Relationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development: Retrospective Cross-Sectional Study

Jessica S Yu,Wei Lu,Tong Xu,Roberta A James,Julia E Hoffman

doi:10.2196/20888

Abstract

BackgroundTechnology is rapidly advancing our understanding of how people with diabetes mellitus experience stress.ObjectiveThe aim of this study was to explore the relationship between stress and sequelae of diabetes mellitus within a unique data set composed of adults enrolled in a digital diabetes management program, Livongo, in order to inform intervention and product development.MethodsParticipants included 3263 adults under age 65 who were diagnosed with diabetes mellitus and had access to Livongo through their employer between June 2015 and August 2018. Data were collected at time of enrollment and 12 months thereafter, which included demographic information, glycemic control, presence of stress, diabetes distress, diabetes empowerment, behavioral health diagnosis, and utilization of behavioral health-related medication and services. Analysis of variance and chi-square tests compared variables across groups that were based on presence of stress and behavioral health diagnosis or utilization.ResultsFifty-five percent of participants (1808/3263) reported stress at the time of at least 1 blood glucose reading. Fifty-two percent of participants (940/1808) also received at least 1 behavioral health diagnosis or intervention. Compared to their peers, participants with stress reported greater diabetes distress, lower diabetes empowerment, greater insulin use, and poorer glycemic control. Participants with stress and a behavioral health diagnosis/utilization additionally had higher body mass index and duration of illness.ConclusionsStress among people with diabetes mellitus is associated with reduced emotional and physical health. Digital products that focus on the whole person by offering both diabetes mellitus self-management tools and behavioral health skills and support can help improve disease-specific and psychosocial outcomes.

Highlights

Diabetes mellitus currently affects over 10.5% of the United States population, or over 34 million Americans, and comes with significant medical, psychological, and economic burdens [1]
Of the 29,270 individuals with diabetes mellitus that enrolled in the Livongo for Diabetes program and received devices, 25,286 (86.3%) engaged with the program by taking at least one blood glucose reading
JMIR Diabetes 2020 | vol 5 | iss. 4 | e20888 | p. 5. The purpose of this descriptive study was to explore the relationships between stress, diabetes mellitus–related symptoms, and blood glucose control among people using Livongo, a digital diabetes mellitus management program for people with diabetes mellitus and other chronic conditions

Summary

Introduction

Diabetes mellitus currently affects over 10.5% of the United States population, or over 34 million Americans, and comes with significant medical, psychological, and economic burdens [1]. It is the leading cause of kidney failure, nontraumatic lower limb amputations, and blindness; a major cause of cardiovascular disease and stroke; and the seventh leading cause of death among adults in the United States [2]. People with diabetes mellitus spend an average of US $13,700 annually on medical expenses, which is more than double that of people without [5]. The US healthcare system spends an average of US $245 billion annually http://diabetes.jmir.org/2020/4/e20888/. Technology is rapidly advancing our understanding of how people with diabetes mellitus experience stress

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Discussion

Conclusion