This past week, I was in an office in St. Petersburg seeing patients and almost all of them were on insulin. In fact they were either on Reg and NPH, or 70/30 lin mix. I have always believed that for most type 2 patients who don’t count carbs or use a correction factor that human insulins work as well as the analogs. However, for one particular patient the use of mixed insulin made no sense, using R and NPH was not good, and using a vial and syringe made no sense with his vision problems. I went to talk to the clinician about a change and learned a couple of things. This was a capitated patient, meaning the clinician received a flat fee to care for him and that included medications as well. He explained to me that pens cost more than vials and syringes, and that using medications like glargine and aspart would cost more than he gets for each patient.
I just spent a week at CES looking at all the digital health products and although they sound great, few of our patients can actually afford to use them. This morning, researchers at google announced a modified contact lens that can measure glucose in the eye fluid. Sounds like a great idea but if we can’t afford to give patients more than one strip a day for testing, how can we even imagine an insurance company that would pay for contact lenses?
Every so often, our Diabetes In Control president, Andrew Young, and I get into a discussion on Advanced Glycation End Products (AGEs). It usually revolves around the concept that how you cook food has an effect on AGE formation. This week, the information in Item #5 will probably make him the winner.
Dave Joffe, Editor-in-chief