Excerpts from the Wall Street Journal Review and Outlook Section for Today, March 18. If you want to read the whole story (I really didn't take out very much) you have to be a member of WSJ.

The Pro-Diabetes Board
Washington state targets modern medicine. Coming soon to D.C.

The future tragedies of government health care will include today's
many warnings about how it operates in practice. The
subsidize-mandate-overregulate insurance model is imploding in
Massachusetts. Then there's Washington state, where a government
board may decide that modern medicine is too expensive for kids with

Seriously. In 2006, Washington created a board to scrutinize the
cost-effectiveness of various surgeries and treatments, known as the
Health Technology Assessment program. At a hearing today, the panel
will debate glucose monitoring for diabetic children under 18. In
other words, the board is targeting the fundamental standard of
diabetes care that has been the established medical consensus for at
least three decades.

This state issue deserves far more scrutiny, if only because
ObamaCare and the stimulus devoted billions of dollars to comparative
effectiveness research.... In theory, it sounds great. But the Health
Technology Assessment is an example of how comparative effectiveness
will work in the real world, as the political system tries to find
ways to restrict or limit treatment to control entitlement spending.

(Diabetes) Patients
do so either with finger sticks that are read by an electronic meter
or continuous glucose monitors that track blood sugar levels
virtually in real time.

The Health Technology Assessment has homed in on both technologies,
claiming that the "effectiveness and optimal frequency of
self-monitoring of blood glucose in patients is controversial." Not
among physicians. But in a recent report, the panel suggests that
there isn't enough "evidence" to support monitoring among childhood
and adolescent diabetics, and that the randomized controlled trials
that have been conducted aren't high quality.

Such a trial would violate medical ethics: A group of children would
essentially be required to not monitor glucose putting them at risk
for long-run complications from too high or low blood sugar,
including seizures and even death. Following a landmark 1993 trial on
tight glycemic control, and the vastly improved outcomes since, the
clinical benefits of intensive management are irrefutable.

Except, apparently, to a government board looking to scrimp.
Washington's Health Technology Assessment makes decisions for
state-subsidized health care, including Medicaid beneficiaries,
public employees and prisoners about 750,000 people. If it bans
continuous monitors or limits finger sticks to a certain daily number
at today's hearing, pediatric patients and their parents will lose
the tools and the more and better information they need to manage
their disease.

More to the point, as shown by the arbitrary Washington state method,
political comparative effectiveness isn't about informing choices.
It's really about taking away options.

Which brings us from Washington state to Washington, D.C. The Health
Technology Assessment program's director, Leah Hole-Curry, was
appointed last year as a governor of the comparative effectiveness
board established by ObamaCare. The national board is known as the
Patient-Centered Outcomes Research Institute, yet at an early meeting
in November, Ms. Hole-Curry and the other 14 governors debated
whether or not patients were the institute's "primary constituents."

Now this agenda is on autopilot. The institute is built on
self-executing funding that is, not subject to annual appropriations
like other federal programs and dedicated taxes on insurers. At the
very least Americans deserve some honesty about who these people are
and what they favor.

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Am shaking my head so hard that I may give myself whiplash. Horror story--indeed. Have other choice words I'd like to add if this wasn't a PG-13 community. Reading articles like this convinces me we're doomed as a culture. Layer upon layer of corruption & unconscionable profit driven greed. Hopeless. Bring back the guillotine.
A kid from wall street told me five years ago on a plane back from some very expensive salmon fishing : " that America needed another revolution". I didn't believe my ears. Should have paid attention and sold all our shares.
You shouldn't have to subscribe to read the whole article. If you access it though a Google search result it will give you the whole article. It did me for me at least.

The problem with this "story" is that it's not a story. If you actually go to the WSJ website and read the small print above the article you'll see it's an opinion piece. This sounds like more anti-Obama fear mongering to me.
I've found information on what they're talking about. I've only been able to read a little bit of it so far, but I can tell you right now it doesn't sound arbitrary. There was a period of time where they were taking the public's suggestions on the topic. Here's the site if you want to check it out:

For what it's worth, my diabetologist -- a professor at U.W. -- is skeptical about CGM. He says that testing interstitial fluid is delayed (20 minutes or so after BG changes) and that the accuracy just isn't there yet. He thinks that CGM would be of limited usefulness for me -- that any hypo alarms would come too late to be of much use, given my erratic and rare drops.

On the other hand, he's all in favor of me testing my BG's 6 to 8 plus times per day if that's what we need to do to get a handle on my BG's and get me under good control.

I think intelligent, well-intentioned people can disagree about the effectiveness of treatment and management options.
And I would venture to guess 99% of the folks that use CGMS on this site would beg to differ with your diabetologist's opinion. Fingerstick glucose monitoring can't even hold a candle to the level of info you get from a CGMS. I think PWD should be the only group that should be making these "decisions".
I would like to try CGMS, but as a type 2, I'm not sure I would like wearing a device all the time if I don't really need it.

I also left out of my earlier post that I am allergic to most adhesives and would probably be dealing with a red, itchy, bumpy rash at each site, which figured in to my discussion with my doctor.

I agree that we should be the final decision-makers about our care. My point was that every time a researcher or doctor has a different opinion, it is not necessarily due to some big, scary conspiracy to hurt diabetics in order to make money/save money.

Good-hearted, intelligent people can legitimately disagree.
I agree. Discussion leads to a better level of care.
My doctor is a professor at U.W. but I see him through Group Health, Dr. David McCulloch (author, by the way, of "The Diabetes Answer Book".)

There may be a difference because I'm a T2, but Dr. McCulloch was kind of enthused about some of the new CGM's coming out in the next year or two if clinical trials go well. He liked the results so far on one that is implanted under your (?) collarbone that monitors whole blood, not interstitial fluid. I didn't get all the details but he said it was "more like a pacemaker" in that it was inside your body and not just "plugged in" to your body fat.

I said, "If it's accurate and you don't have to use adhesive on your skin then sign me up!" (I'm allergic to most adhesives.)

I'm a database geek and I firmly believe that I can never have too many diabetes data points. ;0) As soon as I get my next job, I'm going to start saving for one of these new CGM's, whether Group Health likes it or not. I think he said they're scheduled to come out in 2013?
Unlike with a pump, you wouldn't even need to use it all the time, but could wear to get more data points for certain foods/events or if you make a change to your lifestyle that might be affecting numbers. It would save on the cost too.
The accuracy thing seems overblown to me. I was sort of like 'eh' but figured I'd get one anyway and have been very pleasantly suprised with how useful the data is, despite the potential for inaccuracy? The allergy thing is probably a dealbreaker though.

One thing that I think is that 6-8 isn't quite enough data points? I love the hundreds of data points from the CGM but really got things in more in line w/ about 10-14 tests/ day as you can 'cover' your whole day, spot trends and steal a march on suprises sneaking up on you?
I agree. The CGM is a great tool even if just for trending, though when I have a good sensor it's so much more than that. I actually shocked my endo (who doesn't quite 'get' technology) when I told him that I haven't reduced testing. He said something to the effect of, then what's the point? I told him that it's about testing smarter. I now usually wake up in-range because I don't have to wait until I wake up to find out that I shot up or down unexpectedly, even if being woken from a nice dream is a high price to pay!




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