Covering mHealth Tools for Diabetes Management

The United States has experienced increasing prevalence and incidence of diabetes (types 1 and 2) in recent decades.

However, complications due to diabetes have declined substantially (Edward et al., 2014). This is in part due to proper care management, increased patient engagement, and attention to factors resulting in health disparities.

Senators Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.) wrote a letter to the Administrator of the Centers for Medicare and Medicaid Services (CMS) urging review of coverage policies for "clinically appropriate treatment" for people living with diabetes. This includes mobile health (mHealth) devices such as glucose monitoring tools and other care management devices.

CMS has an unfortunate history of reservation when it comes to coverage for mHealth and telehealth. As a result, it has been subject to Congressional pressure to relax regulations or increase reimbursements. Patients living in rural or remote areas can access care, increase engagement, and save on healthcare costs associated with chronic disease using mHealth and telemedicine. Interventions delivered in this format have been found to be cost effective and culturally relevant (Mallow et al., 2015; Mallow, Theeke, Barnes, Whetsel & Mallow, 2014).

The letter to CMS has been praised by mHealth advocates who believe digital health is an effective complement to treatment and should be covered by Medicare. The FDA announced approval of the Dexcom G6 integrated CGM system, recognized as the first device to integrate with other compatible medical devices such as insulin pumps, blood glucose monitors, and other diabetes management devices. Paired with an insulin dosing device, it automatically triggers the insulin injection when sensors detect high blood glucose levels. Other devices approved by the FDA include Medtronic's Guardian Connect CGM platform for monitoring blood sugar readings.

Research and evaluation studies will continue investigating the technology and functionality of mHealth while examining mHealth's role on treatment, outcomes, and cost. You can access a copy of the Senators' letter, by clicking here. (PDF)