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

Jennifer B Bollyky, Dena Bravata, Jason Yang, Mark Williamson, Jennifer Schneider, Jennifer B Bollyky, Dena Bravata, Jason Yang, Mark Williamson, Jennifer Schneider

Abstract

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.

Figures

Figure 1
Figure 1
Estimated HbA1c (eA1c) change over time by the intervention group.
Figure 2
Figure 2
(a) Frequency of lifestyle coaching interactions correlated by engagement level and intervention arm. (b) Engagement with a Restore Health coach is correlated with weight loss and BG change.
Figure 3
Figure 3
Diabetes Empowerment Scale (DES-SF). The DES-SF asks respondents on a 5-point scale how much they agree with eight statements related how they feel they are coping with diabetes (strongly disagree = 1, strongly agree = 5). Higher scores are associated with greater empowerment. Individual intervention groups did not vary significantly from each other, however the overall mean DES-SF score at registration was significantly lower than at that at 6 months after registration (0.7 difference, p = 0.03).

References

    1. Menke A., Casagrande S., Geiss L., Cowie C. C. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. 2015;314(10):1021–1029. doi: 10.1001/jama.2015.10029.
    1. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. 2013;36(4):1033–1046. doi: 10.2337/dc12-2625.
    1. Hunt C. W. Technology and diabetes self-management: an integrative review. 2015;6(2):225–233. doi: 10.4239/wjd.v6.i2.225.
    1. American Diabetes Association. Standards of medical care in diabetes—2015: summary of revisions. 2015;38(Supplement 1):S4–S4. doi: 10.2337/dc15-S003.
    1. Ziegler R., Heidtmann B., Hilgard D., et al. Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. 2011;12(1):11–17. doi: 10.1111/j.1399-5448.2010.00650.x.
    1. Allemann S., Houriet C., Diem P., Stettler C. Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. 2009;25(12):2903–2913. doi: 10.1185/03007990903364665.
    1. Downing J., Bollyky J., Schneider J. HbA1c reduction and fewer days with high and low blood glucose readings with cellular-enabled glucose meter. 2016;65(Supplement 1)
    1. Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. 2009;374(9702):1677–1686. doi: 10.1016/S0140-6736(09)61457-4.
    1. The Diabetes Prevention Program (DPP) Research Group. The diabetes prevention program (DPP): description of lifestyle intervention. 2002;25(12):2165–2171. doi: 10.2337/diacare.25.12.2165.
    1. Darkins A., Ryan P., Kobb R., et al. Care coordination/home telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. 2008;14(10):1118–1126. doi: 10.1089/tmj.2008.0021.
    1. Su W., Chen F., Dall T. M., Iacobucci W., Perreault L. Return on investment for digital behavioral counseling in patients with prediabetes and cardiovascular disease. 2016;13, article 150357 doi: 10.5888/pcd13.150357.
    1. R Foundation for Statistical Computing. R Core Team. R: a language and environment for statistical computing. 2016,
    1. Nathan D. M., Kuenen J., Borg R., et al. Translating the A1C assay into estimated average glucose values. 2008;31(8):1473–1478. doi: 10.2337/dc08-0545.
    1. Anderson R. M., Funnell M. M., Fitzgerald J. T., Marrero D. G. The diabetes empowerment scale: a measure of psychosocial self-efficacy. 2000;23(6):739–743. doi: 10.2337/diacare.23.6.739.
    1. . August 2017, .
    1. Fitch K., Pyenson B. S., Iwasaki K. Medical claim cost impact of improved diabetes control for medicare and commercially insured patients with type 2 diabetes. 2013;19(8):609–620. doi: 10.18553/jmcp.2013.19.8.609.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit