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Connected Meters, Coaching Help Improve Diabetes Outcomes

Livongo meter

Livongo connected blood glucose meter (Livongo Health)

15 June 2018. A study of people with type 2 diabetes shows the combination of intensive lifestyle coaching with a blood glucose meter connected to the Internet results in more weight loss and lower blood glucose levels. Findings from a test of the device made by Livongo Health in Mountain View, California, with different coaching programs, appear in the 16 May issue of the Journal of Diabetes Research.

Diabetes is a chronic disorder where the pancreas does not create enough insulin to process the sugar glucose to flow into the blood stream and cells for energy in the body. In type 2 diabetes, which accounts for at least 90 percent of all diabetes cases, the pancreas produces some but not enough insulin, or the body cannot process insulin. According to the International Diabetes Federation, diabetes affects an estimated 425 million people worldwide, of which 46 million are in North America.

Livongo designs digital systems for managing diabetes, including analytics derived from data provided by individuals using the company’s smartphone-based technology. The system includes a smart blood glucose meter that connects to cellular networks, and transmits data from the meter to family members, clinicians monitoring the person’s condition, and third-party diabetes counselors certified by Livongo. The meter also collects other data related to the person’s health, such as physical activity.

Data from the smart meter are sent as well to a database in the cloud, where a rules-based inference engine analyzes the data and offers personalized guidance to the individual with diabetes and his or her physician. Livongo users with the mobile app can receive coaching, with tips on nutrition and lifestyle changes, from licensed third-party counselors. People connected to the meter in the Livongo community can provide feedback via voice telephone, e-mail, or text message.

A research team from Livongo and Stanford University sought to determine the optimum level of coaching plus Livongo technology that returns the best results for people with type 2 diabetes. More than 1,900 adults registered in the Livongo program since 2014 were invited to take part in a 12-week study using Livongo meters alone, with a connected weight scale, combined with light lifestyle coaching, or intensive lifestyle coaching. Light coaching offers a 20-minute introductory call and standardized lessons, text messages, meal ratings, and activity recommendations. Intensive coaching includes a 60-minute introductory call, with personalized goal setting, lessons, text messages, meal ratings, and activity recommendations. Restore Health in Palo Alto, California provided the coaching.

Individuals taking part in the study all had type 2 diabetes, were overweight, and had no yet achieving their target blood glucose levels. Of the 1,936 invited to take part, 454 agreed to participate, and 330 completed the study. Participants were randomly assigned to one of the 4 treatment groups: Livongo meter only, Livongo meter and connected scale, Livongo meter and light coaching, and Livongo meter and intensive coaching.

After 12 weeks, participants in the intensive coaching group showed the most weight loss, 6.4 pounds, and lower blood glucose levels of 0.7 percent on average. Light coaching participants lost 4.1 pounds and reduced their blood glucose by 0.4 percent. Those using Livongo and the connected scale had the fewest reductions in both measures. The intensive coaching program costs 5.5 times as much as light coaching.

“Personalization is key to diabetes management,” says Jennifer Bollyky in a company statement. Bollyky heads clinical research at Livongo and is the lead author on the study, as well as a faculty member at Stanford. “This study demonstrates that short periods of intensive coaching when people get stuck on their way to their glucose and weight goals can be empowering and helpful.”

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