One of the most interactive glucose monitors I've ever used is the Livongo meter, with its touchscreen color display and subscription-based model for ordering new strips. Introduced in 2014, this meter is paired with a coaching service that we previewed in late Fall.

We're very grateful now for the opportunity to review the Livongo meter and coaching service at no cost, thanks to our friend and fellow type 1 Manny Hernandez, who works for the California company.

The coaching aspect definitely took some getting used to on my part. And while it wasn't a life-changer for me personally, I do see an audience for this and think it serves an important purpose for PWDs (people with diabetes) who really need and want that kind of real-time access.

As we've said before, Livongo kind of wrote the book on integrating coaching into mobile devices. And in November, the Livongo meter became the first to include for remote updating, instead of having to replace the device or buy a new one when new features become available.

One important note going in here is that this meter is not sold directly to consumers. Rather, at this time, you can only get it through your doctor's office, or an employer or health plan, where it is set up and paid for by those entities.

So with that in mind going in, here are our impressions of the Livongo meter and coaching service.

 

(Note that we promised to follow up on our Fall overview of three mobile D-education and coaching tools with hands-on reviews. Please see our mySugr Coaching review from December, and keep an eye out for our review by month's end.)

 

Livongo Meter Basics

First up, the meter basics (based on the Livongo starter kit we were sent):

  • Form Factor: The meter is a black rectangle shape (complete with pointy corners) that fits into the palm of your hand. Generally, it seemed bulky and too large for me -- especially since I was comparing it to my trusty Bayer Contour Next meter that's more the size of a large USB stick. But over time, the Livongo meter grew on me, mainly because the screen display is so appealing (see below). I didn't care for the Livongo-designed case personally (even though 'Mine editor Amy begs to differ), as I found it too flimsy for my taste and it doesn't hold my Afrezza cartridges and strips the way I like. Luckily, everything fit inside my preferred hard-cover case nicely.
  • Color Touchscreen: This is what truly captured my interest. I like the color boxes and touchscreen aspect of this meter, allowing you to select easy-to-read windows like "Check BG," "My Logs," "Messages," and "Share and easy eat hand" at the touch of a fingertip. The whole meter menu system is well-designed and easy to navigate, IMHO.
  • Cloud-Connected: Like other wireless meters, the Livongo meter sends all your results to a "smart cloud." But this one not only stores data but also sends you feedback and suggestions on what to do next (!) After every test, the data is automatically sent to the cloud and you simply watch the meter display for immediate feedback.
  • Insights: It's also kind of fun that while you're waiting the five seconds for your blood sugar result to appear, the meter offers health trivia like, "All milk sold in the U.S. has vitamin D," and "Did you know that regular exercise will increase your energy level?" Or even "Did you know that it takes 21 days to form a habit?" I got to the point of actually waiting with suspense to see the next mystery piece of info, like with a fortune cookie ;)
  • Logging: It's a straight-up BG logging setup. You can tag your result by clicking on a variety of prompts about how you're feeling, to offer a bit more context. For example, "I feel fine." Although noticeably, I used the "Other" option a lot since there wasn't an "Illness" choice of any sort and I've been under the weather. They ought to add that option! You can also hit the Insulin or Carbs button to note that your reading is associated with dosing or eating, but unfortunately it doesn't allow you to just enter those items separate from any glucose data being logged.
  • Unlimited Test Strips: This is a huge selling point for Livongo. The company's proud of the unlimited strips they offer, built into the Livongo business model -- no matter how many strips you may use each month! Not only is this economical, but there is something appealing about the quick and easy re-ordering of strips right off your meter and having them delivered them right to your door, instead of you having to keep track and do the work, and then worry about deductibles and co-payments. Am I right?! I have to note that the Livongo strips themselves are pretty large, especially compared to common brand-name brand strips. This could be seen as a plus or minus, depending on your POV. They're certainly easier to handle if you have dexterity issues.
  •  Mobile App: Yes, there is a mobile app. I'm an Android guy and found the app on Google Play Store. It works just as you'd expect, displaying my diabetes data and allowing you to share that data by email or interact directly by email with a Livongo coach. It also includes some healthy recipes and other tips and tricks. While I appreciated the ability to email for coaching info in the Android environment, I would've liked to have been able to message the coaches directly within the app like users can do with the mySugr system.  

And on that note, as to the Livongo Coaching itself...

Diabetes Coaching

What you get from is something that's becoming a new normal: CDE (certified diabetes educator) interaction, mobile-health style -- in this case via a mixture of phone texts, emails and phone calls if desired. This is above and beyond the BG management "insights" that are automatically displayed every time you enter a test result.

The way it works is that you actually register as a Livongo user when you order your meter, providing your email and phone number for text messaging. As Livongo's customers currently get on the system through their health plan, employer, or doctor, this registration is part of the process. By default, you're set up to receive email and text messages from the Livongo coaches, but I learned that you can also turn off those notifications if you prefer.

Unless the feature is turned off, you will automatically receive a text if you get a test result that's out-of-range high or low -- like I did.

Coach: "Hi, Mike. This is (so and so), one of the health coaches at Livongo. I just wanted to make sure everything is OK. Please call or text me." She then asked if I knew why my level was elevated, and when I responded with a "Yes," she pressed for more detail.

Me: "Different reasons: I'm sick. Ate without dosing last night. And also, I'm testing out my Afrezza effect at the tail-end of a coughing sickness when my inhaled insulin wasn't working effectively."

She asked if I had any questions, and if I'd tested my ketones (I hadn't, and didn't plan to), and expressed sympathy that I'd been feeling under the weather. She offered a last bit of advice on staying hydrated, and that was the end of that initial exchange.

Within that same day, it was nice that this particular coach emailed me a document on "Sick Day Guidelines" that contained some common sense tips for dealing with illness. That was a nice touch, I must say.

Regarding being contacted by a coach, you can adjust the BG range settings so that you don't get notified unless your sugars go below 50 or above 400 (rather than 70 or 300, for example). A few times, I let my BG go extra high just to see just how quickly these coaches would respond -- they were pretty prompt, within minutes of my 400+ blood sugar.

If you have the meter in hand and want to proactively tap the coaching service, you hit the the "easy eat hand" icon and you're able to "Contact a Coach" -- which submits a request through the cloud and within the hour sends you an email and text message prompting you to schedule an appointment with one of the coaches by phone. I personally found that prompt kind of annoying, because I was always in search of the answer to an immediate question.

Instead, I found using the Android app on my phone was more convenient. You can click the "easy eat hand" icon there to send an email; a template pops up where you can plug in your question. This usually resulted in a response within the hour (typically from the call center in Chicago). Not bad, but email still seems painfully slow if you're of the Texting Generation.

Once I had received an initial text message response from the Chicago-based team, I was able to use that text address to interact with the coaches over time. I tried texting after hours and on weekends and the Livongo coaches were VERY prompt!

Over the course of the month or so, I posed various questions to the Livongo coaching team, including one about whether they'd had any experience with Afrezza in D-management, but they declined to answer since that touched on specifics of adjusting medication dosing. Yup, just like our advice column here, these coaches can't address medication dosing specifics, which are best left to the doctor-patient relationship. Basically, what you CAN ask is anything you would ask a CDE about general lifestyle, food, carb-counting, behavioral issues, etc.

I also floated a question about dealing with diabetes burnout, and any tips or tricks they might have to battle that. Here's what one coach offered:

All in all, I interacted with four different coaches, receiving voicemails from two and texts from two others. We're told by Livongo that you do have the option to choose your own individual coach and stick with that individual, which is really nice.

Compare and Contrast

Overall, I found the response pretty prompt and the answers I received to be solid. So kudos to Livongo for that.

In comparison to the mySugr coaching program however, I found a few things lacking. First, in mySugr, everything happens inside the app, which is much more simplified and streamlined. Whereas with Livongo, you're dealing with a mix of phone text messages, emails and phone calls. It was a just A LOT going on, that I found kind of burdensome (especially as I was dealing with my own D-burnout during this period of time).

Also, in mySugr, I really like the fact that you can log lots of other data alongside BG results, such as specifics of insulin doses and carb counts if you're interested in just tracking that info independent of BG data. And you can even upload pictures of your food or medication. That was a big advantage for me so I could track my Afrezza dosing data -- whereas Livongo is basically limited to glucose data.

To be honest, I also found the text messages every time I was out of range to be more of a nag than anything else. But that may be in part because I was cranky and out-of-range a lot with my cold. And I didn't immediately understand that I could turn this notification off. As a type 1, I test so darn often that I just don't want to be bugged about every result. But I do see the value for people who may test less often and really want to talk to an expert about their not-so-ideal results.

While this may not be the meter I'd opt to buy and the coaching didn't sway me personally for my own diabetes care, I think what Livongo offers is different and can certainly help fill in the time gaps between doctor visits or individual CDE office instances for those with diabetes.  

Would I recommend this product? (as they like to ask in consumer reviews). For those who want a bright, clear interactive meter and some hand-holding with their D-management -- yes, I definitely would.