A free 6-month program run by Blue Circle Health helps fill in care gaps for adults with type 1 diabetes (T1D), whether they are managed by an endocrinologist or primary care, and has recently been expanded to 20 eastern US states.

The virtual program was founded in 2021 and is fully supported by the Helmsley Charitable Trust.

“Only 1 in 4 people with T1D achieve healthy blood glucose management. Recent changes at the federal level will soon make things even more challenging with millions set to lose or have reduced access to health insurance,” Blue Circle Health CEO Leonard D’Avolio, PhD, said in a message on the company website.

“We wanted to fill in the gaps that exist in our current healthcare system,” endocrinologist Monica Gomberg, MD, vice president of clinical care at Blue Circle Health, told Medscape Medical News. “The Blue Circle Health mission is to learn the best way to care for as many people as possible living with T1D and to share those learnings to improve T1D care everywhere.”

The program takes people of any T1D duration, with a wide range of needs, and offers a variety of services, including endocrinology care, insurance navigation, counseling, and peer support. Interactions are conducted via text, phone calls, and videoconferencing, in both English and Spanish.

“We have a very large underserved population [in the US]. We’re able to give them financial access, access to devices for free, as well as a case manager,” Gomberg said. “We also work with a lot of people who perhaps have all the services they need but have never been able to talk to someone about diabetes-related distress — we have a service line just for that,” she added. “Or maybe they’ve never met someone else with T1D. There really is that spectrum.”

A patient assistance program is available for people with incomes below 300% of the federal poverty level who are struggling to afford medications and supplies. A 90-day introduction to continuous glucose monitoring (CGM), including FreeStyle Libre 3 Plus sensors, is provided through Abbott’s “compassionate care” program. Blue Circle Health provides education on CGM use.

To date, the program has enrolled more than 1000 nonpregnant adults with T1D, with about 350 active participants in any given 6-month period.

The latest Helmsley funding for Blue Circle Health was $45 million for 2025-2028.

Outcomes Data Show Benefit

Of 1007 participants enrolled between January 2024 and mid-November 2025, 33% were aged 18-30 years, 43% 30-50 years, 21% 50-70 years, and 3% 70-90 years. Two thirds (62%) were female. Just over half (54%) were White, 24% Hispanic/Latino, and 18% Black/African American. A majority (53%) had private insurance, 21% had government insurance, and 21% were uninsured. More than a third (35%) had annual incomes of less than $50,000. A majority (54%) reported having an endocrinologist.

Even those who see an endocrinologist might encounter long waits for appointments and experience needs between visits, Gomberg pointed out.

Over the 6 months, the program team keeps the individual’s care team updated on their progress and coordinates any additional needed care with them. “We have no intention of duplicating the services they’re already getting,” she noted.

Program staff have been collecting outcomes data. Among 47 enrollees who completed the program between June and December 2024 and who took the T1-Diabetes Distress Assessment System at baseline and after completion, there were significant reductions in distress in 9 of the 10 scale categories (P < .05). Those findings were presented in a poster earlier this year at the American Diabetes Association (ADA) 85th Scientific Sessions. 

Other outcomes are also being tracked, Gomberg said. “We’re constantly looking at the data. Patients give us feedback on their experiences and the amount of care they’re getting and the time it takes for them to see any one of our service lines. All of those data points are feeding what we do and how we do it in order to constantly make it better. Everything we do is around what the patient is needing and asking us for and not around what we’re reimbursed for,” Gomberg said.

Sustainability Concerns

Michael J. Haller, MD, professor and chief of pediatric endocrinology at the University of Florida in Gainesville, Florida, was involved in the development of Blue Circle Health, when it was an offshoot of a program he’s involved with called Extension for Community Healthcare Outcomes (ECHO) Diabetes. This program trains primary care providers to manage individuals with T1D and insulin-requiring type 2 diabetes who lack access to routine specialty care in underserved communities. The program was initially funded by Helmsley, but they shifted support to Blue Circle Health. ECHO Diabetes is now supported by the ADA.

Regarding Blue Circle Health, Haller told Medscape Medical News, “By being direct to patient and 100% telemedicine, it certainly creates an enterprise where they can provide those services to people who otherwise wouldn’t get them. And that’s got great value, regardless of socioeconomic background.”

But Haller also said that he has concerns about the program’s sustainability, both in terms of how patients do after they “complete the circle” of the program and Helmsley’s ongoing funding, considering that there isn’t likely to be a commercial return on investment.

Blue Circle Health has the potential to raise the level of care to “expert level” and improve the knowledge base of patients if they “can make that happen within 6 months,” he said. However, “I worry most about the folks who are never going to see an endocrinologist, and they’re not going to be able to maintain insurance coverage after 6 months. I worry about them falling back into the system in a bad way.”

Nevertheless, he added, “it’s better than nothing.”

A Blue Circle Health spokesperson told Medscape Medical News, “Helmsley has expressed their commitment to long-term support for this program. Soon, Blue Circle Health will begin to invite others in the community to donate, including industry partners, to help them expand across the entire country.”

Gomberg reported being an employee of Blue Circle Health. Haller reported being a consultant for the program and receiving grants from the National Institutes of Health. 

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR’s Shots blog, and diaTribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.