The Annual Congress of the AACE and the European Congress on Obesity 2013 (Continued)
Continuous Glucose Monitoring and Healthcare Coverage
In a panel discussion, Drs. Bode and Hirsch also highlighted the benefits of using a CGM. Indeed, Dr. Bode stated that many patients who use both a pump and a CGM often give up the pump before they give up the sensor.
Despite its value, it was somewhat discouraging to hear that reimbursement for CGM is still insufficient, or even unavailable, for many patients. For example, Medicare does not cover personal use of CGM, which makes this potentially life-saving technology (i.e., detecting and preventing hypoglycemia) quite expensive for older individuals with diabetes. To emphasize the important role CGM can play in this population, Dr. Hirsch cited T1D Exchange data: 12% of those who have had diabetes for over 40 years and are older than 50 years have experienced having a seizure or being in a coma from hypoglycemia. There are some cases of Medicare covering a CGM, but both Drs. Bode and Hirsch said that it took dedicated patients who wrote letters, called, and demanded that they get coverage for a CGM. Certainly, there are no guarantees, but persistence might currently be the only option. Dr. Hirsch advocated for a CGM trial with Medicare patients to demonstrate the technology's benefits on hypoglycemia. Encouragingly, the American Diabetes Association and Lilly announced a partnership on June 4 to better understand diabetes care in older adults. We hope some of the research efforts include studies on CGM in this population.
European Congress on Obesity 2013 — The Mediterranean Diet
At the European Congress on Obesity in Liverpool, UK, we appreciated hearing Dr. Miguel Ángel Martínez-González (University of Navarra, Pamplona, Spain) speak on his landmark study about the Mediterranean diet, PREDIMED (PREvención con DIeta MEDiterránea). The investigation in which he was the senior author was recently published in the prestigious New England Journal of Medicine (Estruch et al., NEJM, April 2013).
The study found that a Mediterranean diet reduced the risk of heart disease by 30% in people with a high risk for the disease. This type of diet consists of mainly plant-based foods (e.g., fruits, vegetables, whole grains, legumes, and nuts), healthy fats (e.g., virgin olive oil, nuts, and seeds), fish and poultry. The PREDIMED study had nearly 7,500 participants ranging from 55 to 80 years old. They had either type 2 diabetes or three or more metabolic syndrome risk factors (e.g. hypertension, elevated LDL cholesterol, low HDL cholesterol, etc.), but did not have heart disease. Dietitians taught everyone in the study what to eat. The control group was advised to simply reduce their dietary fat, while two other groups ate a Mediterranean diet supplemented with either nuts or virgin olive oil. Different participants stayed in the trial for different years, but after an average of 4.8 years, those who were in either of the two Mediterranean diet groups fared better than those in the control group.
PREDIMED is the first randomized controlled trial in nutrition aimed to prevent cardiovascular disease. Oftentimes, lifestyle modifications, such as changing what people eat or how much exercise they do, are very difficult to sustain over long periods of time. However, participants in the study were able to maintain the Mediterranean diet for nearly five years! We hope that there will be more nutritional studies that investigate interventions with the potential to work well after the trials end.
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