Background: Diabetes-related distress contributes to poor self-management and glycemic control over time. Empowering diabetes patients with health literacy and self-management skills improves self-management behaviors. The Livongo Diabetes Program offers a cellular-enabled, two-way messaging device that measures blood glucose, free unlimited blood glucose test strips; and access to CDE for real-time support and goal setting. We investigated the impact of the Livongo program on diabetes distress and empowerment over 12 months and characterized members with improved responses.
Methods: The Diabetes Distress Survey (DDS2) and Diabetes Empowerment Survey (DES-SF) were administered to 957 Livongo members via email at baseline and month 12. Demographic, clinical and medical spending characteristics of Responders (with improved DDS2 and DES-SF scores or high levels of empowerment and low levels of distress), were compared to Non-responders using student t-tests and Chi-square. Patient characteristics predicting Responder status were determined using logistic regression.
Results: Mean DES-SF improved from 3.9 (pre) to 4.3 (post) (p<0.001). Mean DDS2 improved from 2.4 to 2.2 (p<0.001). Sixty-one percent of members had an improvement in both DDS2 and DES-SF and 94% had improved scores in at least one. A greater proportion of Responders used oral medications only (64% vs. 55%, p=0.01) and had increased number of days with program activities (54% vs. 50%, p=0.02), while a smaller proportion had BG>180 mg/dL (66% vs. 87%, p=0.04). Responders also had lower mean BG (139 vs. 147 mg/dL, p<0.001). Upon multivariable adjustment, Responders were less likely to be Asian, more likely to be younger, have a lower BMI and diabetes duration of 5-10 years. Medical spending was not significantly different between the groups.
Conclusions: Significant improvements in both diabetes distress and empowerment were experienced by members of the Livongo program over 12 months.
J. Bollyky: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health. W. Lu: None. S.L. Painter: Employee; Self; Livongo Health. J. Poon: Employee; Self; Eli Lilly and Company. M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.