Behavioral Diabetes Institute

San Diego, United States

Behavioral Diabetes Institute

San Diego, United States

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News Article | June 22, 2017
Site: www.prnewswire.com

Along with cost savings, Livongo data shows a 0.9 percent reduction in mean HbA1c, an important indicator of how well blood glucose has been managed over a three-month period. This substantial improvement reduces the likelihood of long-term complications such as kidney failure, blindness, heart attacks, and strokes. More detailed information regarding the study can be found here. "At the end of the day, we're not only demonstrating improvement in blood glucose control for Livongo members, we're also saving employers money,"  said Dr. Jennifer Schneider, Chief Medical Officer at Livongo. "Our partnerships with employers improves the lives of many employees and their dependents." "Coming out of American Diabetes Association, there are a number of digital therapeutics in the diabetes space," said Bill Polonksy, PhD, CDE, Associate Clinical Professor in Psychiatry at the University of California San Diego and President and Co-Founder of the Behavioral Diabetes Institute. "But few others have been able to put forward clinical and cost-savings data like Livongo. While much further research is needed to clarify and further substantiate these findings, Livongo's work here is novel and quite promising." Livongo is the leading consumer digital health company that empowers people with chronic conditions to live better and healthier lives. We have developed a completely new approach for diabetes management that combines the latest technology with coaching. By offering the right information, tools, and support, at the right time, we provide our members with real-time, personalized insights and support to make diabetes management easier. We're now expanding our unique insights and approach to other chronic conditions. Our approach is leading to better clinical and financial outcomes while also creating a better experience for people with diabetes and related chronic conditions and their care team of family, friends, and medical professionals. For more information visit: www.livongo.com. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/livongo-demonstrates-cost-savings-for-self-insured-employers-300478005.html


Fisher L.,University of California at San Francisco | Gonzalez J.S.,Yeshiva University | Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute
Diabetic Medicine | Year: 2014

Studies have identified significant linkages between depression and diabetes, with depression associated with poor self-management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure 'depression' in a consistent manner. Because the diagnosis of depression is symptom-based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of 'emotional distress' be considered as a core construct to link diabetes-related distress, subclinical depression, elevated depression symptoms and major depressive disorder (MDD). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient-centred interventions can occur. © 2014 Diabetes UK.


Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Hessler D.,University of California at San Francisco
Diabetes Technology and Therapeutics | Year: 2013

Background: How does real-time (RT) continuous glucose monitoring (CGM) affect quality of life (QOL)? We explored the types and frequencies of diabetes-specific QOL changes resulting from RT-CGM as reported by current users and investigated what patient-reported factors predict these changes. Subjects and Methods: Current RT-CGM users (n=877) completed an online questionnaire investigating perceived QOL benefits/losses since RT-CGM initiation and RT-CGM attitudes and behavior. Exploratory factor analysis (EFA) examined the 16 QOL benefit/loss items to identify underlying factors. Regression analyses examined associations between demographics and RT-CGM attitudes and behavior with the QOL factors emerging from the EFA. Results: Three major QOL factors emerged: Perceived Control over Diabetes, Hypoglycemic Safety, and Interpersonal Support. QOL improvement was common for Perceived Control over Diabetes and Hypoglycemic Safety (86% and 85% of respondents, respectively), although less common for Interpersonal Support (37%). Consistent independent predictors of perceived benefits were greater confidence in using RT-CGM data (P<0.001), satisfaction with device accuracy (P≤0.05) and usability (P<0.01), older age (P<0.01), more frequent receiver screen views (P<0.05), and use of multiple daily injections (Hypoglycemic Safety and Interpersonal Support, P≤0.05). Conclusions: Diabetes-specific QOL benefits resulting from RT-CGM were common. Major predictors of QOL benefits were satisfaction with device accuracy and usability and trust in one's ability to use RT-CGM data, suggesting that "perceived efficacy," for both device and self, are key QOL determinants. Psychoeducational strategies to boost confidence in using RT-CGM data and provide reasonable device expectations might enhance QOL benefits. © Mary Ann Liebert, Inc.


Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Fisher L.,University of California at San Francisco | Hessler D.,University of California at San Francisco | And 2 more authors.
Diabetic Medicine | Year: 2014

Aims: To identify patient-reported obstacles to self-monitoring of blood glucose among those with Type 2, both insulin users and non-insulin users, and to investigate how obstacles are associated with frequency of self-monitoring and use of self-monitoring data. Methods: Patients with Type 2 diabetes (n = 886, 65% insulin users) who attended a 1-day diabetes education conference in cities across the USA completed a survey on current and recommended self-monitoring of blood glucose frequency, how they used self-monitoring results and perceived obstacles to self-monitoring use. Exploratory factor analysis examined 12 obstacle items to identify underlying factors. Regression analyses examined associations between self-monitoring of blood glucose use and the key obstacle factors identified in the exploratory factor analysis. Results: Three obstacle factors emerged: Avoidance, Pointlessness and Burden. Avoidance was the only significant independent predictor of self-monitoring frequency (β = -0.23, P < 0.001). Avoidance (β = -0.12, P < 0.01) and Pointlessness (β = -0.15, P < 0.001) independently predicted how often self-monitoring data were shared with healthcare professionals and whether or not data were used to make management adjustments (Avoidance: odds ratio = 0.74, P < 0.001; Pointlessness: odds ratio = 0.75, P < 0.01). Burden was not associated with any of the self-monitoring behavioural measures. Few differences between insulin users and non-insulin users were noted. Conclusions: Obstacles to self-monitoring of blood glucose use, both practical and emotional, were common. Higher levels of Avoidance and Pointlessness, but not Burden, were associated with less frequent self-monitoring use. Addressing patients' self-monitoring-related emotional concerns (Avoidance and Pointlessness) may be more beneficial in enhancing interest and engagement with self-monitoring of blood glucose than focusing on day-to-day, behavioural issues (Burden). © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.


Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Fisher L.,University of California at San Francisco | Hessler D.,University of California at San Francisco | And 2 more authors.
Diabetes, Obesity and Metabolism | Year: 2010

Aim: To examine patient beliefs, preferences and concerns regarding a once-weekly (QW) glucose-lowering medication option. Methods: A total of 1516 adults with type 2 diabetes drawn from a national Chronic Illness Panel completed an anonymous online survey that assessed perceived attributes of QW therapy, willingness to take an injectable QW medication and patient characteristics that might influence their willingness, such as current perceived glycaemic control and diabetes quality of life (DQOL). Results: Positive attitudes regarding QW medication were common, with current injection users significantly more likely than non-injection users to view beneficial aspects: greater convenience, better medication adherence, improved quality of life (QOL) and a less overwhelming sense of treatment (in all cases, p < 0.001). In all, 46.8% reported that they would likely take an injectable QW medication if recommended by their physician, with current injection users more than twice as likely as non-injection users (73.1 vs. 31.5%; p < 0.001). Greater willingness to take QW medications was associated with poorer DQOL [injection users only; odds ratio (OR) = 1.37, p < 0.01] and poorer perceived glycaemic control (non-injection users only; OR = 1.24, p < 0.05). Concerns arose about consistency of dosage over time, potential forgetfulness and cost. Conclusions: QW glucose-lowering medications are viewed positively by patients with type 2 diabetes, especially if they are current injection users or are dissatisfied with their current treatments or outcomes. Greater convenience, better medication adherence and improved QOL are commonly endorsed attributes. Clinicians may need to review both the positive attributes of QW medications as well as common patient concerns, when considering this option. © 2010 Blackwell Publishing Ltd.


Fisher L.,University of California at San Francisco | Hessler D.M.,University of California at San Francisco | Polonsky W.H.,Behavioral Diabetes Institute | Mullan J.,University of California at San Francisco
Diabetes Care | Year: 2012

OBJECTIVE - To identify the pattern of relationships between the 17-item Diabetes Distress Scale (DDS17) and diabetes variables to establish scale cut points for high distress among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - Recruited were 506 study 1 and 392 study 2 adults with type 2 diabetes from community medical groups. Multiple regression equations associated the DDS17, a 17-item scale that yields a mean-item score, with HbA 1c, diabetes self-efficacy, diet, and physical activity. Associations also were undertaken for the two-item DDS (DDS2) screener. Analyses included control variables, linear, and quadratic (curvilinear) DDS terms. RESULTS - Significant quadratic effects occurred between the DDS17 and each diabetes variable, with increases in distress associated with poorer outcomes: study 1 HbA 1c (P < 0.02), selfefficacy (P < 0.001), diet (P < 0.001), physical activity (P = 0.04); study 2 HbA 1c (P < 0.03), self-efficacy (P < 0.004), diet (P < 0.04), physical activity (P = NS). Substantive curvilinear associations with all four variables in both studies began at unexpectedly low levels of DDS17: the slope increased linearly between scores 1 and 2, wasmoremuted between 2 and 3, and reached a maximum between 3 and 4. This suggested three patient subgroups: little or no distress, <2.0; moderate distress, 2.0-2.9; high distress, ≥3.0. Parallel findings occurred for the DDS2. CONCLUSIONS - In two samples of type 2 diabetic patients we found a consistent pattern of curvilinear relationships between the DDS and HbA1c, diabetes self-efficacy, diet, and physical activity. The shape of these relationships suggests cut points for three patient groups: little or no, moderate, and high distress. © 2012 by the American Diabetes Association.


Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Fisher L.,University of California at San Francisco | Hessler D.,University of California at San Francisco | Edelman S.V.,University of California at San Diego
Current Medical Research and Opinion | Year: 2011

Objective: To survey the self-reported use of self-monitoring of blood glucose (SMBG) among patients with type 2 diabetes (T2DM), both insulin users (IUs) and non-insulin users (NIUs), in the United States and to examine: how often patients test; what SMBG instructions patients report receiving from their health care providers (HCPs); how the frequency of testing conforms with reported HCP recommendations for testing; and what is done with the results of testing. Differences between IUs and NIUs were also investigated. Methods: A convenience sample of 886 T2DM participants at a series of one-day conferences across the United States completed a survey on current and recommended SMBG frequency, how SMBG results were used, and how HCPs reportedly talked about SMBG issues with the patient. IUs (65% of the sample) and NIUs (35%) were examined separately. Results: IUs and NIUs reported testing significantly less frequently than was recommended (in both cases, p<0.001), with wide variations within both groups. Many IUs (42%) and NIUs (50%) did not bring SMBG data regularly to medical visits, and 54% of IUs and 56% of NIUs did not respond regularly to out-of-range SMBG readings. HCPs were generally supportive and responsive to SMBG data. More frequent SMBG was associated with more regular HCP attention to SMBG records, for IUs (p=0.02) and NIUs (p=0.004). Conclusions: Self-reported SMBG use is common in T2DM, though frequency is lower than HCP recommendations. Wide variations in actual and recommended SMBG were observed. HCP support for SMBG is reportedly common, and is associated with greater SMBG frequency. While SMBG data can be valuable, recommendations are often not followed and data often goes unused by both HCPs and patients. © 2011 Informa UK Ltd All rights reserved.


Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Fisher L.,University of California at San Francisco | Schikman C.H.,North Shore University Health System | And 6 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - To assess the effectiveness of structured blood glucose testing in poorly controlled, noninsulin-treated type 2 diabetes. RESEARCH DESIGN AND METHODS - This 12-month, prospective, cluster-randomized, multicenter study recruited 483 poorly controlled (A1C ≥7.5%), insulin-naïve type 2 diabetic subjects from 34 primary care practices in the U.S. Practices were randomized to an active control group (ACG) with enhanced usual care or a structured testing group (STG) with enhanced usual care and at least quarterly use of structured self-monitoring of blood glucose (SMBG). STG patients and physicians were trained to use a paper tool to collect/interpret 7-point glucose profiles over 3 consecutive days. The primary end point was A1C level measured at 12 months. RESULTS - The 12-month intent-to-treat analysis (ACG, n = 227; STG, n = 256) showed significantly greater reductions in mean (SE) A1C in the STG compared with the ACG: -1.2% (0.09) vs. -0.9% (0.10); Δ = -0.3%; P = 0.04. Per protocol analysis (ACG, n = 161; STG, n = 130) showed even greater mean (SE) A1C reductions in the STG compared with the ACG: -1.3% (0.11) vs. -0.8% (0.11); Δ = -0.5%; P < 0.003. Significantly more STG patients received a treatment change recommendation at the month 1 visit compared with ACG patients, regardless of the patient's initial baseline A1C level: 179 (75.5%) vs. 61 (28.0%);<0.0001. Both STG and ACG patients displayed significant (P < 0.0001) improvements in general well-being (GWB). CONCLUSIONS - Appropriate use of structured SMBG significantly improves glycemic control and facilitates more timely/aggressive treatment changes in noninsulin-treated type 2 diabetes without decreasing GWB. © 2011 by the American Diabetes Association.


Hajos T.R.S.,VU University Amsterdam | Polonsky W.H.,Behavioral Diabetes Institute | Pouwer F.,University of Tilburg | Gonder-Frederick L.,University of Virginia | Snoek F.J.,VU University Amsterdam
Diabetes Care | Year: 2014

Objective To determine a cutoff score for clinicallymeaningful fear of hypoglycemia (FoH) on the Hypoglycemia Fear Survey Worry subscale (HFS-W). Research Design And Methods Data on the HFS-W, history of hypoglycemia, emotional well-being (World Health Organization-5 well-being index), and distress about diabetes symptoms (Diabetes Symptom Checklist-Revised) were available from Dutch patients with type 2 diabeteswhowere treated with oral medication or insulin (n = 1,530). Four criteria were applied to define a threshold for clinically meaningful FoH: 1) modal score distribution (MD criterion), 2) scores 2 SDs above the mean (SD criterion), 3) concurrent validity with severe hypoglycemia and suboptimal well-being (CV criterion), and 4) an elevated score (‡3) on more than one HFS-Witem(elevated item endorsement [EI criterion]). Associations between the outcomes of these approaches and a history of severe hypoglycemia and suboptimal well-being were studied. Results Of the 1,530 patients, 19% had a HFS-Wscore of 0 (MD criterion), and 5% reported elevated FoH (HFS-W ‡ mean 1 2 SD; SD criterion). Patients with severe hypoglycemia reported higher HFS-W scores than those without (25 6 20 vs. 15 6 17; P 0.001). Patients with suboptimal well-being reported higher HFS-W scores than those with satisfactory well-being (20 6 18 vs. 13 6 15; P 0.001, CV criterion). Elevated FoH (defined by the EI criterion) was seen in 26% of patients. The SD and EI criteria were the strongest associated with history of severe hypoglycemia. The EI criterion was the strongest associated with suboptimal well-being. Conclusions Although no definite cutoff score has been determined, the EI criterion may be most indicative of clinically relevant FoH in this exploratory study. Further testing of the clinical relevance of this criterion is needed. © 2014 by the American Diabetes Association.


Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Hajos T.R.S.,VU University Amsterdam | Dain M.-P.,Sanofi S.A. | Snoek F.J.,VU University Amsterdam
Current Medical Research and Opinion | Year: 2011

Objective: To examine the scope and underpinnings of psychological insulin resistance (PIR) across eight Western nations, with special attention to the potential influence of beliefs about insulin and broader patient beliefs regarding medications and diabetes. Methods: A total of 1400 subjects with insulin-naïve, type 2 diabetes across eight nations completed an online survey. The survey assessed willingness to start insulin, beliefs about insulin and current medications, and diabetes-related emotional distress. Results: The majority of respondents were male (59.3%), mean age was 51.6 years and mean diabetes duration was 6.1 years. A total of 17.2% reported they would be unwilling to start insulin (the PIR group), while 34.7% were ambivalent and 48.1% indicated they would be willing to do so. Marked differences by country were apparent, with PIR ranging from 5.9% (Spain) to 37.3% (Italy). Both unwilling and ambivalent patients reported significantly more negative (p<0.001; p<0.05) and fewer positive beliefs (p<0.001; p<0.01) about starting insulin, more negative feelings about their current medications (p<0.01, p<0.001), and more diabetes-related distress (p<0.001; p<0.05) than willing patients. Unwilling patients also reported significantly more negative (p<0.05) and fewer positive beliefs (p<0.001) about starting insulin than ambivalent patients. Conclusion: These are the first data demonstrating the prevalence of PIR across Western nations. PIR is strongly linked to positive and negative insulin beliefs, and may also reflect a broader discomfort with medications and with diabetes in general. Of note, however, PIR is a marker of behavioral intent only; it is not known whether this predicts actual behavior at the time when insulin is prescribed. When addressing patients who are reluctant to initiate insulin therapy, clinicians may find it valuable to inquire about their beliefs about insulin and their current medications. © 2011 Informa UK Ltd.

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