scholarly journals The Effect of a Cellular-Enabled Glucose Meter on Glucose Control for Patients With Diabetes: Prospective Pre-Post Study (Preprint)

2019 ◽  
Author(s):  
Jennifer B Bollyky ◽  
Stephanie T Melton ◽  
Tong Xu ◽  
Stefanie L Painter ◽  
Brian Knox
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
The United States ◽  
South Florida ◽  
World Health ◽  
Target Range ◽  
Depression Symptoms ◽  
Diabetes Educator ◽  
Glucose Meter

BACKGROUND Diabetes is a global epidemic affecting approximately 30 million people in the United States. The World Health Organization recommends using technology and telecommunications to improve health care delivery and disease management. The Livongo for Diabetes Program offers a remote monitoring technology with Certified Diabetes Educator outreach. OBJECTIVE The purpose of this study was to examine health outcomes measured by changes in HbA<sub>1c</sub>, in time in target blood glucose range, and in depression symptoms for patients enrolled in a remote digital diabetes management program in a Diabetes Center of Excellence setting. METHODS The impact of the Livongo for Diabetes program on hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>), blood glucose ranges, and depression screening survey results (Patient Health Questionnaire-2 [PHQ-2]) were assessed over 12 months in a prospective cohort recruited from the University of South Florida Health Diabetes Home for Healthy Living. Any patient ≥18 years old with a diagnosis of diabetes was approached for voluntary inclusion into the program. The analysis was a pre-post design for those members enrolled in the study. Data was collected at outpatient clinic visits and remotely through the Livongo glucose meter. RESULTS A total of 86 adults were enrolled into the Livongo for Diabetes program, with 49% (42/86) female, an average age of 50 (SD 15) years, 56% (48/86) with type 2 diabetes mellitus, and 69% (59/86) with insulin use. The mean HbA<sub>1c</sub> drop amongst the group was 0.66% (<italic>P</italic>=.17), with all participants showing a decline in HbA<sub>1c</sub> at 12 months. A 17% decrease of blood glucose checks &lt;70 mg/dL occurred concurrently. Participants with type 2 diabetes not using insulin had blood glucose values within target range (70-180 mg/dL) 89% of the time. Participants with type 2 diabetes using insulin were in target range 68% of the time, and type 1 diabetes 58% of the time. Average PHQ-2 scores decreased by 0.56 points during the study period. CONCLUSIONS Participants provided with a cellular-enabled blood glucose meter with real-time feedback and access to coaching from a certified diabetes educator in an outpatient clinical setting experienced improved mean glucose values and fewer episodes of hypoglycemia relative to the start of the program.

scholarly journals The Effect of a Cellular-Enabled Glucose Meter on Glucose Control for Patients With Diabetes: Prospective Pre-Post Study

JMIR Diabetes ◽  
10.2196/14799 ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. e14799 ◽  
Author(s):  
Jennifer B Bollyky ◽  
Stephanie T Melton ◽  
Tong Xu ◽  
Stefanie L Painter ◽  
Brian Knox
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
The United States ◽  
South Florida ◽  
World Health ◽  
Target Range ◽  
Depression Symptoms ◽  
Diabetes Educator ◽  
Glucose Meter

Background Diabetes is a global epidemic affecting approximately 30 million people in the United States. The World Health Organization recommends using technology and telecommunications to improve health care delivery and disease management. The Livongo for Diabetes Program offers a remote monitoring technology with Certified Diabetes Educator outreach. Objective The purpose of this study was to examine health outcomes measured by changes in HbA1c, in time in target blood glucose range, and in depression symptoms for patients enrolled in a remote digital diabetes management program in a Diabetes Center of Excellence setting. Methods The impact of the Livongo for Diabetes program on hemoglobin A1c (HbA1c), blood glucose ranges, and depression screening survey results (Patient Health Questionnaire-2 [PHQ-2]) were assessed over 12 months in a prospective cohort recruited from the University of South Florida Health Diabetes Home for Healthy Living. Any patient ≥18 years old with a diagnosis of diabetes was approached for voluntary inclusion into the program. The analysis was a pre-post design for those members enrolled in the study. Data was collected at outpatient clinic visits and remotely through the Livongo glucose meter. Results A total of 86 adults were enrolled into the Livongo for Diabetes program, with 49% (42/86) female, an average age of 50 (SD 15) years, 56% (48/86) with type 2 diabetes mellitus, and 69% (59/86) with insulin use. The mean HbA1c drop amongst the group was 0.66% (P=.17), with all participants showing a decline in HbA1c at 12 months. A 17% decrease of blood glucose checks <70 mg/dL occurred concurrently. Participants with type 2 diabetes not using insulin had blood glucose values within target range (70-180 mg/dL) 89% of the time. Participants with type 2 diabetes using insulin were in target range 68% of the time, and type 1 diabetes 58% of the time. Average PHQ-2 scores decreased by 0.56 points during the study period. Conclusions Participants provided with a cellular-enabled blood glucose meter with real-time feedback and access to coaching from a certified diabetes educator in an outpatient clinical setting experienced improved mean glucose values and fewer episodes of hypoglycemia relative to the start of the program.

scholarly journals Pilot Study of a Prototype Integrated Diabetes Management System and the Relationship of Use to Diabetes Management Behaviors and HbA1c Among Type 2 Diabetes Patients

Iproceedings ◽  
10.2196/16298 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e16298
Author(s):  
Connor Devoe ◽  
Nils Fischer ◽  
Tim Hale ◽  
Neda Derakhshani ◽  
Mursal Atif ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Pilot Study ◽  
Basal Insulin ◽  
Diabetes Management ◽  
The United States ◽  
Step Count ◽  
Management Behaviors ◽  
Hba1c Levels

Background Type 2 diabetes (T2D) is the seventh leading cause of death (2017) in the United States, and by 2030 it is estimated that it will affect 439 million globally. Effective glycemic control can be challenging for patients. A tool to guide patients’ in their self-management behaviors and share this data with their physician may improve insulin adherence leading to lower HbA1c. We examined an integrated diabetes management (IDM) system that utilizes a Bluetooth-enabled insulin event capture device, a Bluetooth-enabled glucometer, and an Android smartphone app. IDM data can be viewed by clinicians in the electronic medical record (EMR). Objective The primary aim of this study is to describe how app use is related to insulin adherence, blood glucose measurements, meal snapshots, and step count. Secondarily, we assessed the impact on HbA1c levels over a 3- and 6-month period. Methods Thirty-five participants were enrolled from Boston-area hospitals in this single-arm pilot study. Use of the IDM system was defined as the number of days per week participants logged into the app and moved past the home screen. Three app use groups were created: low app use (0.33-2.46 days per week), medium app use (2.54-5.08 days per week), and high app use (>5.4 days per week). Adherence to insulin, blood glucose measurements, and meal snapshots were defined as a ratio of actual weekly events recorded by participants’ app use divided by their physician’s recommendation. Step count was defined as the total weekly steps for each participant. Daily app-generated data on app use and indicators of diabetes management were collected. HbA1c levels were assessed via blood test at enrollment, 3-months, and 6-months. Using a hierarchical linear mixed model, we examined changes in outcome measures while accounting for random intercepts and slopes to control for variation in individual outcomes over the study. Results Overall app use (average unique days using the app per week) declined from 6.19 days to 3.00 days (at 1 and 24 weeks, respectively). Participants with high app use had significant improvement in bolus and basal insulin adherence per week (0.009 P=.041 [95% CI 0.0004 to 0.018] and 0.016 P<.001 [95% CI 0.0079 to 0.023], respectively), but participants had no significant improvements in blood glucose and meal snapshot adherence or absolute step count. HbA1c significantly decreased per week (coefficient –0.025 [95% CI –0.044 to –0.007], P=.007) with an overall change of 0.6. Participants with high app use significantly improved their HbA1c per week (–0.037 P=.016 [–0.066 to –0.0067]) compared to participants with medium and low app use, yielding a total improvement of 0.88 over 24 weeks. Conclusions Results show that bolus and basal insulin may have increased with higher app use. HbA1c significantly improved over the course of the study, along with significantly greater improvement in HbA1c among participants with higher app use compared to participants in the middle or low app use groups. This study is not designed or intended to evaluate efficacy but provides results to guide the future design and development of this prototype IDM system.

scholarly journals Remote Lifestyle Coaching Plus a Connected Glucose Meter with Certified Diabetes Educator Support Improves Glucose and Weight Loss for People with Type 2 Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jennifer B. Bollyky ◽  
Dena Bravata ◽  
Jason Yang ◽  
Mark Williamson ◽  
Jennifer Schneider
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Cost Effective ◽  
Connected Health ◽  
Diabetes Educator ◽  
Glucose Meter ◽  
Program Costs ◽  
To Receive ◽  
Diabetes Educators

Background. Connected health devices with lifestyle coaching can provide real-time support for people with type 2 diabetes (T2D). However, the intensity of lifestyle coaching needed to achieve outcomes is unknown. Methods. Livongo provides connected, two-way messaging glucose meters, unlimited blood glucose (BG) test strips, and access to certified diabetes educators. We evaluated the incremental effects of adding lifestyle coaching on BG, estimated HbA1c, and weight. We randomized 330 eligible adults (T2D, HbA1c > 7.5%, BMI ≥ 25) to receive no further intervention (n=75), a connected scale (n=115), scale plus lightweight coaching (n=73), or scale plus intense coaching (n=67) for 12 weeks. We evaluated the change in outcomes using ANOVA. Results. Livongo participation alone resulted in improved BG control (mean HbA1c declined: 8.5% to 7.5%, p=0.01). Mean weight loss and additional BG decreases were higher in the intensive compared with the lightweight coaching and scale-only groups (weight change (lb): −6.4, −4.1, and −1.1, resp., p=0.01; BG change (mg/dL): −19.4, −11.3, and −2.9, resp., p=0.02). The estimated 12-week program costs were 5.5 times more for intensive than lightweight coaching. Conclusion. Livongo participation significantly improves BG control in people with T2D. Additional lifestyle coaching may be a cost-effective intervention to achieve further glucose control and weight loss.

Breastfeeding and Postpartum Glucose Regulation Among Women With Prior Gestational Diabetes: A Systematic Review

2020 ◽  
Vol 36 (4) ◽  
pp. 723-738
Author(s):  
Marie Tarrant ◽  
Rishma Chooniedass ◽  
Heidi Sze Lok Fan ◽  
Katie Del Buono ◽  
Stephanie Masina
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Infant Feeding ◽  
The United States ◽  
Glucose Regulation ◽  
Glycemic Status ◽  
Mean Blood Glucose

Background Gestational diabetes mellitus is associated with adverse maternal and fetal outcomes and increases subsequent risk of Type 2 diabetes. Researchers have shown that breastfeeding may reduce diabetes risk in women with recent gestational diabetes. Research aim To assess association between infant feeding and postpartum glucose tolerance in mothers with recent gestational diabetes within 1 year postpartum. Methods A literature search was performed up to December 31, 2019, retrieving articles related to infant feeding, gestational diabetes, and postpartum glucose regulation in four major databases (PubMed, Cochrane, CINAHL, and Embase). Methodological quality was assessed using tools from the United States National Institutes of Health and the National Heart, Lung, and Blood Institute. Results The search yielded 15 cohort studies meeting the selection criteria. Of the 15 studies, 13 (86.7%) examined the influence of breastfeeding on postpartum glycemic status, and eight (53.4%) compared the mean blood glucose values between breastfeeding and non-breastfeeding participants. Of the 13 studies that compared postpartum glycemic status, nine (60%) of the research teams found that breastfeeding lowered rates of impaired glucose tolerance, and four (26.7%) showed no significant change. In eight of the studies reporting mean blood glucose values, six (75%) reported significantly lower fasting plasma glucose in breastfeeding participants, with reductions ranging from 3.7 to 7.4 mg/dL (0.2–0.4 mmol/L). Conclusion Breastfeeding has been associated with improved postpartum glucose regulation in mothers with gestational diabetes. In pregnant women with gestational diabetes, breastfeeding may reduce the risk of Type 2 diabetes, and women with gestational diabetes should be strongly encouraged and supported to breastfeed.

scholarly journals Evaluation of a Diabetes Remote Monitoring Program Facilitated by Connected Glucose Meters for Patients with Poorly Controlled Type 2 Diabetes: A Randomized Crossover Trial. (Preprint)

2020 ◽  
Author(s):  
Daniel J. Amante ◽  
David M. Harlan ◽  
Stephenie C. Lemon ◽  
David D. McManus ◽  
Oladapo O. Olaitan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Usual Care ◽  
Remote Monitoring ◽  
Treatment Satisfaction ◽  
Monitoring Program ◽  
Cost Of Care ◽  
Glucose Meter ◽  
Diabetes Center

BACKGROUND Patients with poorly-controlled type 2 diabetes (T2D) experience increased morbidity, mortality and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices that automatically upload SMBG data to secure cloud-based databases, allow for improved sharing and monitoring of SMBG data. Real-time monitoring of SMBG data presents opportunities to provide timely support to patients responsive to abnormal SMBG recordings. Such diabetes remote monitoring programs can provide patients with poorly-controlled T2D additional support needed to improve critical outcomes. OBJECTIVE To evaluate six months of a diabetes remote monitoring program facilitated by cellular-connected glucose meter, access to a diabetes coach and support responsive to abnormal blood glucose recordings greater than 400 mg/dL or below 50 mg/dL in adults with poorly controlled T2D. METHODS Patients (n=120) receiving care at a diabetes center of excellence participated in a two-arm, 12-month randomized crossover study. The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. The coach answered questions, assisted in goal setting, and provided support in response to abnormal glucose levels. One group received the intervention for six months before returning to usual care (IV/UC). The other group received usual care before enrolling in the intervention (UC/IV) for six months. Change in hemoglobin A1c (HbA1c) was the primary outcome and change in treatment satisfaction was the secondary outcome. RESULTS Improvements in mean HbA1c were seen in both groups during the first six months (IV/UC -1.1% (SD 1.5) vs. UC/IV -0.8% (1.5), p < 0.001). After crossover, there was no significant change in HbA1c in IV/UC (mean HbA1c change +0.2 (1.7), p=0.41); however, those in UC/IV showed further improvement (mean (SD) HbA1c change -0.4% (1.0), p < 0.01). A mixed-effects model showed no significant treatment effect (IV vs. UC) over 12 months (p=0.06). However, participants with higher baseline HbA1c and those in first time period experienced greater improvements in HbA1c. Both groups reported similar improvements in treatment satisfaction throughout the study. CONCLUSIONS Patients enrolled in the diabetes remote monitoring program intervention experienced improvements in HbA1c and treatment satisfaction similar to usual care at a specialty diabetes center. Future studies on diabetes remote monitoring program should incorporate scheduled coaching components and involve family members and caregivers. CLINICALTRIAL Study details can be found at clinicaltrials.gov with the study identifier number: NCT03124043.

scholarly journals Impact of Antidepressant Use on Healthcare Utilization among Individuals with Type 2 Diabetes and Depression Symptoms in the United States: Sociodemographic, Clinical, and Behavioral Factors Matter

2018 ◽  
Vol 15 (9) ◽  
pp. 1904
Author(s):  
Ammena Binsaleh ◽  
Alexandra Perez ◽  
Ioana Popovici ◽  
Silvia Rabionet
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Healthcare Utilization ◽  
Access To Health Care ◽  
The United States ◽  
Depression Symptoms ◽  
Behavioral Factors ◽  
Antidepressant Use

Individuals with diabetes are twice as likely to struggle from depressive symptoms than individuals without diabetes. However, this joint condition is undertreated in nearly two-thirds of patients. Failure to monitor the comorbidity may lead to suboptimal therapy. This study evaluated the association of antidepressant use with healthcare utilization in a national sample of patients with type 2 diabetes and depression symptoms in the United States. It further assessed the differences in sociodemographic, clinical, and behavioral factors between those who use antidepressants and those who do not. This study was a secondary data analysis using the National Health and Nutrition Examination Survey (NHANES) for the period 2005–2014. To assess if there were significant differences in sociodemographic, clinical, and behavioral factors between those who were taking antidepressants or not, Chi Square and independent t-tests were used. To assess if there was a significant association between antidepressant use and healthcare utilization, univariate and multivariate regression analyses were conducted. Of the 955 participants, only 33% were on antidepressants. There were significant differences in sociodemographic, clinical, and behavioral factors among those who used antidepressants and those who did not. Regardless of antidepressant use, the study population had access to health care. Those on antidepressants had fewer diabetes specialists’ visits and more mental health care. There might be underlying health care disparities related to the use of, and access to, antidepressants. Further studies are needed to comprehensively explore the management of these comorbidities.

Do Postprandial Glucose Levels add Important Clinical Information When Fasting Glucose Levels are Near Normal in Non-Insulin-Dependent Patients with Type 2 Diabetes?

2009 ◽  
Vol 142 (6) ◽  
pp. 298-302
Author(s):  
Kerry D. Mansell ◽  
David F. Blackburn ◽  
Dean T. Eurich
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Clinical Information ◽  
Postprandial Glucose ◽  
Target Range ◽  
Insulin Dependent ◽  
The Mean ◽  
Dependent Type ◽  
Diabetes Patients

Background: Practice guidelines recommend that both fasting and postprandial blood glucose measurements be performed to achieve glycemic targets, yet few type 2 diabetes patients engage in postprandial glucose (PPG) testing. The purpose of this study was to determine if PPG testing provides important additional clinical information beyond fasting plasma glucose (FPG) tests in well-controlled, non-insulin-dependent type 2 diabetes patients. Methods: Subjects were recruited from 8 pharmacies and instructed to perform daily FPG tests during days 1 to 7 (run-in phase) and daily FPG and PPG tests during days 8 to 21 (test phase). Results: The mean FPG from 362 tests ( n = 52 subjects) in the run-in phase was 7 mmol/L (SD 1.4). In the test phase, the mean FPG was 7 mmol/L (SD 1.6) and the mean PPG was 8.4 mmol/L (SD 2.2) from 700 tests. For FPG tests in the recommended target range of 4 to 7 mmol/L, 87% (322/370) of corresponding (same-day) PPG tests were within the target range of 5 to 10 mmol/L. In subjects whose mean FPG was 4 to 7 mmol/L, 87% of PPG tests were also within target limits. Conclusion: Community pharmacists are often asked by patients how frequently they should be monitoring their blood glucose, but the evidence supporting self-monitoring of blood glucose (SMBG) in non-insulin-dependent type 2 diabetes patients is conflicting and unclear. Given the results from this small study, testing PPG may be unnecessary for non-insulin-dependent type 2 diabetes patients achieving FPG targets, but further study is required.

scholarly journals Diabetes and Sports

2016 ◽  
Vol 11 (1) ◽  
pp. 58-63
Author(s):  
Michael Yurkewicz ◽  
Michael Cordas ◽  
Amy Zellers ◽  
Michael Sweger
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Signs And Symptoms ◽  
The United States ◽  
Care Plan ◽  
Type I ◽  
Adequate Hydration

More than 29 million people in the United States have diabetes mellitus, including both type 1 and type 2 diabetes. The CDC also estimates that upward of 86 million people can be classified as prediabetic, with as many as 30% of these people transitioning into diabetes within the next 5 years. Individuals with type 1 diabetes account for roughly 5% of those patients. Dating back to 2008 and 2009, roughly 18 000 youth were diagnosed with type 1 diabetes each year. The prevalence of diabetes is well known; most of the studies that are completed today relate to the progression and/or treatment of those with type 2 diabetes. Yet most physicians will have to take care of a type 1 diabetic patient who will want to be active. Having a fundamental knowledge of how exercise affects insulin and blood glucose and how to manage these patients is important. Time must be taken to modify each treatment regimen for each individual. One cannot stress enough the importance of providing patient education, ensuring adequate hydration, recognizing signs and symptoms of hypoglycemia/hyperglycemia, and how to treat and prevent these serious complications. All patients must have a care plan and access to supplies during exercise. It is known that poorly controlled blood glucose can have detrimental consequences in the long term. The question is if type I diabetic athletes who are allowed to have higher blood glucose during exercise are at the same risk for these potential complications.

Sign in / Sign up

Export Citation Format

Share Document