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


Through the challenge, Ascensia aims to support companies who are developing the next big leap forward in digital solutions that could facilitate better type 2 diabetes management and help relieve the burden it places on individuals, healthcare systems and society. Although solutions and therapies in this area continue to improve year on year, many of the emerging technologies currently in development need further investment to ensure they can play a critical role in helping people with type 2 diabetes to better self-manage all aspects of their condition. "At Ascensia we are excited to be launching this challenge, as we want to encourage innovation in our field and rethink how digital technology can help people with type 2 diabetes manage their day to day lives," said Michael Kloss, CEO Ascensia Diabetes Care. "This challenge represents the modern approach to finding innovative solutions for people with diabetes, alongside our own R&D. This challenge will not solve the diabetes epidemic on its own, but it is a critical step in the development of new diabetes solutions. It aims to find, support and nurture ideas from start-ups that have the potential to revolutionize diabetes management. We hope this challenge can generate novel ideas from undiscovered sources, and with Ascensia's support we want to be able to bring them to a global patient population." The competition will seek submissions from Europe, the Americas and Asia Pacific with entries open from October 1, 2017 for Europe and November 6, 2017 for Asia Pacific and the Americas. Entries can be submitted via the online portal at ascensiadiabeteschallenge.com. A judging panel, made up of independent experts from diabetes and digital health from across the world, as well as members of the Ascensia Medical, R&D and Commercial teams, will assess the entries and determine finalists and the winner.  Dr. William Polonsky, a clinical psychologist, Dr. Masood Nazir, a general practitioner with a special interest in diabetes and digital health, and Robin Swindell, a type 2 diabetes blogger, have been confirmed as the first three judges, and additional judges will be announced shortly. Dr. William Polonsky, President and Co-Founder of the Behavioral Diabetes Institute, San Diego, USA, explained, "Behavioral interventions are the key to enhancing self-management in type 2 diabetes, and digital solutions are desperately needed as a means to engage patients over the long-term and enable sustainable behavior change. Unfortunately, current digital solutions have not yet been able to fully address the needs of patients or effectively support self-management and long-term behavior change. I am thrilled to be part of the Ascensia Diabetes Challenge to try and find the next innovations to address the burden of type 2 diabetes." Robin Swindell, a person with type 2 diabetes and active blogger from the UK said, "Like most patients with type 2 diabetes, I only see a healthcare professional for a couple of hours a year at most. For the rest of the time we rely on self-management. We need to find innovative digital solutions that can better support self-management for us. Solutions need to be able to be personalized and fit into their lives. They should also offer quantitative data that can help us to better understand and manage our condition and provide motivation. Digital solutions have the ability to address these needs. I am delighted to be involved in this challenge and hope it will unearth a new innovation that can make a real impact for me and other patients." Ascensia has partnered with yet2, an open innovation services company, to launch this global challenge. yet2 will be managing the submission process and initial review of entries. They will use their experience with open innovation challenges to facilitate the review of entries, manage intellectual property screening and support the judging process. Michael Kloss added, "As a company that is focused on diabetes, we want to be driving the agenda in diabetes innovation, demonstrate our ongoing support for the diabetes community as a trusted partner, and show our commitment to continued research, innovation and development of new solutions." For further information about Ascensia Diabetes Care, visit: http://www.ascensia.com. For further information about yet2, please visit: http://www.yet2.com.


Grâce à ce défi, Ascensia vise à soutenir les entreprises qui travaillent actuellement sur le prochain grand bond en avant dans les solutions numériques susceptibles de faciliter une meilleure gestion du diabète de type 2 et d'aider à soulager le fardeau qu'il impose aux patients, aux systèmes de santé et à la société. Malgré l'évolution continue des solutions et thérapies dans ce domaine d'année en année, bon nombre des technologies émergentes en cours de développement nécessitent des investissements supplémentaires afin de s'assurer qu'elles puissent jouer un rôle déterminant en aidant les personnes atteintes de diabète de type 2 à mieux gérer elles-mêmes tous les aspects de leur maladie. « Chez Ascensia, nous sommes ravis de lancer ce défi, car nous souhaitons encourager l'innovation dans notre domaine et repenser la manière dont la technologie numérique peut aider les personnes atteintes de diabète de type 2 à gérer leur vie au quotidien », a déclaré Michael Kloss, CEO d'Ascensia Diabetes Care. « Ce défi représente l'approche moderne visant à trouver des solutions innovantes pour les personnes atteintes de diabète, parallèlement à notre propre service de R&D. Il ne résoudra pas l'épidémie du diabète à lui seul, mais il s'agit d'une étape cruciale dans le développement de nouvelles solutions pour le diabète. Il vise à trouver, soutenir et nourrir les idées des start-ups qui ont le potentiel de révolutionner la gestion du diabète. Nous espérons que ce défi pourra générer des idées innovantes issues de sources nouvelles, et avec le soutien d'Ascensia, nous voulons être en mesure de les fournir à une population de patients mondiale. » Le concours acceptera les candidatures d'Europe, des Amériques et d'Asie-Pacifique, les inscriptions étant ouvertes à partir du 1er octobre 2017 pour l'Europe et du 6 novembre 2017 pour l'Asie-Pacifique et les Amériques. Les candidatures peuvent être soumises via le portail en ligne à l'adresse ascensiadiabeteschallenge.com. Un jury, composé d'experts indépendants des secteurs du diabète et de la santé numérique du monde entier, ainsi que de membres des équipes médicales, de R&D et commerciales d'Ascensia, évaluera les candidatures et désignera les finalistes et le gagnant. Le Dr William Polonsky, psychologue clinicien, le Dr Masood Nazir, médecin généraliste ayant un intérêt spécial pour le diabète et la santé numérique, et Robin Swindell, blogueur atteint de diabète de type 2, ont été confirmé comme les trois premiers juges, tandis que les autres membres du jury seront prochainement annoncés. Le Dr William Polonsky, président et cofondateur du Behavioral Diabetes Institute à San Diego, aux États-Unis, a expliqué : « Les interventions comportementales sont essentielles pour améliorer l'auto-gestion du diabète de type 2, et des solutions numériques sont désespérément nécessaires en tant que moyens d'engager les patients sur le long terme et d'assurer un changement comportemental durable. Malheureusement, les solutions numériques actuelles n'ont pas encore été en mesure de répondre pleinement aux besoins des patients ou de soutenir efficacement l'auto-gestion et le changement comportemental à long terme. Je suis ravi de faire partie de l'Ascensia Diabetes Challenge afin d'essayer de trouver les prochaines innovations qui permettront de faire face au fardeau du diabète de type 2. » Robin Swindell, personne atteinte de diabète de type 2 et blogueur actif du Royaume-Uni, a commenté : « Comme la plupart des patients atteints de diabète de type 2, je vois un professionnel de santé pendant quelques heures par an tout au plus. Le reste du temps, nous devons nous gérer nous-mêmes. Nous devons trouver des solutions numériques innovantes capables de mieux soutenir l'auto-gestion pour nous. Ces solutions doivent être personnalisables et s'intégrer facilement dans notre vie. Elles doivent aussi offrir des données quantitatives qui peuvent nous aider à mieux comprendre et gérer notre maladie tout en nous motivant. Les solutions numériques ont la capacité de répondre à ces besoins. Je suis heureux d'être impliqué dans ce défi et j'espère qu'il permettra de découvrir une nouvelle innovation capable d'avoir un impact réel pour moi et les autres patients. »


Today, during the 53rd Annual Meeting of the European Association for the Study of Diabetes (EASD), Ascensia Diabetes Care announced the launch of the Ascensia Diabetes Challenge, a global innovation competition that is seeking innovative digital solutions to support diabetes management and improve the lives of those living with type 2 diabetes. The challenge aims to find new ways to help tackle the management of the global epidemic of type 2 diabetes by unearthing undiscovered solutions from diabetes innovators. Finalists, runners-up and the winner will all receive cash prizes to support further development of their ideas from a total prize fund of EURO 200,000. Through the challenge, Ascensia aims to support companies who are developing the next big leap forward in digital solutions that could facilitate better type 2 diabetes management and help relieve the burden it places on individuals, healthcare systems and society. Although solutions and therapies in this area continue to improve year on year, many of the emerging technologies currently in development need further investment to ensure they can play a critical role in helping people with type 2 diabetes to better self-manage all aspects of their condition. "At Ascensia we are excited to be launching this challenge, as we want to encourage innovation in our field and rethink how digital technology can help people with type 2 diabetes manage their day to day lives," said Michael Kloss, CEO Ascensia Diabetes Care. "This challenge represents the modern approach to finding innovative solutions for people with diabetes, alongside our own R&D. This challenge will not solve the diabetes epidemic on its own, but it is a critical step in the development of new diabetes solutions. It aims to find, support and nurture ideas from start-ups that have the potential to revolutionize diabetes management. We hope this challenge can generate novel ideas from undiscovered sources, and with Ascensia's support we want to be able to bring them to a global patient population." The competition will seek submissions from Europe, the Americas and Asia Pacific with entries open from October 1, 2017 for Europe and November 6, 2017 for Asia Pacific and the Americas. Entries can be submitted via the online portal at ascensiadiabeteschallenge.com. A judging panel, made up of independent experts from diabetes and digital health from across the world, as well as members of the Ascensia Medical, R&D and Commercial teams, will assess the entries and determine finalists and the winner.  Dr. William Polonsky, a clinical psychologist, Dr. Masood Nazir, a general practitioner with a special interest in diabetes and digital health, and Robin Swindell, a type 2 diabetes blogger, have been confirmed as the first three judges, and additional judges will be announced shortly. Dr. William Polonsky, President and Co-Founder of the Behavioral Diabetes Institute, San Diego, USA, explained, "Behavioral interventions are the key to enhancing self-management in type 2 diabetes, and digital solutions are desperately needed as a means to engage patients over the long-term and enable sustainable behavior change. Unfortunately, current digital solutions have not yet been able to fully address the needs of patients or effectively support self-management and long-term behavior change. I am thrilled to be part of the Ascensia Diabetes Challenge to try and find the next innovations to address the burden of type 2 diabetes." Robin Swindell, a person with type 2 diabetes and active blogger from the UK said, "Like most patients with type 2 diabetes, I only see a healthcare professional for a couple of hours a year at most. For the rest of the time we rely on self-management. We need to find innovative digital solutions that can better support self-management for us. Solutions need to be able to be personalized and fit into their lives. They should also offer quantitative data that can help us to better understand and manage our condition and provide motivation. Digital solutions have the ability to address these needs. I am delighted to be involved in this challenge and hope it will unearth a new innovation that can make a real impact for me and other patients." Ascensia has partnered with yet2, an open innovation services company, to launch this global challenge. yet2 will be managing the submission process and initial review of entries. They will use their experience with open innovation challenges to facilitate the review of entries, manage intellectual property screening and support the judging process. Michael Kloss added, "As a company that is focused on diabetes, we want to be driving the agenda in diabetes innovation, demonstrate our ongoing support for the diabetes community as a trusted partner, and show our commitment to continued research, innovation and development of new solutions." For further information about Ascensia Diabetes Care, visit: http://www.ascensia.com. For further information about yet2, please visit: http://www.yet2.com.


Through the challenge, Ascensia aims to support companies who are developing the next big leap forward in digital solutions that could facilitate better type 2 diabetes management and help relieve the burden it places on individuals, healthcare systems and society. Although solutions and therapies in this area continue to improve year on year, many of the emerging technologies currently in development need further investment to ensure they can play a critical role in helping people with type 2 diabetes to better self-manage all aspects of their condition. "At Ascensia we are excited to be launching this challenge, as we want to encourage innovation in our field and rethink how digital technology can help people with type 2 diabetes manage their day to day lives," said Michael Kloss, CEO Ascensia Diabetes Care. "This challenge represents the modern approach to finding innovative solutions for people with diabetes, alongside our own R&D. This challenge will not solve the diabetes epidemic on its own, but it is a critical step in the development of new diabetes solutions. It aims to find, support and nurture ideas from start-ups that have the potential to revolutionize diabetes management. We hope this challenge can generate novel ideas from undiscovered sources, and with Ascensia's support we want to be able to bring them to a global patient population." The competition will seek submissions from Europe, the Americas and Asia Pacific with entries open from October 1, 2017 for Europe and November 6, 2017 for Asia Pacific and the Americas. Entries can be submitted via the online portal at ascensiadiabeteschallenge.com. A judging panel, made up of independent experts from diabetes and digital health from across the world, as well as members of the Ascensia Medical, R&D and Commercial teams, will assess the entries and determine finalists and the winner.  Dr. William Polonsky, a clinical psychologist, Dr. Masood Nazir, a general practitioner with a special interest in diabetes and digital health, and Robin Swindell, a type 2 diabetes blogger, have been confirmed as the first three judges, and additional judges will be announced shortly. Dr. William Polonsky, President and Co-Founder of the Behavioral Diabetes Institute, San Diego, USA, explained, "Behavioral interventions are the key to enhancing self-management in type 2 diabetes, and digital solutions are desperately needed as a means to engage patients over the long-term and enable sustainable behavior change. Unfortunately, current digital solutions have not yet been able to fully address the needs of patients or effectively support self-management and long-term behavior change. I am thrilled to be part of the Ascensia Diabetes Challenge to try and find the next innovations to address the burden of type 2 diabetes." Robin Swindell, a person with type 2 diabetes and active blogger from the UK said, "Like most patients with type 2 diabetes, I only see a healthcare professional for a couple of hours a year at most. For the rest of the time we rely on self-management. We need to find innovative digital solutions that can better support self-management for us. Solutions need to be able to be personalized and fit into their lives. They should also offer quantitative data that can help us to better understand and manage our condition and provide motivation. Digital solutions have the ability to address these needs. I am delighted to be involved in this challenge and hope it will unearth a new innovation that can make a real impact for me and other patients." Ascensia has partnered with yet2, an open innovation services company, to launch this global challenge. yet2 will be managing the submission process and initial review of entries. They will use their experience with open innovation challenges to facilitate the review of entries, manage intellectual property screening and support the judging process. Michael Kloss added, "As a company that is focused on diabetes, we want to be driving the agenda in diabetes innovation, demonstrate our ongoing support for the diabetes community as a trusted partner, and show our commitment to continued research, innovation and development of new solutions." For further information about Ascensia Diabetes Care, visit: http://www.ascensia.com. For further information about yet2, please visit: http://www.yet2.com.


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.


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 | 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.

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