Livongo: An Interactive Meter and Coaching Service

Learn how you can improve your diabetes management

Research shows that blood glucose monitoring and diabetes self-management education (DSME) can improve health outcomes in people with diabetes, including better blood glucose control. What if you could pair the two in real time? Livongo is a data-based health coaching program that enables people with diabetes to share blood glucose records with Certified Diabetes Educators (CDEs). People with diabetes receive feedback in real time—within minutes if there is an emergency.

How Does Livongo Work?

Livongo's goal is to reduce the burden of managing diabetes. They've created relationships with sponsors, such as health plans, health systems, or self-insured employers to empower people with diabetes to better control their blood sugar. The meter's over-the-air capability allows the system to provide people with diabetes, feedback throughout the day, allowing for actionable changes to their diabetes management right away. They don't have to wait to be seen by the doctor for changes to be made.

People using Livongo are given a smart touch glucose meter. They can share their numbers with their health care team and be provided with feedback. If their blood sugar goes out of range, either too high or too low, they get a call or text from a Livongo CDE to make sure they are okay—in a way, it's like having a personal diabetes assistant.

When the Livongo system is used in a health care setting, the results can be integrated into electronic medical records, giving physicians access to a wealth of data and helping them to improve treatment plans.

Program Director, Registered Dietitian (RD), and CDE, from the Mount Sinai Diabetes Alliance, Maria Elena Rodriguez, says, "When patients enroll in the program, individual blood sugar targets are set. When the blood sugar goes out of that target range, they are contacted. The person with diabetes can decide how they want to be contacted or they can deny communication."

The way the coaching system works is variable for different settings. At Sinai, for instance, a team of CDEs have a portal login and password and are able to review blood glucose records. "When a person checks their blood sugar the data gets sent to the portal," Rodriguez says.

Each CDE of The Diabetes Alliance at Mount Sinai has a scheduled day where they look at the alerts. The CDEs oversee the alerts and call the person with diabetes. If they feel the information discussed needs to be shared with the physician, they can send the doctor a note in the electronic medical record. Once the doctor responds, the CDE will contact the person with diabetes again and provide them updated instructions.

For example, if a person has several high blood sugar alerts and is in need of a medication change, the CDE can discuss this with the doctor. Should the doctor want to make changes to the person's treatment plan, the CDE can communicate the changes to the person.

Rodriguez says, "This system has really helped our patients manage their diabetes because there is no limitation on how many times they can test their blood sugar. Unlimited strips and lancets are provided. The typical patient gets around 30 strips per month, which isn't enough. Unlimited testing provides a large amount of actionable data."

How Does the Smart Meter Work?

The smart, colored touch screen meter is easy to use and easy to read. It works like a regular blood glucose monitor, but with some major enhancements.

A cellular chip inside allows the meter to automatically upload readings safely and securely. Once your blood sugar is processed, you will receive immediate feedback, particularly if your blood sugar is out of range. Additionally, while you are waiting for your blood sugar to upload, you'll receive health promotion messages. When your blood sugar is complete, data is then transmitted to the Livongo team.

Additional Meter Features Include:

  • You have the capability of using the meter to fax blood glucose readings and trend information to your medical team. Additionally, you can sign up family members to have access to your logs and/or to receive alerts.
  • Behavior scientists have created thousands of health tips and messages for you to read while waiting for your blood sugar to upload.

What Do the Coaches Do?

The coaches with whom you'll be interacting with are CDEs who are educated on everything diabetes related. They serve as your liaison between you and your physician as well as your cheerleader and educator. The CDE's can:

  • Check in to discuss meal plans, exercise, and medicine management, as well as provide support.
  • The Livongo team provides real-time support 24/7/365 coverage. Coaches are standing by to advise on nutrition, lifestyle, diabetes, weight loss, and high blood pressure. If your blood sugar drops dangerously low, 50 mg/dL, or high (usually above 400mg/d/L), the new Livongo system is set up to call patients right away, within minutes. This level can set be set differently by every individual member with wirelessly-enabled glucose monitoring devices.
  • Upon your request, your Livongo team will call or text you when they need to communicate with you.

What About Supplies?

One of the biggest perks is that the program provides you with the meter, test strips, and lancets for free. And you cannot run out, because supplies and refills are unlimited. Supplies are also shipped to your home free of charge. This provides savings that improve engagement and increases satisfaction.

What Does the Research Say?

Studies conducted have shown that those people using the Livongo program, have had many improvements in their diabetes management as well as their quality of life. They report:

  • Reduced rate in emergency room and hospital visits
  • Improved medicine adherence, which improves blood sugar control
  • Decrease in diabetes medical costs for users and self-insured employers
  • Reduction in blood sugar and hemoglobin A1c
  • Less blood glucose excursions, specifically hyperglycemia (high blood sugar)

Certified by the AADE

Livongo is the first virtual diabetes management program to be certified by the American Association of Diabetes Educators (AADE). It meets the national standards of diabetes self-management education and support. The meter not only allows you to track blood glucose but also gives you the capability of setting up reminders for your important self-care parameters such as A1C, eye exam, etc.

How Can You Sign Up?

In order to qualify, you must have a type 1 or type 2 diabetes diagnosis. Ask your health care team, employer or health plan if they are partnered with Livongo. If this is the case, Livongo is set up and paid for by those entities. You do not have to pay for anything out-of-pocket.

Note, your health system may require you to meet specific parameters for enrollment. For example, some institutions require a person to have a specific insurance and level of A1C before being included. Spouses and dependents often qualify as well. If however, you are no longer eligible due to a change in your insurance provider or relocation, Livongo can offer the program at $49.99 per month.

In addition, as of 2017 Livongo announced a way to make the Livongo system available directly to consumers, through their Family Care Plan. The Family Care Plan provides the same support, unlimited supplies, and smart meter for $64.99. You must commit to a three-month subscription in order to receive the benefits.

Are There Any Drawbacks?

While this system seems to have everything you could want, some users "find the communication to be invasive, or too much," says Rodriguez. People using the system may also find it difficult to stay engaged once enrolled. Rodriguez recommends that you stick to one type of communication, for example, email or text so that you are not inundated with messages. According to Rodriguez, "This may help to organize your info and prevent you from becoming too overwhelmed."

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Article Sources
  • Powers, et. al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the american diabetes association, the american association of diabetes dducators, and the academy of nutrition and dietetics. Diabetes Care 2015 Jul; 38(7): 1372-1382. DOI: 10.2337/dc15-0730.

  • Downing J, Bollyky J, Schneider J. Use of a connected glucose meter and certified diabetes educator coaching to decrease the likelihood of abnormal blood glucose excursions: the livongo for diabetes program. J Med Internet Res 2017;19(7):e234 DOI: 10.2196/jmir.6659.