Need Diabetes Proposal Ideas for a Paper

Diabetes Advocacy Public Advocacy
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I need some help from the tudiabetes community.

I am in a Technical Writing course and my final grade involves writing a professional Proposal. Without going into detail, think of it like a grant proposal that might be written to get funding for something.

Anyway I will need to include an issue or problem, show supporting facts and data, and then propose a solution with my reasons why I think it’s worth the money.

If you’re still reading THANKS!

What I want from you all is any issues you (as a diabetic) would like a solution for. It could be anything you have issues with like: insurance, pump problems, diabetes management problems, needed software for tracking, information, education, etc. You know what issues you have, let me know.

If it sounds like something I can address or support then I will write about it.

Thanks, Roger

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There are a few things that come to mind regarding PWD. One of the things that happens the longer people have D, they lose their ability to detect hypos. I have been T1 for 38 years and without my dexcom cgms I couldn't tell you if I was 50 or 250. I am so very lucky that my insurance company covers this device 100% without any question or copay.
But I am in the minority. There are at least 2 PWD of 67 and 76 years respectively who cannot get a CGM because medicare will not cover it.
What I would like is for any T1D to have access and coverage/funding for a CGM. Not only will it save the insurance companies money in the long run in avoiding complications and ER visits for hypoglycemic/hyperglycemic events, but it will go a long way to helping PWD live more active healthy lives without the risks of undetected and possibly life threatening "excursions".

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thank you clare. i'll be having my 49th 'diabirthday' this month. i am on ssd, & very grateful for the most part for the benefits. i have hypo unawareness & all that good stuff, but, i can't afford a cgm. i have some bad episodes, don't need to go into that now. i do have a petition on change.org, i'm not a good people person but over a period of time & with some really good people helping, have over 600 signatures. i am planning to send this to the administrator/coo of medicare and medicaid services when i reach 1000 signatures(5000 would be better!). roger, sorry i couldn't be of more assistance to you, i hope you do very well on your paper & in your course. clare, thank you again for posting this, if you would like to check out my petition here is the link:
http://www.change.org/petitions/medicare-cover-continuous-glucose-monitors-for-those-who-really-need-them

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Write a grant to fund a study that compares outcome from Medicare participants (T1 or T2 or both) that use the Medicare limited amount (2-4/day) to fingerstick testing to a group that can test much more frequently (4-8/day).

Medicare policy changed recently to limit the number of test strips that can be used. This limitation will have some detrimental health outcomes, it's just a matter of time. People need to be encouraged to test more; Medicare tells them it's OK to just do a few tests per day and call it good! That's a slow-motion disaster.

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Thanks Peanut, I signed the petition this morning. Bravo to you for starting it. We need more grass roots campaigns to get things changed. Perhaps you could ask admin if you could post that here somewhere ?
Congrats on your Diaversary - or Diabirthday, I "celecbrated" my 38th year on Mother's day at the graduation of my son from college.

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I agree with Terry. The value of testing cannot be underestimated. I have learned so much more with CGM so I think the more testing the better control.

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Two thoughts:

I am very concerned about the number of diabetic meds that have been recalled or questioned because of side effects. something about the process of testing a drug before marketing needs to be improved.

I think that insurance companies are taking too much control over treatment. You should be able to get the prescriptions your doctor prescribes. How often does the insurance company stop the diabetic from getting what they need? taking into account that moving drugs into tiers where some treatments are far too expensive for the patient is part of this control.

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Well I agree with the number of test strip study. However, here is a more direct issue involving test strips. How about study the accuracy of various meters for publication. With this information we could get comparisons of meter accuracy versus the cost of strips. Something we cannot do today. Actually the test could be fairly inexpensive to conduct given that no new technology need be devised.

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Perhaps the development of "best practice" guidelines for medical professionals serving diabetic clients. :)

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thanks & thanks clare :) i have put it up here, will see if i can do it again. have also put it up on several other sites, will keep trying. appreciate the encouragement.

you go roger!

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I signed your petition. Thanks for posting it!

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I think that there are three major things that need to be changed.

The first is getting a proper diagnosis. Many people are misdiagnosed with T2 before finding out that they're really LADA or T1. This causes many different expensive meds to be "wasted" before the person finds out that what they really need is insulin.

The second is proper education, specifically for people with T2. Testing once in the morning is NOT a good indicator of what your BG is like. An A1c of 7.5% isn't "good enough" just because they're diabetic. And this causes complications, which put a greater burden on the healthcare system that's trying to save some money by refusing proper training.

The third is proper supplies. People should not be denied pumps or CGMs or test strips or Novolog vs. Humalog because the insurance companies say no. Insurance companies are stupid, and they aren't living with this disease. The less access people get to adequate management tools, the more the insurance companies will have to pay in the future for the complications that could have been prevented by providing a little more supplies. If you do the math for the cost of a pump, test strips, insulin, CGM, etc, it will probably come out less than the cost of seven years of dialysis (the average amount of time a person spends on dialysis before dying). Literally half of dialysis in the US is one on PWD, mostly T2. Factor in the cost of amputations and other complications stuff and you'll have your answer--the cost-benefit analysis comes out to favor more supplies.

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thank you so much :)

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I have insulin-dependent diabetes. I live in a warm climate.
I have found - first as a result of unexplained hypoglycemic episodes, and then by trial and error - that exposing myself to sunlight - has a rather immediate effect on my BG. About 1/2 hour in direct sunlight can lower the BG by about 30 mg/dll. Sometimes even more dramatically.

I googled the topic and only find the opposite, like 'sunburn can raise BG', and some discussions about Vitamin D lowering BG (but that is a longer-term effect, not immediate as I noticed with the sun).

I would propose this as an issue to be researched.

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Negg, I like this one. Gotta give it a try.

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I would love to see a service which helps people research their insurance coverage and options. It can start with one person, and a flat hourly rate. Maybe try for some funding to help people who can't afford to pay. Lots and lots of research up front, and also on a continuing basis, but other than that it shouldn't be too expensive to get off the ground.

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Can you help pin this paper down ANY?
============================

The exclusively punitive nature of medical interactions? Whatever is said can and will be held against us in future.

The nature of treatment is short-term DAMAGE CONTROL, not health. Why?

Why do the prices keep rising on basic mandatory materials, insulin, strips? Items which have been manufactured for decades. The obscene rising costs are transferred/generated by.... unprofitable production lines? Lost legal cases? Failed drug lines?

Why do the latest insulin(s) only last 28 days before "loosing" efficacy? Why aren't/can't additives be added, and prolong the shelf life! Gee... cant think of any reason $$$$$$$$$$$$$$$$$$$$$$

Why are insulin vials made of GLASS, not a plastic-polymer composite, which would prevent breakage?! Why!

Why are closed-loop systems impossible to build re: meters, pumps, CGM's

Why are "treatments" solely externalized solutions of the most simplistic rote symptoms and never internalized cognitive approaches instead?

Why are insulin syringes never done in micro-doses, half units, quarter units?

How much do insulin strips COST to manufacture? Where is the obscene rising cost generated by?

What mental health problems are CAUSAL by the current technological focus of treatment

What psychology approach would be ideal for the treatment of Type 1 Diabetes?

Why is the AADE (American Association of Diabetes Educators) not have a "civilian" advisory? Peer mentors, etc.

Why is there NO professional organization which has a specifically DIABETIC component which advises them directly?! Our diabetes experience MATTERS yet is openly demeaned

Give me some time I can find others...

Roflmao

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Stuart, I have to disagree with some of your points:

1. the prices of insulin and stripes are obscene but: the prices for analog insulins are rising because the patents are running out in some years. After that countries with the technology like india will copy them. The prices will fall again. The same has happened with regular insulins. The current rise is just a sign of their defeat.

2. newer insulins use less additives because most of these substances are questionable for our health. Today we just know more about them than in the 80s. Is longer shelf life really worth the risks?

3. insulin vials are made of glass for good reasons:

a) substances from plastic-polymer composites could dissolve into the insulin.
b) plastic-polymer allows the passage of oxygen and other gases into the insulin. This is the main reason why insulin is degrading faster in pumps using plastic vials.

4. with the current sensor technology all roads to reliable closed-loop systems are blocked. It is the sensor technology not meeting the requirements. The rest of the system is not that complicated.

5. syringes in smaller scales are not suitable for insulin in the higher U100 concentration. For that you need a good mechanical solution that is offered by half unit and 0,1 unit pens (NovoPen Echo, Pendiq Pen). Of course you could develop a micro-dosing syringe with lower concentrations like U20. But for cost reasons most manufacturers just produce U100 - with the exception of VIAject.

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Actually the "bionic pancreas" closed loop system is not blocked by sensor technology. Current Dexcom G4 sensors are quite adequate according to the main researcher Dr. Edward Damiano. The thing that is preventing a good, reliable closed loop system from moving forward is stable glucagon. Currently glucagon is not stable and needs to be changed every day. The Beacon Hill trials of the bionic pancreas and the Joslin camp trials this summer were quite successful. Dr. Damiano has a son with T1, he said his son is going to college in 47 months, the closed loop BP will be ready in 46 months.

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Quite adequate is really not enough. Ask Dexcom users if they would trust an insulin/glucose delivering device doing its dosage adjustments based on Dexcom results alone. Quite likely the Dexcom is the best device we have but it is far from ready for this task. Today not even insulin injections should be calculated with Dexcom numbers. This will not change in 46 months (~4 years) with the current sensor technology. Finally the FDA will not give the clearance to use the device on people. Dr. Damiano will be in deep trouble if his son is using the device on his own account. Again in my personal experience current sensor technology does not cut it. Just sleeping on the side or putting pressure on the sensor can lead to false lows. There is also the problem of the A1c this device is agreed to meet. An A1c of 7 just to prevent lows is not sufficient for me.

Looking at it economically there is more troubling news. A patient on MDI costs $10 per day. A patient with a pump costs $20 per day. With the closed-loop patients need sensors and glucagon too. I would guestimate that this doubles the costs to $40 per day. To me it is quite obvious that the project will just benefit a small group of people. This is disappointing especially if you have high hopes in new technologies.

Just as a side note: Dr. Damiano is working on "bionic beta and alpha cells". The term "bionic pancreas" is a misnomer by itself because in the next 100 years mankind will not be able to develop an artificial pancreas. So for the next 100 years any serious disease of the pancreas will be a life threatening condition. This just to put things into perspective. But perhaps my expectations for a name coming from a biomedical engineer are just too high.