Remote Application and Use of Real-Time Continuous Glucose Monitoring by Adults with Type 2 Diabetes in a Virtual Diabetes Clinic.

The Onduo Virtual Diabetes Clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists. Adults with T2D (n = 594) who were evaluated by a VDC endocrinologist, remotely prescribed and mailed a real-time continuous glucose monitoring (rtCGM) device and used ≥1 sensor completed a CGM satisfaction questionnaire. The CGM satisfaction score was 4.5 ± 0.8 out of 5. Most respondents (94.7%) agreed/strongly agreed that they were comfortable inserting the sensor remotely and that rtCGM use improved understanding of the impact of eating (97.0%), increased diabetes knowledge (95.7%), and helped improve diabetes control when not wearing the sensor (79.4%). HbA1c (n = 372) decreased from 7.7% ± 1.6% to 7.1% ± 1.2% (P < 0.001; 10.2 months). These data suggest that it is feasible to provide rtCGM directly to individuals with T2D through a VDC without in-office training. Intermittent use of rtCGM was well-received by adults with T2D and was associated with improvement in HbA1c.

Impact of Participation in a Virtual Diabetes Clinic on Diabetes-Related Distress in Individuals With Type 2 Diabetes.

The Onduo Virtual Diabetes Clinic is a telehealth program for people with type 2 diabetes that combines mobile app technology, remote personalized lifestyle coaching, connected blood glucose meters, real-time continuous glucose monitoring (rtCGM) devices, and clinical support from board-certified endocrinologists. This analysis evaluated change in diabetes distress among 228 program participants who reported moderate distress (score 2.0-2.9) or high distress (score ≥3.0) on the 17-item Diabetes Distress Scale (DDS17) at enrollment. Participants reported significant reductions in overall distress from 3.0 ± 0.8 at baseline to 2.5 ± 0.9 (P <0.001) at an average of 6 months of follow-up. Significant reductions in all DDS17 subscale scores were observed; most notable were reductions in the regimen-related and emotional distress subscales (-0.9 and -0.4, respectively; both P <0.001). Significantly greater reductions in overall distress (P = 0.012) and regimen-related distress (P <0.001) were reported by participants who were prescribed and used intermittent rtCGM (n = 77) versus nonusers (n = 151). Although the generalizability of these findings may be limited by the study's small sample size and potential for self-selection bias, these results do suggest that telemedicine programs such as the Onduo VDC could be a valuable tool for addressing the problem of diabetes-related distress.

A Virtual Type 2 Diabetes Clinic Using Continuous Glucose Monitoring and Endocrinology Visits.

The Onduo Virtual Diabetes Clinic (VDC) telehealth technology/care model for adults with type 2 diabetes (T2D) combines connected devices, remote lifestyle coaching, and clinical support with a mobile App. Key differentiating program features are the availability of live video consultations with board-certified endocrinologists for medication management and real-time continuous glucose monitor use for higher-risk participants. Preliminary data (n = 740) suggest that participation was associated with a significant improvement in HbA1c with up to 6 months follow-up in those not meeting treatment targets. HbA1c decreased by 2.3% ± 1.9%, 0.7% ± 1.0%, and 0.2% ± 0.8% across baseline categories of >9.0%, 8.0%-9.0% and 7.0% to <8.0%, respectively (all P < .001). These findings suggest that the VDC has potential to support individuals with T2D and their clinicians in diabetes management between office visits.

The Impact of Specialized Telephonic Guides on Employee Engagement in Corporate Well-Being Programs.

Employer-sponsored well-being programs have been growing in popularity as a means to control rising health care costs and increase workplace productivity. Engagement by employees is necessary for these programs to achieve their desired effects. Extrinsic motivators in the form of incentives and surcharges are commonly introduced by employer program sponsors to promote meaningful engagement. Although these may be successful in achieving a degree of engagement, individuals benefit by being intrinsically motivated as they modify behaviors and improve short- and long-term well-being. Telephonic guides equipped with motivational interviewing and other behavioral strategies to improve engagement may bridge the gap between extrinsic and intrinsic motivation. The objectives of this study are to determine characteristics associated with employee utilization of these guides when offered and to compare subsequent program engagement rates between utilizers to a propensity score matched group of employees who were not offered the service. The data were retrieved from a well-being program provider's database. The study examined 166,258 employees across 35 employers. It found utilizers were older, proportionally more female, in the manufacturing industry, incented to use the guide service, offered a larger incentive for program participation, had healthier self-reported behaviors, and had a higher perception of their employer's focus on well-being. The study found that guide utilizers were significantly more likely to engage in telephonic coaching, digital coaching, and activity tracking up to 6 months. The study's findings suggest telephonic guides using a range of behavioral techniques are an effective strategy to drive well-being program engagement.

Outcome-based and Participation-based Wellness Incentives: Impacts on Program Participation and Achievement of Health Improvement Targets.

OBJECTIVE: This study examined whether worksite wellness program participation or achievement of health improvement targets differed according to four incentive types (participation-based, hybrid, outcome-based, and no incentive). METHODS: The study included individuals who completed biometric health screenings in both 2013 and 2014 and had elevated metrics in 2013 (baseline year). Multivariate logistic regression modeling tested for differences in odds of participation and achievement of health improvement targets between incentive groups; controlling for demographics, employer characteristics, incentive amounts, and other factors. RESULTS: No statistically significant differences between incentive groups occurred for odds of participation or achievement of health improvement target related to body mass index, blood pressure, or nonhigh-density lipoprotein cholesterol. CONCLUSIONS: Given the null findings of this study, employers cannot assume that outcome-based incentives will result in either increased program participation or greater achievement of health improvement targets than participation-based incentives.

The effectiveness of a health promotion program after 3 years: evidence from the University of Minnesota.

BACKGROUND: Health promotion programs for the workplace are often sold to employers with the promise that they will pay for themselves with lowered health care expenditures and reduced absenteeism. In a recent review of the literature, it was noted that analysts often caution not to expect a positive return on investment until the third year of operation. OBJECTIVE: This study investigates whether a positive return on investment was generated in the third year for the health promotion program used by the University of Minnesota. It further investigates what it is about the third year that would explain such a phenomenon. MEASURES: The study uses health care expenditure data and absenteeism data from 2004 to 2008 to investigate the effect of the University's lifestyle and disease management programs. It also investigates the effectiveness of participation in Minnesota's 10,000 Steps walking program and Miavita self-help programs. RESEARCH DESIGN: A differences-in-differences equations approach is used to address potential selection bias. Possible regression to the mean is dealt with by using only those who were eligible to participate as control observations. Propensity score weighting was used to balance the sample on observable characteristics and reduce bias due to omitted variables. RESULTS: The study finds that a 1.76 return on investment occurs in the third year of operation that is generated solely by the effect of disease management program participation in reducing health care expenditures. However, neither of the explanations for a third-year effect we tested seemed to be able to explain this phenomenon.

The effectiveness of health promotion at the University of Minnesota: expenditures, absenteeism, and participation in specific programs.

OBJECTIVES: To determine the effectiveness of the University of Minnesota's worksite health promotion program in reducing health care expenditures during the first 2 years of the program; to investigate the program's effect on absenteeism; and to study the effect of specific disease- or lifestyle-management programs on both health care expenditures and absenteeism. METHODS: Health care expenditures and absenteeism of program participants were compared with those who were eligible but did not participate. Differences-in-differences regression equations with random effects were used to account for selection. RESULTS: Participation in the general disease management program over 2 years was associated with significant reductions in expenditures, as was participation in programs for certain specific diseases. No consistently significant absenteeism or lifestyle management effects were found. CONCLUSIONS: : Although the program significantly reduced expenditures, it did not generate a positive return on investment.

A return-on-investment analysis of the health promotion program at the University of Minnesota.

OBJECTIVE: To determine the return-on-investment, if any, for the health promotion program adopted by the University of Minnesota in 2006. METHODS: Regression analysis was used to determine the cost-savings in annual health care expenditures associated with three components of the program: a risk assessment, a risk management program, and a disease management (DM) program. Differences-in-differences equations with random effects were used to deal with selection bias. RESULTS: The analysis suggests that the DM reduced spending by about $1375 per year for each participant. The risk assessment and risk management components had no effect on spending in this initial year. CONCLUSIONS: DM reduced health care spending at the University of Minnesota, but not enough to generate a positive return-on-investment. A number of factors may qualify this conclusion.

Quality-adjusted life years lost from nonfatal motor vehicle accident injuries.

BACKGROUND: A number of studies have estimated the quality-adjusted life years (QALYs) lost from nonfatal motor vehicle accident injuries, but these estimates have a number of limitations. OBJECTIVE: The goal of this study is to estimate the QALYs lost from the typical motor vehicle accident injury based on 1) data obtained through a standard preference elicitation procedure, 2) both permanent and nonpermanent injuries, and 3) a more realistic baseline quality-of-life level from which to determine the QALY decrement. This study also intends to demonstrate the advantages of using self-reported health status as the basis for determining a change in QALYs. RESEARCH DESIGN: Ordered probit equations were estimated to determine the change in self-reported health status associated with 3 categories of injuries. These results were next converted to their marginal effects and weighted by the quality-of-life estimates for self-reported health status found in Nyman and others (2007). The quality-of-life decrements for the 3 categories of injury were then converted to QALY decrements by applying estimates of the duration of that injury type. SUBJECTS: The data came from 8 years of the Medical Expenditure Panel Survey (MEPS), from 1997 to 2004. MEASURES: Self-reported health status categories were excellent, very good, good, fair, or poor. RESULTS: The reference case decrement for an average motor vehicle accident injury is 0.0612 QALYs or 0.0360 QALYs, if discounted at 3%. CONCLUSIONS: Quality-of-life weights for self-reported health status can be used to exploit the data in large national surveys.

Quality-of-life weights for the US population: self-reported health status and priority health conditions, by demographic characteristics.

BACKGROUND: Many of the large ongoing national surveys of the US population contain a question that asks for the respondent's self-reported health status: "excellent," "very good," "good," "fair," or "poor." These surveys could be used to conduct cost-utility analyses of health care policies, treatments or other interventions if quality-of-life (QOL) weights for the self-reported health statuses were also available. OBJECTIVE: The objective of this study was to produce nationally representative QOL weights for self-reported health status and for 10 "priority" health conditions, by a series of demographic variables. RESEARCH DESIGN: The Medical Expenditure Panel Survey contains the questions from the EQ-5D health status measure. A recent study has calculated time-trade-off-derived QOL weights corresponding to the EQ-5D health states for a large sample of Americans. We use these data to construct QOL weights for the 5 self-reported health status categories and 10 priority health conditions, by a series of demographic variables. RESULTS: Mean and median QOL weights were produced for self-reported health status, the 10 priority health conditions, and the demographic variables. We also report mean QOL weights for the self-reported health state and priority health conditions, by the demographic variables. Finally, ordinary least squares and censored least absolute deviation regression equations were used to estimate adjusted QOL weights for these variables. CONCLUSIONS: By providing nationally representative QOL weights for self-reported health status and 10 priority health conditions, by demographic variable, we have facilitated the use of large national surveys for conducting cost-utility analysis and increased their value to researchers and policy makers.