602-P: Validity of a Feeling-State Tag Accompanying Blood Glucose (BG) Measurements in a Digital Remote Diabetes Management Program (RDMP)

Background: Diabetes is thought to have a bi-directional relationship with mental health, including stress. Therefore, it is increasingly important to understand stress of patients with diabetes in real-time. Despite extensive use and success of RDMPs, there is limited psychometric research on the development of real-time measures of stress in the context of RDMPs. The objective of this study is to examine the validity of a stress tag among participants in an RDMP. Methods: Participants in the study (ages 8-92) were enrolled in Livongo for Diabetes, an RDMP offering a glucometer that prompts user to endorse a feeling-tag to provide behavioral context to BG readings. Participants also received smartphone surveys at baseline, 6 months, and 12 months containing a two-item Diabetes Distress Scale SF. Repeated BG and stress data from the first 12 months of the program were aggregated to 3-month windows surrounding the smartphone surveys. Two-part generalized linear mixed models were used to test association between stress tags and DDS-SF. Results: Participants (N=470) were, on average, 59.69 years old, 50% female, and 80% White, with 91% reporting type 2 diabetes and 36% reporting insulin usage. Two-part models revealed that each additional point on the DDS-SF scale was associated with a 46% increased likelihood (95% CI: 1.23-1.75) of any stress tag at that time point (z=4.25, p Conclusions: The study found that a stress tag during glucometer use was associated with DDS-SF. In the context of an RDMP, a stress indicator allows for real-time data analysis, and thus a better understanding of a patient9s experience with their disease. Future studies may seek to understand the extent to which such stress measures can be used to predict lapses in medication adherence. Disclosure E. Dzubur: Employee; Self; Livongo, Teladoc Health, Stock/Shareholder; Self; Livongo, Teladoc Health. L. Fan: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company, Stock/Shareholder; Spouse/Partner; Eli Lilly and Company. R. James: Employee; Self; Livongo, Teladoc Health, Stock/Shareholder; Self; Livongo, Teladoc Health. W. Lu: Employee; Self; Teladoc Health. E. Meadows: Employee; Self; Eli Lilly and Company, Employee; Spouse/Partner; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company, Stock/Shareholder; Spouse/Partner; Eli Lilly and Company. M. Perez-nieves: Employee; Self; Eli Lilly and Company. B. Shah: Employee; Self; Teladoc Health, Stock/Shareholder; Self; Teladoc Health.