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Diabetes is a global epidemic affecting approximately 30 million people in the United States. The World Health Organization recommends using technology and telecommunications to improve health care delivery and disease management. The Livongo for Diabetes Program offers a remote monitoring technology with Certified Diabetes Educator outreach.The purpose of this study was to examine health outcomes measured by changes in HbAThe impact of the Livongo for Diabetes program on hemoglobin AA total of 86 adults were enrolled into the Livongo for Diabetes program, with 49% (42/86) female, an average age of 50 (SD 15) years, 56% (48/86) with type 2 diabetes mellitus, and 69% (59/86) with insulin use. The mean HbAParticipants provided with a cellular-enabled blood glucose meter with real-time feedback and access to coaching from a certified diabetes educator in an outpatient clinical setting experienced improved mean glucose values and fewer episodes of hypoglycemia relative to the start of the program.

Background Diabetes is a global epidemic affecting approximately 30 million people in the United States. The World Health Organization recommends using technology and telecommunications to improve health care delivery and disease management. The Livongo for Diabetes Program offers a remote monitoring technology with Certified Diabetes Educator outreach. Objective The purpose of this study was to examine health outcomes measured by changes in HbA1c, in time in target blood glucose range, and in depression symptoms for patients enrolled in a remote digital diabetes management program in a Diabetes Center of Excellence setting. Methods The impact of the Livongo for Diabetes program on hemoglobin A1c (HbA1c), blood glucose ranges, and depression screening survey results (Patient Health Questionnaire-2 [PHQ-2]) were assessed over 12 months in a prospective cohort recruited from the University of South Florida Health Diabetes Home for Healthy Living. Any patient ≥18 years old with a diagnosis of diabetes was approached for voluntary inclusion into the program. The analysis was a pre-post design for those members enrolled in the study. Data was collected at outpatient clinic visits and remotely through the Livongo glucose meter. Results A total of 86 adults were enrolled into the Livongo for Diabetes program, with 49% (42/86) female, an average age of 50 (SD 15) years, 56% (48/86) with type 2 diabetes mellitus, and 69% (59/86) with insulin use. The mean HbA1c drop amongst the group was 0.66% (P=.17), with all participants showing a decline in HbA1c at 12 months. A 17% decrease of blood glucose checks Conclusions Participants provided with a cellular-enabled blood glucose meter with real-time feedback and access to coaching from a certified diabetes educator in an outpatient clinical setting experienced improved mean glucose values and fewer episodes of hypoglycemia relative to the start of the program.

Objective: The present study examines the relationship between parenting self-efficacy, social support in parenting tasks, and parenting-related stress for parents with and without type 1 diabetes (T1D). Research Design and Methods: Parents with and without T1D completed self-report measures addressing demographic, parenting (e.g., parental stress, support, and self-efficacy), and diabetes-related variables. One-way ANOVAs examined the effect of parent T1D diagnosis on parent demographic and parenting-related data. In addition, regression analyses examined main and interactive effects of parent T1D diagnosis and perceived parenting support in accounting for parenting stress. Results: Parents with a T1D diagnosis self-reported more parenting-related stress than parents without a T1D diagnosis. In addition, for parents with T1D, parenting stress was significantly positively correlated with parent age at diagnosis and significantly negatively correlated with most recent HbA1c, parenting self-agency, and perceived parenting support; however, among parents without a T1D diagnosis, the relationship between parenting stress and support was null. A regression analysis examining main and interactive effects of parent T1D diagnosis and perceived parenting support on parenting stress was significant, yielding a significant two-way interaction. Conclusions: Results suggest that parents with T1D may experience more parenting-related stress than parents without a chronic illness. Furthermore, higher levels of social support are associated with lower levels of parenting stress for this group of parents with T1D. Thus, results underscore the importance of parenting support for parents with T1D and further emphasize the importance of continued research in the area of parenting with T1D.

Objective : The clinical transition from pediatric to adult diabetes care is often challenging for both young adults with type 1 diabetes (T1D) and the health care providers (HCPs) who care for this population. This study presents insights into the perceptions and needs of both patients with diabetes and HCPs during the clinical transition. Research Design and Methods : Two separate surveys were administered with questions specifically tailored to each audience. Perceptions of the transition phase for both patients with T1D and HCPs were analyzed for general trends and then compared to investigate similarities and differences between patient and provider needs. Results : Both patients and HCPs expressed concerns regarding poor patient-provider communication during transition and the barriers to independently managing diabetes self-care responsibilities (e.g. navigating insurance, ordering supplies, arranging healthcare appointments). Although 45% of HCPs reported screening transition age patients for mental health issues related to diabetes, only 9% of patients stated their provider offered this opportunity. Furthermore, patients reported facing a variety of challenges not discussed with their HCP including: sexual issues (28%), depression or anxiety (17%), and eating disorders (11%). Conclusions : Training in the assessment of young adult T1D needs and effective communication techniques may assist HCPs in working more effectively with young adults. Offering mental health screenings for transition age patients may open the conversation to discuss diabetes concerns such as depression, sexual challenges, and eating disorders not currently being addressed. Both patients and providers desire improved communication with more emphasis on independently managing diabetes responsibilities and adjusting to new life situations.

Objective: Diabetes prevention interventions have a proven positive effect on health outcomes. The goal of this project is to understand the factors that motivate and deter people with prediabetes from utilizing evidence-based education programs, such as the Diabetes Prevention Program (DPP). Research Design and Methods: Formative research was conducted among program facilitators, health providers who care for diabetes patients, and patients living with prediabetes to generate an in-depth understanding of perceptions of the program. The methodology included a mixed methods approach. A total of 97 interviews and 5 focus groups were conducted with health providers, program facilitators, and patients. An online survey was administered to 50 patients with prediabetes. Results: All three populations agreed the DPP aided in implementing lifestyle changes and preventing the onset of type 2 diabetes, and the classes provided a positive experience for support, in-depth discussion, and opportunities for learning how to make lifestyle changes. However, while the overall benefits of the program were expressed, there were barriers noted by all populations that affect program utilization and physician referrals. General lack of knowledge, cost of the program, and the significant time commitment necessary to complete the program were barriers discussed. Conclusions: The Diabetes Prevention Program is successful in helping individuals with prediabetes make positive lifestyle changes. The lack of knowledge about the program, however, is a deterrent for utilization. Creation of a social marketing campaign based on the findings from this research will aim to increase healthcare provider referrals to the DPP.

Objective: Little data exists regarding the emerging population of adults diagnosed with type 2 diabetes (T2DM) at a younger age. This study was conducted to gain insight related to diabetes distress and self-efficacy among adults diagnosed with T2DM between 18-40 years of age. Research Design and Methods: : Individuals diagnosed with T2DM between 18-40 years of age (n = 118) completed an online survey in either English or Spanish. The survey included two validated scales to understand levels of diabetes distress and self-efficacy. Independent samples t-tests were conducted to examine differences among gender, while Pearson correlation coefficients were conducted to examine the relationships of current age, age of diagnosis, duration of diabetes, HbA1c values, and insulin use with multiple domains of diabetes distress and self-efficacy. Results: Both regimen-related distress and interpersonal distress were reported at levels worthy of clinical attention. Overall diabetes-related distress, emotional-burden, and physician-related distress were slightly below the level of clinical significance. Bivariate analysis suggests strong positive relationships between HbA1c values and each domain of diabetes distress. Additionally, negative correlations were found between insulin use and overall diabetes distress, emotional-burden, physician-related distress, regimen-related distress, and interpersonal distress. Conclusions: Findings suggest adults diagnosed with T2DM at a younger age experience levels of diabetes distress worthy of clinical attention, particularly regarding regimen-related and interpersonal distress. T2DM programs should include psychosocial education and communication strategies for improving social support to enhance overall quality of life for this population.

Background Childhood obesity is a major public health problem that is the focus of many child health programs and policies throughout the nation. Florida in particular has high rates of childhood obesity and inconsistent policies to address the issue. This paper examines the scope and challenge of addressing the childhood obesity epidemic in Florida from the perspective of childhood obesity stakeholders. Methods As part of a larger assessment of the health of Florida's children for the Florida Child Health and Healthcare Quality Chartbook, the authors conducted focus groups and interviews with stakeholders from private and public organizations. The stakeholders represented healthcare providers, state and local agencies, and community-based programs that address nutrition and physical activity education, access to healthcare, health screenings, and environmental and policy change related to preventing childhood obesity. Results Stakeholders identified best practices, challenges, barriers, and priorities for addressing childhood obesity. Multilevel approaches, emphasizing the family were identified as best practices, along with the need for environmental policy change. Funding and a need for data were identified as the biggest challenges, while overcoming barriers such as myths and misinformation and developing a unified obesity message were identified as motivators. Conclusions The major findings indicate that, although positive progress is being made in specific communities, a coordinated and comprehensive response is needed. To create policy and normative change, a statewide, multilevel framework is needed with a unifying message to better target policymakers. The framework should include targeted efforts at all levels that include education, promotion and environmental policy change.