From: Robacker, Maire [Robacker.Maire@scrippshealth.org]
Sent: Thursday, May 13, 2004 4:02 PM
To: 'FDADocket@oc.fda.gov'
Subject: comment on docket #2004N-0086

As a diabetes educator who sees patients in private clinic settings as well
as community clinic settings, I am seeing the numbers of patient referrals
to our practice falling sharply as the epidemic of diabetes grows. Many of
the patients we do end up seeing sadly have complications. Many gaps exist
in obtaining adequate education and management.  Many of the insured
populations in our area are denied a referral which would cover access to
ADA recognized diabetes self-management education programs. Medicaid is
frequently not accepted by outpatient programs because payment will not
cover cost.  Some insurance's will allow one or two visits which is
inadequate to meet the education and behavioral/lifestyle changes needed in
the self-management of diabetes.
 For the rising numbers who are uninsured and underinsured many clinics do
not have the resources to offer diabetes education/management unless there
is a source of funding. 
Other barriers include lack of funds to pay for co-payments for services and
medications. Since the average number of medications a person with diabetes
and other complications needs is approx. 20 different medications, some of
which may not be covered or have high co-pays, it is not unusual to patients
to have to make hard choices - food, shelter or meds.
As to  prevention  sadly many of out patients are coming in late for care
and prevention is still not a priority for insurance companies even though
it is now widely reported that all will have to pay the high cost of the
complications if not prevented. 
Thank you for your attention. 

Maire Robacker RN,MSN,CDE
Diabetes Clinical Specialist 
Scripps Whittier Diabetes Program
858-626-5670 
858-626-7111 Fax
619-290-6348 pager


"Scripps Information Security" 
------------------------------------------------------------------------------
This e-mail and any files transmitted with it may contain privileged and confidential information and are intended solely for the use of the individual or entity to which they are addressed. If you are not the intended recipient or the person responsible for delivering the e-mail to the intended recipient, you are hereby notified that any dissemination or copying of this e-mail or any of its attachment(s) is strictly prohibited. If you have received this e-mail in error, please immediately notify the sending individual or entity by e-mail and permanently delete the original e-mail and attachment(s) from your computer system. Thank you for your cooperation.


==============================================================================