Clinical Policy Title: Disposable Continuous Subcutaneous Insulin Infusion Pumps

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Clinical Policy Title: Disposable Continuous Subcutaneous Insulin Infusion Pumps"

Transcription

1 Clinical Policy Title: Disposable Continuous Subcutaneous Insulin Infusion Pumps Clinical Policy Number: Effective Date: March 1, 2014 Initial Review Date: Nov. 20, 2013 Most Recent Review Date: Nov. 19, 2014 Next Review Date: November 2015 Policy contains: OmniPod Insulin Management System (Insulet Corp., Bedford, MA). V Go Disposable Insulin Delivery System (Valeritas Inc., Shrewsbury, MA). RELATED POLICIES: CP# Diabetes Self-Management Training (DSMT) Services CP# Interstitial Continuous Glucose Monitors (CGMS) ABOUT THIS POLICY: Keystone First has developed clinical policies to assist with making coverage determinations. Keystone First clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of medically necessary, and the specific facts of the particular situation are considered by Keystone First when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. Keystone First clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. Keystone First clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, Keystone First will update its clinical policies as necessary. Keystone First clinical policies are not guarantees of payment. Coverage Policy Keystone First considers the use of disposable continuous subcutaneous insulin infusion (CSII) pumps to be investigational and, therefore, not medically necessary. Limitations: All other uses of disposable CSII pumps are not medically necessary. This policy only applies to the disposable CSII pumps and does not apply to standard insulin pumps. NOTE: The following code is not on the Pennsylvania Medical Assistance Fee Schedule: A External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories Alternative Covered Services Multiple daily injections of insulin. Non-disposable external continuous infusion insulin pumps. 1

2 Background Intensive insulin therapy is an aggressive treatment approach for persons with diabetes who require close monitoring of blood glucose levels and frequent doses of insulin. Innovations in insulin delivery and glucose monitoring are designed to improve glycemic control and quality of life (QOL) while limiting adverse effects, such as hypoglycemia and weight gain. These advances include continuous subcutaneous insulin infusion (CSII), real-time continuous glucose monitoring (rt-cgm) and sensor-augmented pumps, which combine rt- CGM with CSII. Intensive insulin therapy consists of CSII using rapid-acting insulin or multiple (at least three) daily injections (MDI) along with glucose monitoring. An Agency for Healthcare Research and Quality (AHRQ) systematic review of randomized controlled trials (RCTs) found that CSII and MDI have similar effects on glycemic control and hypoglycemia for children or adolescents with Type 1 diabetes mellitus (T1DM) and for adults with Type 2 diabetes mellitus (T2DM); CSII has a favorable effect on HbA1c in adults with T1DM (Golden 2012, Yeh 2012). For glycemic control, rt-cgm is superior to the self-monitoring of blood glucose (SMBG) finger stick, and sensor-augmented insulin pumps are superior to MDI and SMBG, without increasing the risk for hypoglycemia. Adolescents and adults with T1DM reported better overall QOL with CSII than those treated with MDI. These data suggest that intensive insulin therapies designed to optimize glycemic control can be individualized to maximize treatment satisfaction and QOL. Despite these developments, many persons with diabetes continue to experience considerable fear of hypoglycemia, which may compromise care and treatment adherence, leading to worsening metabolic control (Anhalt 2010). Traditional CSII pumps are connected to the body via an infusion set and tubing for delivering insulin, but the tubing can kink or disconnect and compromise convenient and discreet use. As a result, a number of external insulin infusion patch pumps have been developed that involve no visible tubing, adhere to the body, are partially or completely disposable, and may be worn and operated discreetly under clothing. Some require a separate wireless controller device, and others include all necessary control components (Anhalt 2010). According to the American Diabetes Association (ADA), strong evidence indicates most people with T1DM should be treated with MDI injections (three to four injections per day of basal and prandial insulin) or CSII using insulin analogs to reduce hypoglycemia risk that matches prandial insulin to carbohydrate intake, premeal blood glucose and anticipated activity (ADA 2014). For persons with T2DM, due to its progressive nature insulin therapy may eventually be indicated (ADA 2014). The American Association of Clinical Endocrinologists (AACE) Consensus Panel on Insulin Pump Management (2010) defined the ideal candidate for CSII pump therapy as a motivated and DM-educated person with T1DM or insulinopenic T2DM who currently performs four or more insulin injections and four or more self-monitored blood glucose measurements daily and is willing and intellectually and physically able to undergo the rigors of insulin pump therapy initiation and maintenance (Grunberger 2010). Eligible candidates should be capable of self-management through frequent self-monitored blood glucose measurements (at least initially) and/or the use of a continuous glucose sensor device. Candidates must be able to master carbohydrate counting and insulin correction and adjustment formulas and troubleshoot 2

3 problems related to pump operation and blood glucose levels. Finally, patients should be emotionally mature, with a stable life situation, and willing to maintain frequent contact with members of their health care team, in particular their pump-supervising physician (Grunberger 2010). Both guidelines emphasize the choice of CSII device should be based on the patient s abilities, goals and needs, but neither guideline specifically recommends one device disposable or non-disposable over another. Regulation As of this writing, two external, disposable insulin infusion devices without visible tubing have received FDA 510(k) premarket approval as Class II devices (product code LZG) and are commercially available in the U.S. (FDA 2014a). They are: OmniPod Insulin Management System (Insulet Corp., Bedford, MA) Indicated for patients with diabetes who require insulin. It is a single-use, disposable device that consolidates the pump, tubing and subcutaneous needle into one compact unit (pod) and uses wireless remote technology called the Personal Diabetes Manager (PDM) to control the insulin pump. The unit is worn up to three days before requiring replacement. OmniPod originally received FDA 510(k) clearance under the name of ixl -II Diabetes Management System in Since then, several clearances have been granted that address modifications to the system, most notably integration of in vitro blood glucose measurement into the PDM and smaller and more lightweight models. Newer models are compatible with Novolog /NovoRapid, Humalog or Apidra brands of U-100 insulin. The next generation OmniPod insulin pump has been cleared for marketing (K131294), and these previous models will be discontinued (Insulet 2013): o OmniPod Insulin Management System (Insulet Corp.), cleared on August 29, 2013, (K131294). o OmniPod Insulin Management System (Insulet Corp.), cleared on December 7, 2012 (K122953). o Freestyle Glucose Meter incorporated into the OmniPod Insulin Management System (Insulet Corp.) cleared on December 15, 2011 (K111669). o ixl-ii Diabetes Management System with Blood Glucose Measurement (Insulet Corp.) cleared on January 3, 2005 (K042792). o ixl Diabetes Management System (Insulet Corp.) cleared on December 19, 2003 (K031373). V Go Disposable Insulin Delivery Device (Valeritas Inc., Shrewsbury, MA): indicated for adult patients with T2DM requiring insulin (Valeritas 2013). The V Go is a fully disposable, non electronic, self-contained, sterile, patient-fillable, single-use disposable, subcutaneous insulin infusion device with an integrated stainless steel subcutaneous needle. After filling the V Go with insulin, the device is secured to the patient's skin over the infusion site with an adhesive-backed foam pad located on the back of the pump. It provides a continuous preset basal rate of insulin and allows for on demand bolus dosing around mealtimes, and must be replaced daily. Three device models (delivering 20, 30 and 40 units/day) are preset to address the different basal and bolus requirements of each patient with a window in the top of the pump to allow the user to check the drug in the reservoir and monitor the progress of the infusion. The manufacturer s website further notes that if regular adjustments or modifications to the preset basal rate of insulin are required in a 3

4 24-hour period, or if the amount of insulin used at meals requires adjustments of less than 2-unit increments, use of the V Go Disposable Insulin Delivery Device may result in hypoglycemia (Valeritas 2013). The devices are: o V Go Insulin Delivery System (Models V Go 20, V Go 30, V Go 40; Valeritas Inc.) qualified using Humalog and Novolog, cleared on February 23, 2011 (K103825). o V Go Disposable Insulin Delivery Device (Models V Go 20, V Go 30, V Go40; Valeritas Inc.) qualified using Humalog, cleared December 1, 2010 (K100504). Methods Searches Keystone First searched PubMed and the databases of: UK National Health Services Centre for Reviews and Dissemination. Agency for Healthcare Research and Quality s National Guideline Clearinghouse and other evidence-based practice centers. The Centers for Medicare & Medicaid Services. Searches were conducted on October 28, 2013, to November 1, 2013, using the term "insulin infusion systems"[mesh] for articles published in English. Included were: Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and greater precision of effect estimation than in smaller primary studies. Systematic reviews use predetermined transparent methods to minimize bias, effectively treating the review as a scientific endeavor, and are thus rated highest in evidencegrading hierarchies. Guidelines based on systematic reviews. Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple cost studies), reporting both costs and outcomes sometimes referred to as efficiency studies which also rank near the top of evidence hierarchies. Findings No systematic reviews or economic analyses of either the OmniPod or V Go external insulin infusion pumps were identified. Existing evidence from Hayes Search & Summary reports consists of small observational studies of patients with diabetes who are experienced in the use of traditional CSII (Hayes 2013a; Hayes 2013b). One additional study investigated single-dose and averaged-dose accuracy of incremental basal deliveries for the OmniPod and three durable models of insulin pumps (Jahn 2013). The findings are summarized below: For the V Go Disposable Insulin Delivery device, two small, low-quality studies were found with insufficient reporting on patient selection criteria or health outcomes to permit conclusions on its safety or impact on health outcomes. Multiple adverse effects and safety issues have been reported to the FDA s Manufacturer and User Facility Device Experience (MAUDE) database (FDA 2014b). Therefore, the existing research evidence of the V Go Disposable Insulin Delivery device is insufficient to permit conclusions regarding its safety and effectiveness. For the Omnipod, results of low-quality, single clinical studies suggest it may offer comparable shortterm glycemic control to that of traditional CSII pumps in young adults and children with T1DM, and in adults with uncontrolled T2DM with severe insulin resistance. The newer, lighter OmniPod models offer ease of use and may be preferred particularly by those with active lifestyles. These results have not 4

5 been replicated in larger, higher-quality studies, nor has the impact on other health outcomes been determined. Results of single technical studies suggest the OmniPod may not improve upon the technical limitations of traditional CSII using current insulin analogues that are not rapid enough to achieve desired peak pre-prandial insulin concentrations, catheter wear time that may affect insulin absorption or dose accuracy (Hayes 2013b, Jahn 2013). However, insulin delivery with the OmniPod may be less susceptible to the siphon effect that might occur as a result of the position of the traditional CSII pump in relation to its tubing. The clinical significance of these findings has not been evaluated. In light of more than 500 adverse effects and safety issues reported to the FDA s MAUDE database since its approval, the existing research evidence of the OmniPod is insufficient to permit conclusions regarding its safety and effectiveness (FDA 2014c). Summary of Clinical Evidence Citation Hayes (2013a) V Go Hayes (2013b) OmniPod Jahn (2013) Content, Methods, Recommendations Key points: Searches retrieved six review articles, one cohort study (n = 6), one retrospective cohort study (n = 23); low quality. Seven adverse events associated with the V Go system in MAUDE database, no recalls reported. Hayes viewpoint There is insufficient published evidence to assess the safety and/or impact on health outcomes or patient management. Key points: Searches retrieved five reviews, one multicenter comparison, cohort study (n = 6), three laboratory studies, one randomized crossover study (n = 29), one prospective study (n = 20), one comparison study (n = 20) and three conference abstracts; low quality. > 500 adverse events listed in MAUDE database associated with the OmniPod device since August Results of single studies suggest: Young adult patients with T1DM experienced with CSII preferred OmniPod to CSII and OmniPod fit better into their lifestyle without compromising glycemic control. OmniPod improves glycemic control and QOL better than MDI in children with T1DM. OmniPod using U500 regular insulin was safe and effective at glycemic control in adults with uncontrolled T2DM and severe insulin resistance. Results of single studies suggest OmniPod may not overcome technical limitations of traditional CSII with respect to inability to achieve desired preprandial peak insulin concentration due to the relatively slow PK of current insulin analogues or the effect of catheter wear time on insulin absorption. Results of one study suggest OmniPod may offer less variation in insulin delivery than traditional CSII that may be susceptible to the siphon effect in the tubing during low basal rates. Hayes viewpoint There is insufficient published evidence to assess the safety and/or impact on health outcomes or patient management. Key points: Technical in vitro evaluation of single-dose and averaged-dose accuracy of incremental basal deliveries for one patch model and three durable models of insulin pumps. 5

6 Citation Content, Methods, Recommendations Results significant differences in single-dose and averaged-dose accuracy among the insulin pumps tested, differences were most evident between the OmniPod and the durable pump models. Of the pumps studied, the Animas OneTouch Ping demonstrated the best single-dose and averaged-dose accuracy. Further research on the clinical relevance of these findings is warranted. Methods Searches Keystone First searched PubMed and the databases of: UK National Health Services Centre for Reviews and Dissemination. Agency for Healthcare Research and Quality s National Guideline Clearinghouse and other evidence-based practice centers. The Centers for Medicare & Medicaid Services. Searches were conducted on November 12, 2014, using the term "insulin infusion Ssystems"[MeSH] and free text terms OmniPod and V Go for articles published in English since November 1, Included were: Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and greater precision of effect estimation than in smaller primary studies. Systematic reviews use predetermined transparent methods to minimize bias, effectively treating the review as a scientific endeavor, and are thus rated highest in evidencegrading hierarchies. Guidelines based on systematic reviews. Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple cost studies), reporting both costs and outcomes sometimes referred to as efficiency studies which also rank near the top of evidence hierarchies. Findings No new systematic reviews, guidelines, individual studies or economic analysis were identified for this policy update. Therefore, the policy remains unchanged. Other clinical policies Organization CMS NCD Infusion Pumps Manual Section Policy No specific mention of disposable external CSII (e.g., OmniPod or V-Go). (Effective for services performed on or after December 17, 2004.) Continuous subcutaneous insulin infusion (CSII) and related drugs/supplies are covered as medically reasonable and necessary in the home setting for the treatment of diabetic patients who: (1) either meet the updated fasting C-Peptide testing requirement, or are beta cell autoantibody positive; and, (2) satisfy the remaining criteria for insulin pump therapy as described below. Patients must meet either criterion A or B as follows: Criterion A The patient has completed a comprehensive diabetes education program, and has been on a program of multiple daily injections of insulin (i.e., at least three injections per day), with frequent self-adjustments of insulin doses for at least six months prior to initiation of the insulin pump, and has documented frequency of glucose self-testing an average of at least four times per day during the two months prior to initiation of the insulin pump, and meets one or more of the following criteria while on the multiple daily injection regimen: 6

7 Glycosylated hemoglobin level (HbAlc) > 7.0%. History of recurring hypoglycemia. Wide fluctuations in blood glucose before mealtime. Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl. History of severe glycemic excursions. Criterion B The patient with diabetes has been on a pump prior to enrollment in Medicare and has documented frequency of glucose self-testing an average of at least four times per day during the month prior to Medicare enrollment. General CSII criteria: In addition to meeting criterion A or B above, the following general requirements must be met: Must be beta cell autoantibody positive; OR The patient with diabetes must be insulinopenic per the updated fasting C-peptide testing requirement defined below: Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110% of the lower limit of normal of the laboratory's measurement method. For patients with renal insufficiency and creatinine clearance (actual or calculated from age, gender, weight and serum creatinine) 50 ml/minute, insulinopenia is defined as a fasting C-peptide level that is less than or equal to 200% of the lower limit of normal of the laboratory's measurement method. Fasting C-peptide levels will only be considered valid with a concurrently obtained fasting glucose 225 mg/dl. Levels only need to be documented once in the medical records. Continued coverage of the insulin pump would require that the patient be seen and evaluated by the treating physician at least every three months. The pump must be ordered by and follow-up care of the patient must be managed by a physician who manages multiple patients with CSII and who works closely with a team including nurses, diabetes educators and dietitians who are knowledgeable in the use of CSII. Glossary Basal insulin A low level of insulin that covers the body s need for insulin between meals and during the night. Bolus insulin The additional amounts of insulin needed in response to glucose taken in during a meal. Diabetes A metabolic disease in which the body s inability to produce any or enough insulin causes elevated levels of glucose in the blood. Fingerstick Blood test that measures the amount of glucose in a drop of venous blood produced by pricking the finger. Glucose Simple sugar found in the blood. Glycemia The concentration of glucose in the blood. 7

8 Glycemic control Typical levels of blood glucose in a person with diabetes mellitus used as a "target" goal for treatment. Glycemic excursions Fluctuations of a person s blood glucose levels during the course of a day. Glycosylated hemoglobin level The attachment of glucose to hemoglobin A in the blood; also, a test that measures the level of hemoglobin A1c in the blood to determine the average blood sugar concentrations for the preceding two to three months. Also called glycated hemoglobin, glycohemoglobin, glycosylated hemoglobin, HA1c or HbA1c. Hyperglycemia Abnormally high level of glucose in the blood. Hypoglycemia Abnormally low level of glucose in the blood. Insulin Hormone released by the pancreas in response to increased levels of glucose in the blood. Insulinopenia Deficient secretion of insulin by the pancreas, resulting in hyperglycemia. Medically Necessary- A service or benefit is Medically Necessary if it is compensable under the MA Program and if it meets any one of the following standards: The service or benefit will, or is reasonably expected to, prevent the onset of an illness, condition or disability. The service or benefit will, or is reasonably expected to, reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury or disability. The service or benefit will assist the Member to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the Member and those functional capacities that are appropriate for Members of the same age. Prandial During or relating to a meal. Rapid acting insulin A type of insulin that starts to lower blood glucose within five to 10 minutes after injection and has its strongest effect 30 minutes to three hours after injection, depending on the type used. Real time The process of producing information without any delay. Subcutaneous Administration by injection under the skin. Type 1 diabetes A lifelong condition in which the pancreas stops making insulin. Previously known as insulin dependent diabetes mellitus, (IDDM) or juvenile diabetes. Type 2 diabetes A form of diabetes in which insulin is present but does not work adequately because the body either does not produce enough insulin or the cells ignore the insulin. Previously known as adultonset diabetes mellitus, or noninsulin dependent diabetes mellitus. 8

9 References Professional society guidelines/others: American Diabetes Association. Standards of medical care in diabetes Diabetes care. Jan 2014;37 Suppl 1:S Grunberger G, Bailey TS, Cohen AJ, et al. Statement by the American Association of Clinical Endocrinologists Consensus Panel on insulin pump management. Endocrine Practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. Sep Oct 2010;16(5): Peer-reviewed references: Anhalt H, Bohannon NJ. Insulin patch pumps: their development and future in closed-loop systems. Diabetes Technol Ther Jun;12 Suppl 1:S51 8. Golden SH, Brown T, Yeh HC, et al. Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness. Comparative Effectiveness Review No. 57. (Prepared by Johns Hopkins University Evidencebased Practice Center under Contract No I.) AHRQ Publication No. 12-EHC036-EF. Rockville, MD: Agency for Healthcare Research and Quality. July Hayes, Inc. Hayes Medical Technology Report. V-Go Disposable Insulin Delivery Device (Valeritas Inc.). Lansdale, PA. Hayes, Inc. July, (a) Hayes, Inc., Hayes Medical Technology Report. Omnipod Insulin Management System (Insulet Company). Lansdale, PA. Hayes, Inc. May, (b) Jahn LG, Capurro JJ, Levy BL. Comparative dose accuracy of durable and patch insulin infusion pumps. J Diabetes Sci Technol Jul;7(4): U.S. Food and Drug Administration. 510(k) Premarket Notification Database searched using product code LZG. Available at: Accessed November 12, (a) U.S. Food and Drug Administration. MAUDE Manufacturer and User Facility Device Experience Database searched using product code LZG and Valeritas as manufacturer. Available at: Accessed November 12, (b) U.S. Food and Drug Administration. MAUDE Manufacturer and User Facility Device Experience Database searched using product code LZG and Insulet as manufacturer. Available at: Accessed November 12, (c) Valeritas, Inc. The V-Go. Helps control blood glucose with simple basal-bolus insulin delivery. Available at: Accessed November 12,

10 Yeh HC, Brown TT, Maruthur N, et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med Sep 4;157(5): Clinical Trials: Searched clinicaltrials.gov on November 12, 2014 using terms omnipod or V-Go or Insulin pump, open studies only. No trials found. Centers for Medicare & Medicaid Services (CMS) National Coverage Determination: National Coverage Determination (NCD) for Infusion Pumps (280.14) Accessed Nov. 14, 2014 Local coverage determinations: External Infusion Pumps (L5044) Pennsylvania (16003) External Infusion Pumps (L11555) South Carolina (18003) Commonly submitted codes Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill accordingly. CPT Code Description Comment REFILLING AND MAINTENANCE OF PORTABLE PUMP HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (UP TO 2 HOURS) ICD-9 Code Description Comment Secondary diabetes mellitus Diabetes mellitus Diabetes mellitus complicating pregnancy, childbirth or the puerperium. V58.67 Long-term (current) use of insulin. ICD-10 Code Description Comment E089 Diabetes mellitus due to underlying condition without complications. 10

11 E099 E139 E119 O24xx Z794 Z9641 Drug- or chemical-induced diabetes mellitus without complications. Other specified diabetes mellitus without complications. Type 2 diabetes mellitus without complications. Unspecified pre-existing diabetes mellitus in pregnancy, unspecified trimester. Long term (current) use of insulin. Presence of insulin pump (external) (internal). HCPCS Level II A9274 Description External ambulatory insulin delivery system, disposable, each; includes all supplies and accessories. Comment 11

Clinical Policy Title: Disposable Continuous Subcutaneous Insulin Infusion Pumps

Clinical Policy Title: Disposable Continuous Subcutaneous Insulin Infusion Pumps Clinical Policy Title: Disposable Continuous Subcutaneous Insulin Infusion Pumps Clinical Policy Number: 06.02.01 Effective Date: March 1, 2014 Initial Review Date: Nov. 20 th, 2013 Most Recent Review

More information

Insulin Infusion Pumps

Insulin Infusion Pumps Medical Coverage Policy Insulin Infusion Pumps EFFECTIVE DATE: 09/01/2004 POLICY LAST UPDATED: 08/06/2013 OVERVIEW The policy addresses insulin infusion pumps that are worn externally and those that are

More information

Clinical Policy Title: Insulin Infusion Therapy (Insulin Pumps)

Clinical Policy Title: Insulin Infusion Therapy (Insulin Pumps) Clinical Policy Title: Insulin Infusion Therapy (Insulin Pumps) Clinical Policy Number: 06.02.01 Effective Date: July 1, 2015 Initial Review Date: November 20, 2013 Most Recent Review Date: April 15, 2015

More information

MEDICAL COVERAGE POLICY. SERVICE: Insulin Pump and Continuous Glucose Monitoring. PRIOR AUTHORIZATION: Required. POLICY:

MEDICAL COVERAGE POLICY. SERVICE: Insulin Pump and Continuous Glucose Monitoring. PRIOR AUTHORIZATION: Required. POLICY: Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your particular benefit plan. Each benefit

More information

Criteria: CWQI HCS-123 (This criteria is consistent with CMS guidelines for External Infusion Insulin Pumps)

Criteria: CWQI HCS-123 (This criteria is consistent with CMS guidelines for External Infusion Insulin Pumps) Moda Health Plan, Inc. Medical Necessity Criteria Subject: Origination Date: 05/15 Revision Date(s): 05/2015 Developed By: Medical Criteria Committee 06/24/2015 External Infusion Insulin Pumps Page 1 of

More information

External Insulin Pumps Corporate Medical Policy

External Insulin Pumps Corporate Medical Policy External Insulin Pumps Corporate Medical Policy File name: External Insulin Pumps File code: UM.DME.02 Origination: 4/2006 Last Review: 02/2014 (ICD-10 remediation only) Next Review: 10/2014 Effective

More information

Clinical Policy Guideline

Clinical Policy Guideline Policy Title: External Insulin Infusion Pump Effective Date: 11/29/2001 Clinical Policy Guideline Date Reviewed: 07/22/10, 12/13/10, 02/18/11, 09/11, 01/23/13, 06/18/14, 07/29/15 I. DEFINITION An external

More information

Get Primed on Pumps: A beginners guide to Insulin Pump Therapy

Get Primed on Pumps: A beginners guide to Insulin Pump Therapy Get Primed on Pumps: A beginners guide to Insulin Pump Therapy Advantages of insulin pump therapy There are many advantages to using an insulin pump. Anyone can do it with the right training and support.

More information

Continuous Subcutaneous Insulin Infusion (CSII)

Continuous Subcutaneous Insulin Infusion (CSII) IMPORTANCE OF FOCUS CSII (Insulin pumps) have been used for more than 35 years. In the U.S. in 2005, the level of insulin pump penetration was estimated at 20 to 30% in patients with type 1 diabetes mellitus

More information

Medical Policy Insulin Pumps

Medical Policy Insulin Pumps Medical Policy Insulin Pumps Document Number: 027 Authorization required Insulin Pumps & supplies Notification within 24 hours of service or next business day No Prior Authorization Not covered Pulsatile

More information

Starting patients on the V-Go Disposable Insulin Delivery Device

Starting patients on the V-Go Disposable Insulin Delivery Device Starting patients on the V-Go Disposable Insulin Delivery Device A simple guide for your practice For adult patients with Type 2 diabetes on basal insulin who need to take the next step Identify appropriate

More information

CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES

CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES Protocol: END002 Effective Date: 6/1/2015 Table of Contents Page COMMERCIAL COVERAGE RATIONALE... 1 MEDICARE COVERAGE RATIONALE...

More information

Basal and Bolus Insulin 7/16/2014. Jackie Aday RN, BSN, CDE Jeni Neighbors RN, BSN, CDE. BASAL: Small amount of insulin infused every few minutes

Basal and Bolus Insulin 7/16/2014. Jackie Aday RN, BSN, CDE Jeni Neighbors RN, BSN, CDE. BASAL: Small amount of insulin infused every few minutes Jackie Aday RN, BSN, CDE Jeni Neighbors RN, BSN, CDE Insulin Pump Therapy Open looped system in which a small amount of insulin is continuously infused through a cannula or needle (basal rate) Larger doses

More information

ADMINISTRATIVE POLICY AND PROCEDURES MedStar Family Choice

ADMINISTRATIVE POLICY AND PROCEDURES MedStar Family Choice ADMINISTRATIVE POLICY AND PROCEDURES MedStar Family Choice Policy #: 1405 Subject: Continuous Glucose Effective Date: 12/01/2012 Monitoring Devices Revision Dates: 10/13, 10/14 Section: Care Management

More information

MEDICAL POLICY No R6 CONTINUOUS GLUCOSE MONITORING

MEDICAL POLICY No R6 CONTINUOUS GLUCOSE MONITORING CONTINUOUS GLUCOSE MONITORING Effective Date: May 3, 2013 Review Dates: 2/03, 1/04, 7/04, 7/05, 6/06, 6/07, 2/08, 8/08, 8/09, 4/10, 4/11, 4/12, 4/13, 5/14, 5/15, 5/16 Date Of Origin: February 26, 2003

More information

MEDICAL POLICY POLICY TITLE DIABETIC SELF-MANAGEMENT TRAINING PROGRAM POLICY NUMBER MP- 2.076

MEDICAL POLICY POLICY TITLE DIABETIC SELF-MANAGEMENT TRAINING PROGRAM POLICY NUMBER MP- 2.076 Original Issue Date (Created): July 1, 2005 Most Recent Review Date (Revised): Effective Date: May 24, 2011 August 31, 2011- RETIRED I. POLICY Initial diabetic self-management training (DSMT) may be considered

More information

Technological Advances in Diabetes Management. Patti Duprey, MS, APRN

Technological Advances in Diabetes Management. Patti Duprey, MS, APRN Technological Advances in Diabetes Management Patti Duprey, MS, APRN 22nd Annual Northeast Regional Nurse Practitioner Conference May 6-8, 2015 DISCLOSURES Speakers Bureau for Sanofi Pasteur and Janssen.

More information

Insulin Pump Management and Continuous Glucose Monitoring Systems (CGMS)

Insulin Pump Management and Continuous Glucose Monitoring Systems (CGMS) Insulin Pump Management and Continuous Glucose Monitoring Systems (CGMS) Faith Daily, RN, BSN, CDE, CPT Certified Diabetes Educator/Insulin Pump Trainer August 16, 2014 Why Pump Therapy? Mimics normal

More information

sad EFFECTIVE DATE: POLICY LAST UPDATED:

sad EFFECTIVE DATE: POLICY LAST UPDATED: Medical Coverage Policy Glucose Monitoring Systems sad EFFECTIVE DATE: 12 01 2014 POLICY LAST UPDATED: 11 18 2014 OVERVIEW This policy addresses several methods of monitoring blood glucose: the glucometer,

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Afrezza Page 1 of 6 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Afrezza (human insulin) Prime Therapeutics will review Prior Authorization requests Prior Authorization

More information

Insulin Delivery and Glucose Monitoring Methods: Future Research Needs

Insulin Delivery and Glucose Monitoring Methods: Future Research Needs Future Research Needs Paper Number 32 Insulin Delivery and Glucose Monitoring Methods: Future Research Needs Identification of Future Research Needs From Comparative Effectiveness Review No. 57 Prepared

More information

Medical Coverage Policy Glucose Monitoring Systems sad

Medical Coverage Policy Glucose Monitoring Systems sad Medical Coverage Policy Glucose Monitoring Systems sad EFFECTIVE DATE: 03 03 2009 POLICY LAST UPDATED: 01 17 2012 OVERVIEW This policy addresses several methods of monitoring blood glucose: the glucometer,

More information

Clinical Policy Title: Home uterine activity monitoring

Clinical Policy Title: Home uterine activity monitoring Clinical Policy Title: Home uterine activity monitoring Clinical Policy Number: 12.01.01 Effective Date: August 19, 2015 Initial Review Date: July 17, 2013 Most Recent Review Date: July 15, 2015 Next Review

More information

Insulin Pump Therapy and Continuous Glucose Sensor Use in the Management of Diabetes Mellitus

Insulin Pump Therapy and Continuous Glucose Sensor Use in the Management of Diabetes Mellitus Insulin Pump Therapy and Continuous Glucose Sensor Use in the Management of Diabetes Mellitus Louis Haenel, IV, DO, FACOI, FACE Endocrinology Roper Hospital Charleston, SC Dr. Louis Haenel IV has disclosed

More information

Clinical and cost-effectiveness of continuous subcutaneous insulin infusion therapy in diabetes.

Clinical and cost-effectiveness of continuous subcutaneous insulin infusion therapy in diabetes. PROTOCOL Clinical and cost-effectiveness of continuous subcutaneous insulin infusion therapy in diabetes. A. This the revised protocol (April 2002) B. Review team Contact for correspondence: Dr Jill Colquitt

More information

Medical Benefit Effective Date: 04/01/11 Next Review Date: 01/13 Preauthorization* Yes Review Dates: 07/07, 07/08, 07/09, 01/10, 01/11, 01/12

Medical Benefit Effective Date: 04/01/11 Next Review Date: 01/13 Preauthorization* Yes Review Dates: 07/07, 07/08, 07/09, 01/10, 01/11, 01/12 Continuous or Intermittent Monitoring of Glucose in Interstitial (10120) Medical Benefit Effective Date: 04/01/11 Next Review Date: 01/13 Preauthorization* Yes Review Dates: 07/07, 07/08, 07/09, 01/10,

More information

Anneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES

Anneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES Anneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES Many parents whose child is diagnosed with Type 1 diabetes wonder: Why is this happening to my child?

More information

Alternative method for delivering insulin using continuous subcutaneous insulin infusion (CSII) open loop system

Alternative method for delivering insulin using continuous subcutaneous insulin infusion (CSII) open loop system ISHP Spring CE Conference April 12, 2015 St. Luke s Medical Center Randi Lynn Griffiths, PharmD Clinical outpatient pharmacist Boise VA Medical Center Boise, Idaho Alternative method for delivering insulin

More information

Insulin Administration: What You Don t Know May Hurt Your Patient

Insulin Administration: What You Don t Know May Hurt Your Patient Insulin Administration: What You Don t Know May Hurt Your Patient Jaime A. Davidson, MD, FACP, MACE Clinical Professor of Internal Medicine UT Southwestern Medical Center Dallas, Texas Jaime A. Davidson,

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Continuous Monitoring of Glucose in the Interstitial Fluid File Name: Origination: Last CAP Review: Next CAP Review: Last Review: continuous_monitoring_of_glucose_in_the_interstitial_fluid

More information

The Diabetes Self Management Insulin Pump Therapy Program

The Diabetes Self Management Insulin Pump Therapy Program The Diabetes Self Management Insulin Pump Therapy Program Is part of a Nationally recognized program taught by CPT s Offers classes during the daytime in a three part series: PRE-PUMP CLASS SALINE START

More information

Anneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES

Anneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES Anneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES Many parents whose child is diagnosed with Type 1 diabetes wonder: Why is this happening to my child?

More information

Intensive Insulin Therapy in Diabetes Management

Intensive Insulin Therapy in Diabetes Management Intensive Insulin Therapy in Diabetes Management Lillian F. Lien, MD Medical Director, Duke Inpatient Diabetes Management Assistant Professor of Medicine Division of Endocrinology, Metabolism, & Nutrition

More information

Algorithms for Glycemic Management of Type 2 Diabetes

Algorithms for Glycemic Management of Type 2 Diabetes KENTUCKY DIABETES NETWORK, INC. Algorithms for Glycemic Management of Type 2 Diabetes The Diabetes Care Algorithms for Type 2 Diabetes included within this document are taken from the American Association

More information

Contractor Information. LCD Information. Local Coverage Determination (LCD): HbA1c (L32939) Contract Number 11202

Contractor Information. LCD Information. Local Coverage Determination (LCD): HbA1c (L32939) Contract Number 11202 Local Coverage Determination (LCD): HbA1c (L32939) Contractor Information Contractor Name Palmetto GBA opens in new window Contract Number 11202 Contract Type MAC - Part B LCD Information Document Information

More information

Diabetes Medications: Insulin Therapy

Diabetes Medications: Insulin Therapy Diabetes Medications: Insulin Therapy Courtesy Univ Texas San Antonio Eric L. Johnson, M.D. Department of Family and Community Medicine Diabetes and Insulin Type 1 Diabetes Autoimmune destruction of beta

More information

Diabetes and Technology. Disclosures Certified Insulin Pump Trainer for: Animas Medtronic Diabetes Omnipod. Rebecca Ray, MSN, APRN, FNP-C

Diabetes and Technology. Disclosures Certified Insulin Pump Trainer for: Animas Medtronic Diabetes Omnipod. Rebecca Ray, MSN, APRN, FNP-C Diabetes and Technology Rebecca Ray, MSN, APRN, FNP-C Insulin Pump Therapy and Continuous Glucose Monitoring In Patients with Type 2 Diabetes Page 1 Disclosures Certified Insulin Pump Trainer for: Animas

More information

Insulin Pump Therapy

Insulin Pump Therapy Introduction The first insulin pumps, or continuous subcutaneous insulin infusion systems (CSII), were introduced in 1976. These early pumps were the size of a backpack and were unreliable. Since then,

More information

Insulin pump therapy: then and now. Multiple cardiovascular risk intervention. Oxford Medicine Online

Insulin pump therapy: then and now. Multiple cardiovascular risk intervention. Oxford Medicine Online Oxford Medicine Online You are looking at 1-10 of 28 items for: evidence-based AND medicine MED00250 oxford_diabetes_library Insulin pump therapy: then and now John Pickup (ed.) DOI: 10.1093/med/9780199568604.003.0001

More information

Health Professional s. Guide to INSULIN PUMP THERAPY

Health Professional s. Guide to INSULIN PUMP THERAPY Health Professional s Guide to INSULIN PUMP THERAPY Table of Contents Introduction Presenting Insulin Pump Therapy to Your Patients When Your Patient Chooses the Pump Estimates for Starting Insulin Pump

More information

Continuous Insulin Pump Therapy present & Future. Dr. Abdulmoein Al-Agha, Pediatric Endocrinologist

Continuous Insulin Pump Therapy present & Future. Dr. Abdulmoein Al-Agha, Pediatric Endocrinologist Continuous Insulin Pump Therapy present & Future Dr. Abdulmoein Al-Agha, Pediatric Endocrinologist Banting and Best Convergence Toward Automation I n s u l i n D e l i v e r y 1921 Insulin 1979 Pumps We

More information

MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING

MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING 1 RECOGNITION AND DIAGNOSIS OF HYPERGLYCEMIA IN NONCRITICALLY ILL PATIENTS 2 RECOGNITION AND DIAGNOSIS OF HYPERGLYCEMIA AND DIABETES IN THE HOSPITAL

More information

Methods for Delivering Insulin and Monitoring Blood Sugar. A Review of the Research for Children, Teens, and Adults With Diabetes

Methods for Delivering Insulin and Monitoring Blood Sugar. A Review of the Research for Children, Teens, and Adults With Diabetes Methods for Delivering Insulin and Monitoring Blood Sugar A Review of the Research for Children, Teens, and Adults With Diabetes Is This Information Right for Me? Yes, if: Your doctor* has told you that

More information

Diabetes Outpatient Self-Management Training (NCD 40.1)

Diabetes Outpatient Self-Management Training (NCD 40.1) Policy Number 40.1 Approved By UnitedHealthcare Medicare Reimbursement Policy Committee Current Approval Date 02/11/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

Intensifying Insulin In Type 2 Diabetes

Intensifying Insulin In Type 2 Diabetes Intensifying Insulin In Type 2 Diabetes Eric L. Johnson, M.D. Associate Professor Department of Family and Community Medicine University of North Dakota School of Medicine and Health Sciences Assistant

More information

Modern Approaches to Transitions of Care in patients with Hyperglycemia in the Hospital Setting

Modern Approaches to Transitions of Care in patients with Hyperglycemia in the Hospital Setting Modern Approaches to Transitions of Care in patients with Hyperglycemia in the Hospital Setting Etie Moghissi, MD, FACE Clinical Associate Professor UCLA 1 Number (in Thousands) of Hospital Discharges

More information

Objectives PERINATAL INSULIN PUMPS: BASICS FOR NURSES. Historical Perspective. Insulin Pumps in Pregnancy. Insulin Pumps in the US

Objectives PERINATAL INSULIN PUMPS: BASICS FOR NURSES. Historical Perspective. Insulin Pumps in Pregnancy. Insulin Pumps in the US Objectives PERINATAL INSULIN PUMPS: BASICS FOR NURSES Jo M. Kendrick, APN BC, CDE jkendric@utmck.edu Describe indications and contraindications for insulin pump use in hospitalized patients Differentiate

More information

Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes. Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC

Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes. Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC What we ll cover Basal Insulin Basal initiation Basal alone vs. biphasic vs. prandial alone

More information

Present and Future of Insulin Therapy: Research Rationale for New Insulins

Present and Future of Insulin Therapy: Research Rationale for New Insulins Present and Future of Insulin Therapy: Research Rationale for New Insulins Current insulin analogues represent an important advance over human insulins, but clinically important limitations of these agents

More information

The table below logs the history of the steps in development of the document.

The table below logs the history of the steps in development of the document. Paediatric Insulin Pumps Version: 0.4 Committee Approved by: Clinical Cabinet Date Approved 5 February 2014 Author: Responsible Directorate: Janet Wilson Strategy and Commissioning (Children s) Date issued:

More information

Continuous Glucose Monitoring System

Continuous Glucose Monitoring System Continuous Glucose Monitoring System Policy Number: Original Effective Date: MM.02.003 03/13/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 10/24/2014 Section: DME Place(s)

More information

Blood Glucose Monitoring Basics

Blood Glucose Monitoring Basics Blood glucose (BG) monitoring is a critical aspect of diabetes management and, for patients using insulin, the purpose is robust. A patient s insulin dose design and adjustment are based on glycemic patterns

More information

Taking Insulin Pumps to School. Rachel Calendo, MS, RN, CPNP, CDE, Martha Cuevas, RN, BSN, CPT

Taking Insulin Pumps to School. Rachel Calendo, MS, RN, CPNP, CDE, Martha Cuevas, RN, BSN, CPT Taking Insulin Pumps to School Rachel Calendo, MS, RN, CPNP, CDE, Martha Cuevas, RN, BSN, CPT Insulin Pumps Today A micro-computer, about the size of a pager Programmed to deliver both a preset amount

More information

Therapy Insulin Practical guide to Health Care Providers Quick Reference F Diabetes Mellitus in Type 2

Therapy Insulin Practical guide to Health Care Providers Quick Reference F Diabetes Mellitus in Type 2 Ministry of Health, Malaysia 2010 First published March 2011 Perkhidmatan Diabetes dan Endokrinologi Kementerian Kesihatan Malaysia Practical guide to Insulin Therapy in Type 2 Diabetes Mellitus Quick

More information

The Department of Vermont Health Access Medical Policy

The Department of Vermont Health Access Medical Policy State of Vermont Department of Vermont Health Access 312 Hurricane Lane, Suite 201 [Phone] 802-879-5903 Williston, VT 05495-2807 [Fax] 802-879-5963 www.dvha.vermont.gov Agency of Human Services The Department

More information

MANAGEMENT OF TYPE - 1 DIABETES MELLITUS

MANAGEMENT OF TYPE - 1 DIABETES MELLITUS MANAGEMENT OF TYPE - 1 DIABETES MELLITUS INVESTIGATIONS AND TREATMENT MANSI NAIK VII SEMESTER INVESTIGATIONS FASTING BLOOD SUGAR PLASMA GLUCOSE HEMOGLOBIN A 1c SYMPTOMS OF TYPE 1 DIABETES MELLITUS Polyuria

More information

Challenges in Glycemic Control in Adult and Geriatric Patients. Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner

Challenges in Glycemic Control in Adult and Geriatric Patients. Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner Challenges in Glycemic Control in Adult and Geriatric Patients Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner Provide an overview of diabetes prevalence; discuss challenges and barriers

More information

tips Insulin Pump Users 1 Early detection of insulin deprivation in continuous subcutaneous 2 Population Study of Pediatric Ketoacidosis in Sweden:

tips Insulin Pump Users 1 Early detection of insulin deprivation in continuous subcutaneous 2 Population Study of Pediatric Ketoacidosis in Sweden: tips Top International Publications Selection Insulin Pump Users Early detection of insulin deprivation in continuous subcutaneous insulin infusion-treated Patients with TD Population Study of Pediatric

More information

Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol

Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol Ruth LaCasse Kalish, RPh Department of Pharmacy Objectives Review the current practice at UConn Health with sliding

More information

A guidebook for people with diabetes

A guidebook for people with diabetes A guidebook for people with diabetes This booklet is designed to supplement, not replace, your doctor s advice. Please consult your doctor if you have any questions about what you read. You ll learn how

More information

Introduction. We hope this guide will aide you and your staff in creating a safe and supportive environment for your students challenged by diabetes.

Introduction. We hope this guide will aide you and your staff in creating a safe and supportive environment for your students challenged by diabetes. Introduction Diabetes is a chronic disease that affects the body s ability to metabolize food. The body converts much of the food we eat into glucose, the body s main source of energy. Glucose is carried

More information

Clinical Policy Title: Air Ambulance Transport

Clinical Policy Title: Air Ambulance Transport Clinical Policy Title: Air Ambulance Transport Clinical Policy Number: 18.02.02 Effective Date: Oct. 1, 2014 Initial Review Date: April 16, 2014 Most Recent Review Date: May 21, 2014 Next Review Date:

More information

Insulin Initiation and Intensification

Insulin Initiation and Intensification Insulin Initiation and Intensification ANDREW S. RHINEHART, MD, FACP, CDE MEDICAL DIRECTOR AND DIABETOLOGIST JOHNSTON MEMORIAL DIABETES CARE CENTER Objectives Understand the pharmacodynamics and pharmacokinetics

More information

Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home

Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home Clinical Policy Title: Medical alert devices and other interventions for vulnerable peoples safety at home Clinical Policy Number: 17.01.02 Effective Date: April 1, 2015 Initial Review Date: January 21,

More information

Insulin: Breaking Barriers Enhancing Therapies. Jerry Meece, RPh, FACA, CDE jmeece12@cooke.net

Insulin: Breaking Barriers Enhancing Therapies. Jerry Meece, RPh, FACA, CDE jmeece12@cooke.net Insulin: Breaking Barriers Enhancing Therapies Jerry Meece, RPh, FACA, CDE jmeece12@cooke.net Questions To Address Who are candidates for insulin? When do we start insulin? How do the different types of

More information

When services are covered 1 2 We cover insulin pumps and insulin pump supplies, in accordance with the Massachusetts Mandate, Chapter 175.

When services are covered 1 2 We cover insulin pumps and insulin pump supplies, in accordance with the Massachusetts Mandate, Chapter 175. MEDICAL POLICY Policy #: 332 Original policy date: 4/96 Page: 1 of 8 Revised date: 6/27/2014 Title Insulin Delivery Devices Pumps, Pens, and Jet Injectors Related policies: Diabetic Supplies, #202 CGMS,

More information

Lead Clinician(S) (DATE) Approved by Diabetes Directorate on: Approved by Medicines Safety Group on: This guideline should not be used after end of:

Lead Clinician(S) (DATE) Approved by Diabetes Directorate on: Approved by Medicines Safety Group on: This guideline should not be used after end of: Guideline for members of the diabetes team and dietetic department for advising on insulin dose adjustment and teaching the skills of insulin dose adjustment to adults with type 1 or type 2 diabetes mellitus

More information

A Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or

A Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or A Simplified Approach to Initiating Insulin When to Start Insulin: 1. Fasting plasma glucose (FPG) levels >250 mg/dl or 2. Glycated hemoglobin (A1C) >10% or 3. Random plasma glucose consistently >300 mg/dl

More information

CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES

CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES MEDICAL POLICY CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES Policy Number: CS024.E Effective Date: April 1, 2016 Table of Contents COVERAGE RATIONALE APPLICABLE CODES.. DESCRIPTION

More information

Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation

Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation Clinical Policy Title: Leiomyosarcoma and Laparoscopic Power Morcellation Clinical Policy Number: 12.03.01 Effective Date: January 1, 2015 Initial Review Date: August 20, 2014 Most Recent Review Date:

More information

TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY. Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU

TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY. Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU Objectives: 1. To discuss epidemiology and presentation

More information

CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES

CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES MEDICAL POLICY CONTINUOUS GLUCOSE MONITORING AND INSULIN DELIVERY FOR MANAGING DIABETES Policy Number: 2015T0347R Effective Date: April 22, 2015 Table of Contents BENEFIT CONSIDERATIONS COVERAGE RATIONALE

More information

Insulin Pump Therapy in children & Adolescents. Dr. Abdulmoein Al-Agha, MBBS,DCH, FRCP(UK) Pediatric Endocrinologist

Insulin Pump Therapy in children & Adolescents. Dr. Abdulmoein Al-Agha, MBBS,DCH, FRCP(UK) Pediatric Endocrinologist Insulin Pump Therapy in children & Adolescents Dr. Abdulmoein Al-Agha, MBBS,DCH, FRCP(UK) Pediatric Endocrinologist Insulin The most powerful agent we have to control glucose Banting and Best The Miracle

More information

CLINICAL PRACTICE GUIDELINE

CLINICAL PRACTICE GUIDELINE CLINICAL PRACTICE GUIDELINE Procedure: Diabetes Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014 PURPOSE:

More information

Numerous studies have demonstrated that utilization

Numerous studies have demonstrated that utilization DIABETES TECHNOLOGY & THERAPEUTICS Volume 18, Supplement 2, 2016 ª Mary Ann Liebert, Inc. DOI: 10.1089/dia.2015.0369 ORIGINAL ARTICLE Use of Glucose Rate of Change Arrows to Adjust Insulin Therapy Among

More information

Insulin pump therapy: then and now. Technology, current and future. Diabetic nephropathy. Oxford Medicine Online

Insulin pump therapy: then and now. Technology, current and future. Diabetic nephropathy. Oxford Medicine Online Oxford Medicine Online You are looking at 1-10 of 42 items for: evidence-based AND medicine oxford_diabetes_library Insulin pump therapy: then and now John Pickup (ed.) ISBN: 9780199568604 eisbn: 9780199607440

More information

Intensifying Insulin Therapy

Intensifying Insulin Therapy Intensifying Insulin Therapy Rick Hess, PharmD, CDE, BC-ADM Associate Professor Gatton College of Pharmacy, Department of Pharmacy Practice East Tennessee State University Johnson City, Tennessee Learning

More information

WHAT CAN I DO TO REDUCE MY RISK OF DEVELOPING THE COMPLICATIONS OF TYPE 1 DIABETES?

WHAT CAN I DO TO REDUCE MY RISK OF DEVELOPING THE COMPLICATIONS OF TYPE 1 DIABETES? Christian In better control with his pump since 2012 WHAT CAN I DO TO REDUCE MY RISK OF DEVELOPING THE COMPLICATIONS OF TYPE 1 DIABETES? Many people with Type 1 diabetes worry about potential long-term

More information

Insulin Pump Therapy. Jen Block, MSN, RN, CDE Stanford University Department of Pediatric Endocrinology

Insulin Pump Therapy. Jen Block, MSN, RN, CDE Stanford University Department of Pediatric Endocrinology Insulin Pump Therapy Jen Block, MSN, RN, CDE Stanford University Department of Pediatric Endocrinology Disclosures Member of Clinical Advisory Panel for Tandem Work on a variety of clinical trials funded

More information

Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control National Quality Strategy Domain: Effective Clinical Care

Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control National Quality Strategy Domain: Effective Clinical Care Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage

More information

Overview. Provider Qualifications

Overview. Provider Qualifications Overview Diabetes self management training (DSMT) is a collaborative process through which patients with diabetes gain knowledge and skills needed to modify behavior and successfully manage the disease

More information

Clinical Policy Title: Air Ambulance Transport

Clinical Policy Title: Air Ambulance Transport Clinical Policy Title: Air Ambulance Transport Clinical Policy Number: 18.02.02 Effective Date: Sept. 1, 2014 Initial Review Date: April 16, 2014 Most Recent Review Date: May 21, 2014 Next Review Date:

More information

Insulin Delivery Options: Inhale, Inject, and Infuse. Traci Evans, A.N.P., B.C.-A.D.M. Nurse Practitioner The Diabetes Center Ocean Springs, MS

Insulin Delivery Options: Inhale, Inject, and Infuse. Traci Evans, A.N.P., B.C.-A.D.M. Nurse Practitioner The Diabetes Center Ocean Springs, MS Insulin Delivery Options: Inhale, Inject, and Infuse Traci Evans, A.N.P., B.C.-A.D.M. Nurse Practitioner The Diabetes Center Ocean Springs, MS Objectives Identify three ways patients are able to utilize

More information

4/7/2015 CONFLICT OF INTEREST DISCLOSURE OBJECTIVES. Conflicts of Interest None Heather Rush. Heather M. Rush, APRN, CDE Louisville, KY

4/7/2015 CONFLICT OF INTEREST DISCLOSURE OBJECTIVES. Conflicts of Interest None Heather Rush. Heather M. Rush, APRN, CDE Louisville, KY Heather M. Rush, APRN, CDE Louisville, KY CONFLICT OF INTEREST DISCLOSURE Conflicts of Interest None Heather Rush A conflict of interest exists when an individual is in a position to profit directly or

More information

Who is suitable for CSII, Why and How to Access Pump Therapy Mary Bilous and Sue Winship Diabetes Specialist Nurses James Cook University Hospital

Who is suitable for CSII, Why and How to Access Pump Therapy Mary Bilous and Sue Winship Diabetes Specialist Nurses James Cook University Hospital Who is suitable for CSII, Why and How to Access Pump Therapy Mary Bilous and Sue Winship Diabetes Specialist Nurses James Cook University Hospital What is CSII? Insulin pump therapy or Continuous Subcutaneous

More information

Diabetes and Insulin Pumps. Amy S. Pullen Pharm.D ISHP Spring Meeting April 2012

Diabetes and Insulin Pumps. Amy S. Pullen Pharm.D ISHP Spring Meeting April 2012 Diabetes and Insulin Pumps Amy S. Pullen Pharm.D ISHP Spring Meeting April 2012 Objectives Describe the different types of insulin used in diabetes Identify the types of insulin that are compatible with

More information

BASAL BOLUS INSULIN FOR MEDICAL- SURGICAL INPATIENTS

BASAL BOLUS INSULIN FOR MEDICAL- SURGICAL INPATIENTS BASAL BOLUS INSULIN FOR MEDICAL- SURGICAL INPATIENTS C O N T A C T D I A B E T E S S E R V I C E S F O R M O R E I N F O R M A T I O N 8 4 7-9 1 7-6 9 0 7 THIS SLIDE PRESENTATION WAS PREPARED BY SUE DROGOS,

More information

Mary Ann Vann MD Beth Israel Deaconess Medical Center Boston, MA

Mary Ann Vann MD Beth Israel Deaconess Medical Center Boston, MA Mary Ann Vann MD Beth Israel Deaconess Medical Center Boston, MA Presentation Focus SAMBA Consensus Statement VANN 2011 1 References Vann MA. Current Opinion in Anesthesiology. December 2009. Joshi GP,

More information

Concise Consult. Blood Glucose Monitoring System. Innovative technology for advanced accuracy in measuring blood glucose

Concise Consult. Blood Glucose Monitoring System. Innovative technology for advanced accuracy in measuring blood glucose Concise Consult Co n to u r Ne x t EZ Blood Glucose Monitoring System Innovative technology for advanced accuracy in measuring blood glucose For the health care professional How self-monitoring of blood

More information

Hong Kong College of Paediatric Nursing Diabetes Education and Guidance to child and family. #Case Senario#

Hong Kong College of Paediatric Nursing Diabetes Education and Guidance to child and family. #Case Senario# Hong Kong College of Paediatric Nursing Diabetes Education and Guidance to child and family #Case Senario# Veronica Hung - Nurse Consultant (Diabetes) NTWC Case Scenario At A&E CKY, now age 12, S1 student,

More information

Glycaemic Control in Adults with Type 1 Diabetes

Glycaemic Control in Adults with Type 1 Diabetes Glycaemic Control in Adults with Type 1 Diabetes Aim(s) and objective(s) This document aims to provide guidance on good clinical practice in managing glycaemic control in adult patients with Type 1 Diabetes

More information

HEALTH SERVICES POLICY & PROCEDURE MANUAL

HEALTH SERVICES POLICY & PROCEDURE MANUAL Page 1 of 5 PURPOSE To assure that DOP inmates with Diabetes, who require insulin therapy, are receiving high quality Primary Care for their condition. POLICY All DOP Primary Care Providers are to follow

More information

I HAVE JUST BEEN DIAGNOSED WITH TYPE 1 DIABETES

I HAVE JUST BEEN DIAGNOSED WITH TYPE 1 DIABETES Dominika In better control with her pump since 2012 I HAVE JUST BEEN DIAGNOSED WITH TYPE 1 DIABETES The diagnosis of Type 1 diabetes may come as a shock and may lead to many questions, such as: Why is

More information

CLINICAL PERFORMANCE OF CONTINUOUS GLUCOSE MONITORING SYSTEM IN TYPE 1 DIABETICS

CLINICAL PERFORMANCE OF CONTINUOUS GLUCOSE MONITORING SYSTEM IN TYPE 1 DIABETICS Department of Endocrinology, Diabetes and Metabolic Disorders, School of Medicine, Sv. Kiril i Metodij University, Bihaæka 3-2-41, MK-1000 Skopje, Macedonia Original Scientific Paper Received: October

More information

Medical Policy Continuous Glucose Monitors

Medical Policy Continuous Glucose Monitors Medical Policy Continuous Glucose Monitors Document Number: 025 Authorization required Long Term Continuous Glucose Monitors & Sensors Notification within 24 hours of service or next business day No Prior

More information

QUESTION 3. HOW SHOULD THE DATA AND REPORTING BE INTERPRETED?

QUESTION 3. HOW SHOULD THE DATA AND REPORTING BE INTERPRETED? QUESTION 3. HOW SHOULD THE DATA AND REPORTING BE INTERPRETED? AACE/ACE CGM Consensus Conference: Medical, Scientific, Professional, and Educational Societies Question 3a. Are there standard metrics that

More information

Smart Pumping with Insulin Pumps

Smart Pumping with Insulin Pumps Smart Pumping with Insulin Pumps Rita Ketay RN, CDE, Ed.M, BC-ADM Dartmouth Hitchcock Medical Center During this discussion we will: * Review the DCCT recommendations; * Define smart pumping ; * Discuss

More information

Medical Policy Insulin Delivery Devices

Medical Policy Insulin Delivery Devices Medical Policy Insulin Delivery Devices Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information

More information

Asian Journal of Phytomedicine and Clinical Research Journal home page:

Asian Journal of Phytomedicine and Clinical Research Journal home page: Research Article CODEN: AJPCFF ISSN: 2321 0915 Asian Journal of Phytomedicine and Clinical Research Journal home page: www.ajpcrjournal.com A COMPARITIVE STUDY FOR THE ASSESSMENT OF QUALITY OF LIFE USING

More information

There seem to be inconsistencies regarding diabetic management in

There seem to be inconsistencies regarding diabetic management in Society of Ambulatory Anesthesia (SAMBA) Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Review of the consensus statement and additional

More information