JMIR Publications

ABSTRACT

Background:

Technology is rapidly advancing our understanding of how people with diabetes mellitus (DM) experience stress.

Objective:

The aim of this study was to explore the relationship between stress and sequelae of DM within a unique data set composed of adults enrolled in a digital diabetes management program (Livongo) in order to inform intervention and product development.

Methods:

Participants included 3,263 adults under age 65 who were diagnosed with DM and had access to Livongo through their employer between June 2015 and August 2018. Data was collected at time of enrollment and 12 months thereafter, which included demographic information, glycemic control, presence of stress, diabetes distress, diabetes empowerment, and behavioral health (BH) diagnosis and utilization. Analysis of variance and Chi-square tests compared variables across groups that were based on presence of stress and BH diagnosis and/or utilization.

Results:

Fifty-five percent of participants (1,808) reported stress at the time of at least 1 blood glucose (BG) reading. Fifty-two percent (940 participants) also received at least 1 BH diagnosis or intervention. Participants with stress, compared to their peers, endorsed greater diabetes distress, lower diabetes empowerment, had greater insulin use, and poorer glycemic control. Participants with stress and a BH diagnosis/utilization additionally had higher BMI and duration of illness.

Conclusions:

Stress is common among people with DM and associated with worse emotional and physical health. Digital products that focus on the whole person by offering both DM self-management tools and BH skills and support can help improve disease-specific and psychosocial outcomes.