By Julie Washington, cleveland.com
CLEVELAND, Ohio — For people with Type 1 diabetes, life is penny-pinching to afford life-saving insulin, scrambling to book medical appointments and fighting to get health insurance to pay up.
Blue Circle Health, a virtual clinical care education and support program for adults with Type 1 diabetes, wants to lighten the load and improve health outcomes by providing virtual specialists, counseling, education and more — all free. It’s been available in Ohio since November.
“You spend half your life fighting insurance companies to give you what you need, and the other half just dealing with this disease,” said Blue Circle Health CEO Leonard D’Avolio. “It’s just a really challenging condition for folks to live with.”
The telehealth care, education and support program helps Type 1 diabetes patients deal with an incurable disorder that, if left unchecked, can lead to nerve, kidney, eye and foot damage, skin and mouth conditions, and heart and blood vessel disease.
Once they sign up with Blue Circle, participants can meet virtually with diabetes educators, or learn tips on coping with stress from behavioral and peer counselors. Need to find local resources for housing or food? The program’s experts can help with that, too.
The program also offers free trials of continuous glucose monitors, a device worn on the body that can constantly measure blood sugars. Many Type 1 diabetes patients can’t afford the device, even with insurance, D’Avolio said.
Blue Circle Health can provide free services in Ohio and selected other states thanks to support from the Leona M. and Harry B. Helmsley Charitable Trust, a global philanthropy focused on Type 1 diabetes, Crohn’s Disease, Israel, rural healthcare and other topics.
Blue Circle received about $10.9 million in 2024 from the Helmsley trust, a spokesperson said.
“We sound too good to be true,” D’Avolio said. “The biggest thing we have to overcome is helping people understand that there really is a large philanthropy that is investing in this just to help.”
The 38 million Americans who have Type 1 and Type 2 diabetes are at risk for blindness, kidney failure, stroke, heart disease and loss of limbs, according to the U.S. Centers for Disease Control and Prevention.
Medical costs for people with diabetes are more than twice as high as for people without the disorder, the CDC said.
Blue Circle began accepting patients in Florida in January 2024. Since then, it’s expanded to Delaware, Maine and Vermont, with plans to add more states in 2025. Blue Circle served about 450 adults with Type 1 diabetes in 2024, D’Avolio said.
Natalie Bellini, program director for diabetes technology at University Hospitals, has signed up about 25 patients with Blue Circle.
“Now I have an option for them to get care in their own home, for free,” Bellini said.
Blue Circle also takes some of the pressure off overworked diabetes specialists like Bellini, because it gives patients another avenue for support, she said.
Mental health counseling, connections with others living with Type 1 diabetes and help with prescriptions and medical supplies are the Blue Circle services that her patients use most often, Bellini said.
Patients often seek counseling to help cope with the stress of juggling the rising cost of gas and food with the need to buy expensive medical supplies, Bellini said.
“Even when you try really hard and do everything perfectly with diabetes, (blood glucose) numbers still don’t always make sense, right? Because there’s so many things that that can make glucose go up and down,” she said.
The frustration of not being able to perfectly control glucose levels feeds into depression and anxiety.
Bellini has seen first-hand how the program benefits patients, who receive a personalized care plan when they sign up.
A UH patient about to age out of her parents’ health insurance discussed her options with a Blue Circle insurance counselor. The insurance expert urged the patient to consider her diabetic needs, such as insulin and frequent eye exams, when comparing insurance policies, Bellini said.
Another UH patient was allowing her blood sugar levels to run high because she was afraid of having a low blood sugar episode, she said. Severe low blood sugar can lead to seizures or death, but high glucose levels lead to long-term complications such as heart attack and stroke.
A Blue Circle counselor talked to the patient about the root of her fears and how to overcome them, Bellini said.
Participants can stay with the support program for just six months, but can meet virtually with Blue Circle teams as many times as they like during that period.
“We basically have six months in which we’re working together to address any number of challenges you may be facing,” D’Avolio said. At the end of six months, participants can stay connected to Blue Circle through a support group, or can re-enroll one year after their original enrollment.
Participants never pay for Blue Circle services, but they may be responsible for copays for medication and supplies.
“Our whole program is very much about empowerment and education, because this is a lifelong condition for which there is no cure,” D’Avolio said. “If we can help you build confidence and skills in all of these areas, you’ll be in a better position to thrive with this condition.”
Blue Circle participants must be 18 or older, live in a state where Blue Circle is offered, and can’t be pregnant. They can be newly diagnosed, or have lived with Type 1 diabetes for decades.
The program isn’t open to those with Type 2 diabetes, which is a separate but related disorder. The program focuses on Type 1 diabetes because fewer people have that illness. Type 1 diabetes accounts for up to 10% of all diagnosed cases of diabetes, according to federal health data.
Because Blue Circle offers only virtual visits, it works with its clients to ensure they have access to a primary care doctor or their endocrinologist who can perform eye and foot exams.
The program is collecting data on its participants to learn if their outcomes are better as compared to Type 1 diabetes patients who don’t use Blue Circle, but it’s too early for results, D’Avolio said.
In the United States, private health insurance spends about $19,000 annually for the average Type 1 diabetes patient, who also spends another $9,000 out of pocket yearly on medical bills, D’Avolio said.
“We spend an enormous amount of money and get pretty bad outcomes in return for that investment, and create terrible experiences for people with this condition,” he said. “(Blue Circle) is about showing the world that there are better ways.”
