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.

BackgroundDiabetes 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.ObjectiveThe 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.MethodsThe 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.ResultsA 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 <70 mg/dL occurred concurrently. Participants with type 2 diabetes not using insulin had blood glucose values within target range (70-180 mg/dL) 89% of the time. Participants with type 2 diabetes using insulin were in target range 68% of the time, and type 1 diabetes 58% of the time. Average PHQ-2 scores decreased by 0.56 points during the study period.ConclusionsParticipants 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: 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.

The family dinner is a valued tradition that affords opportunities for social interaction and attachment, as well as sharing events of the day, role modeling, connectedness, and problem solving. Guided by the social-marketing framework, this study explored factors associated with the frequency of the family dinner among working mothers with children ages 8-11 years. A qualitative design was used, employing focus groups and Atlas-ti software for thematic analysis. Lack of time, cost, and exhaustion/lack of energy emerged as barriers. Working mothers indicated that a youth-based organization operating as a community partner could increase the frequency of the family dinner by helping with homework completion during after-school care, thereby providing mothers with the time necessary to prepare dinner. This research identified both community partners and working mothers as valued resources for prevention strategies. Interventions developed to increase family dinner frequency should emphasize the perceived value while decreasing the costs/barriers.

Type 1 diabetes affects all aspects of life for both the person with the disease and their loved ones. For partners, negotiating the caregiving role can be challenging.Objective: Partners of people with type 1 diabetes are positioned to provide crucial support for their significant other, but they may struggle with the caregiving role. The purpose of this study was to determine the challenges and needs of these partners. Research Design and Methods:In this qualitative study, in-depth interviews were conducted with 19 partners of people with type 1 diabetes. A semi-structured interview guide was used during the interviews. Thematic analysis was conducted using qualitative data management and analysis software. Results:The analysis of the interviews revealed that partners face numerous challenges in the caregiving of their partner. Partners reported struggling with: (1) emotional strain from fear and distress over diabetes symptoms and complications that results in caregiver burden; (2) determining how to avoid relationship conflict; and (3) knowing how to provide life sustaining care during diabetes medical emergencies.Conclusions: Partners of people with diabetes would benefit from diabetes education targeting emergency care and the psychosocial impacts of diabetes. This additional education could potentially ease the emotional strains of caregiving.