All this talk about healthcare reform got us thinking...

Springtime has brought an unseasonable change this year. After many fits and starts, healthcare reform is now law. It's impossible to miss its historic significance - the first bid for broad healthcare expansion was made by Theodore Roosevelt - but it's also difficult to capture what the sweeping changes will ultimately mean. Naturally, I am left wondering: what does this mean for people with diabetes?

I am encouraged. For starters, it's a strong step forward for those wrestling with the cost of care. Under new provisions, insurance providers will no longer be able to deny coverage or charge excessively high rates due to pre-existing conditions - or as the American Diabetes Association described it, the bill puts an end to the "just because you have diabetes" excuse. This could allow coverage for more people with diabetes, helping them improve their own care and reducing their chances for diabetes-related complications later on.

Of course, there is still so much more to do. Diabetes and obesity need to be addressed as predominant public health concerns - as we have noted previously, most recent estimates suggest that without significant change, the number of people with diabetes in the US will grow from 24 to 44 million over the next 25 years. Critics have pointed out that the recent law - now being framed by President Obama as "health insurance reform" rather than "healthcare reform" - does not adequately address preventive medicine and patient education, where arguably the most important inroads in the diabetes epidemic can be made. The reimbursement system will still focus heavily on quantity rather than quality of care.

Yet I reemphasize: I am encouraged. That's also because spring brought with it a number of FDA Advisory Committee meetings, where the agency reviews safety standards for medical therapies and devices - in March, insulin pumps and blood glucose monitors were called into discussion. We will be writing more about these in our next issue, but it suffices to say our team was excited to hear FDA representatives voicing the need for improvements in diabetes treatments. Surely, many might say, new medications and treatments need to get to patients faster, but new therapies are being approved - for example, we were very excited to see the approval of Medtronic's new insulin pump platform, the Paradigm Revel, covered in NewNowNext this issue. And, we're awaiting this year approvals for potentially transformative treatments - exenatide once-weekly and Qnexa among them - so here's to the FDA for pushing ahead safely to optimize treatments for all patients.

Above all, amid the challenges put forth by providers, economists, insurance agencies, and pharmaceutical companies, I hope that the patient's perspective is not lost in our future healthcare discussions. As you'll see from Logbook, this is what matters most: we're very thankful to Jim Hirsch, who in this issue found us a nine year-old columnist, Boaz Alkalay, to describe his experiences with diabetes. We hope you will get as much out of Boaz's story as we did - truly, patients drive the change we all strive for.

Cheers from sunny San Francisco,

Kelly L. Close