed to also buy a hand-held Freestyle reader, I am now able to monitor readings on my iPhone. I will report back on my experience with the system in a future column.

At least two other CGM systems are available on the market—Medtronic Minimed Guardian Connect and Eversense Implantable—and the costs for each are roughly comparable with Dexcom.

All of these devices are designed for ease, and the Dexcom and Freestyle systems use a sensor in which a very thin filament is painlessly self-inserted under the skin with an applicator to measure interstitial fluid (located between blood vessels and cells) to, ideally, closely approximate blood-sugar levels during a 10-day or two-week period, depending on the brand. I understand there are some accuracy issues, particularly with the Freestyle Libre system, so I will track that with my sensor.

For many diabetics, the fundamental CGM issue is that most private insurers and government Medicare only cover these devices if patients are insulin-dependent, because they require more daily readings than non-insulin-dependent patients and their health risks are presumably greater.

And this pronounced lack of accessibility is no narrow, esoteric issue.

88 million pre-diabetics in U.S.

According to the U.S. Centers for Disease Control, 34 million Americans have been diagnosed with diabetes, and another 88 million with pre-diabetes. Many, many more are unaware they even have diabetes or pre-diabetes, the CDC warns.

What’s important to know in this debate is that, especially for pre-diabetics and those with adult-onset Type II diabetes (like me), lifestyle and nutrition are the significant culprits and can be changed to bring blood-sugar levels back to or closer to normal. But involuntary pathologies also are causative.

In my experience, using the old finger-stick glucose monitoring systems is like trying to understand climate by periodically looking out the window. It only provides a minimal understanding.

When I used the wearable Dexcom system, which updated glucose levels every few minutes, I could track my blood sugar continuously and view a full-day graph at day’s end precisely and numerically displaying every dip and spike. This running knowledge greatly helped me know when salads were wiser than, say, a cupcake and whether I needed, in general, to rein in carbs and sweets, and when. It allowed me to actually control my blood sugar with more rational food choices — not that I always refuse a slide of double-chocolate cake when that was inarguably the worst choice (as it probably always is).

The point is, CGM systems help keep your blood sugar from jumping off the charts into danger zones or even from staying unhealthily at consistently too-high levels. You can’t achieve that with occasional finger pricks, because spikes happen when they happen, whether you’re pricking or not.

So, this article is a high-five for CGM’s but, more importantly, a reproach of a system where so many diabetes sufferers cannot afford an excellent tool for mitigation against this sneaky, potentially devastating, often self-caused disease.

The ethics of CGM denial

Certainly, the companies that developed no-prick glucose systems spent boatloads of money in the process and fairly want to earn back the investment and add profit, but at whose expense? There is a moral issue here, when only relatively wealthy people or those with the most serious forms of the disease are able to access this magical therapeutic aid.

Nonetheless, everyone afflicted anywhere on the diabetes’ continuum would be greatly helped by these devices. Seems a shame that it’s only rationed to the uncommonly sick or rich.

It’s often said that America’s vaunted, very expensive health care system is great at curing and repairing people already dangerously sick or injured, but not so good at preventing illness and injury in the first place.

People like me who are relatively marginally diabetic now face likely worsening of our health profiles in the future due to this insidious disease. So mitigating its effects now by changing our behavior can promise much better health outcomes later.

And what terrific agents CGM systems are for that.

Therefore, I plead with the powers that be in government and the captains of the healthcare industry to find a way to make these no-prick glucose monitors more broadly available, regardless of sufferers’ ability to pay.

It could even save us all a ton of money in the long run, just as improved health outcomes slashed health-care costs after tobacco smoking became quasi-taboo (i.e. far less lung cancer to treat). A few million fewer diabetes-necessitated limb amputations, for instance, adds up to a sizeable cost saving for the healthcare industry, and, thus, the rest of us. Not to mention a relief for those who might have had to endure that surgery and psychic devastation.

Certainly, even armed with the knowledge that CGM’s can provide, not everyone will be disciplined and motivated enough to change their lifestyles for the better, but many will, as I have (mostly). And that’s a very good thing.

The right answer, as always, is not doing anything because of cost.