By Megan Sayles
AFRO Staff Writer
msayles@afro.com
Automated insulin delivery (AID) systems are transforming how people with Type 1 diabetes manage their condition, offering tighter glucose control and more freedom in daily life. Yet, access to this life-changing technology remains uneven. A recent study from the American Diabetes Association found that while 70 percent of White youth with Type 1 diabetes used AID systems, only 47 percent of Black youth did.
The AFRO spoke with Dr. Sherita Hill Golden, Hugh P. McCormick Family Professor of Endocrinology and Metabolism at Johns Hopkins Medicine, about the promise of this technology, the barriers that persist and policies that could help close these gaps.
AFRO: From your perspective, what are the most significant benefits automated insulin delivery systems provide for patients, particularly when it comes to glucose control and quality of life?
Dr. Sherita Hill Golden: I think automated insulin delivery systems are one of the most exciting advances in the field of diabetes, particularly for managing Type 1 diabetes. The primary benefit of them is that compared to non-automated insulin delivery systems— taking multiple shots a day— there’s a significant improvement in blood sugar control. The reason that’s important is the better the blood sugar is controlled, the less likely a patient with diabetes is to develop complications like vision loss, renal failure, loss of limbs and others.
Blood sugar control means flexibility—which is particularly important for young professionals, but even also for middle-aged and older adults who also have busy schedules. You know you don’t have to go look for insulin and a syringe and check your blood sugar. You also have a lower risk of developing low blood sugar, which can be very frightening for patients with diabetes, because they feel shaky, disoriented, confused and unsettled. A lot of patients used to refrain from controlling their glucose as tightly because they were worried that the sugar would drop low when they were sleeping or exercising, which is quite dangerous. With these automated insulin delivery devices there’s much less hypoglycemia, or low blood sugar, and that definitely improves quality of life.
AFRO: While AID systems offer clear advantages, what are some of the limitations or disadvantages that patients and providers should be aware of?
SHG: There are some patients who are not comfortable having to have the device stuck to them. There’s an insertion site for the insulin pump, and there’s a sensor that’s usually on the arm. In the Summer, if someone is wearing a short-sleeve shirt, you’ll see the little round glucose sensor on the back of their arm. For some people, they don’t necessarily want to make an announcement about having diabetes. That can be a limitation. Also, some people may occasionally have skin reactions where the device is inserted. But, they’ve really tried to improve them so that’s less likely to happen.
AFRO: How do cost and insurance coverage affect who is able to use automated insulin delivery systems—and who gets left out?
SHG: Almost all insurance companies cover these devices now because they are basically the standard of care management for Type 1 diabetes. Medicaid covers them and most commercial insurance does too. The real issue becomes making sure people have access to insurance. Unfortunately, a lot of times, insurance is tied to employment. If someone’s working for a company that is a smaller business and doesn’t offer insurance or if they are unemployed, that’s clearly going to be a barrier.
This is why there’s so much focus on extending the cost subsidies for the premiums under the Affordable Care Act. That’s going to help people not have to pay so much out of pocket. If there are cuts to Medicaid, that means the out-of-pocket costs could be higher. When that happens, people may forgo the use of theology or their insurance altogether because they can’t afford to enroll. That is a particularly devastating outcome that we all hope won’t happen.
AFRO: What policy or healthcare system changes would you like to see to make automated insulin delivery systems more accessible and beneficial for all patients, regardless of race or income?
SHG: In research, after devices come out, there’s clinical studies that are done to prove that they improve clinical outcomes. Then, they get approval from the Food and Drug Administration (FDA) and can go into clinical practice guidelines. After that, there’s also a follow up study on all of the people who are now using these devices. You tend to have a more diverse group of people represented there. It’s important to continue that kind of work.
From a policy standpoint, it’s important that we further the expansion of Medicaid, as opposed to considering any moves to reduce funding, because that’s going to make technology and care more accessible in all areas. It’s also important to promote telemedicine further rather than take it away so it can reach patients in areas where they don’t have easy access to a diabetes specialist or clinician.
With Type 1 diabetes we’re talking about a fairly young population, and now there’s people with Type 1 who are living until they’re older adults. We want that to continue to happen, but the only way it can is if we make sure people are well-controlled early so they don’t get complications.
