Incentives for Internet-based Adherence to SMBG for Teens With T1D

Incentives for Internet-based Glucose Testing in Adolescent Type 1 Diabetes

Self-management of diabetes can result in long-term benefits, such as delaying or preventing the development of a number of unnecessary health complications, and can even reduce the chances of premature death. Because adherence to diabetes self-management often declines during adolescence, it is critically important to develop interventions that increase adherence of diabetes self-management skills in this population.

Study Overview

• Status: Completed
• Conditions: Contingent Versus Noncontingent Incentives
• Intervention / Treatment: Behavioral: Internet-delivered, Incentive-based intervention + Motivational Interviewing; Behavioral: Internet-delivered, non-contingent incentives + Motivational Interviewing

Detailed Description

Intensive glycemic control among diabetics decreases the risk of both the development and progression of a number of medical complications associated with diabetes. Self-monitoring blood glucose is a critical component of diabetes self-management and is correlated with improvements in glycemic control. Nevertheless, adherence to blood glucose monitoring is generally poor, particularly among youth, with one study reporting that only ~ 25% of adolescents adhered to the recommended frequency of blood glucose testing.

The current study will use a powerful, scientifically-based behavioral intervention - contingency management (CM) to increase self-monitoring of blood glucose and improve glycemic control among adolescents with Type 1 diabetes. CM involves giving incentives for objective evidence of a target behavior and has been shown to have a robust and reliable impact in promoting behavior change. Our previous research used the Internet to objectively monitor smoking and reinforce smoking cessation (via video recorded carbon monoxide submissions), which resulted in robust increases in smoking abstinence. The current proposal extends this effective Internet-based CM intervention to address the significant health issue of non-adherence to blood glucose testing and glycemic control among youth. Two groups of non-adherent adolescents will be recruited. One group will earn incentives over the Internet for submitting webcam recorded videos that show them testing their blood glucose. A different group will be given standard care recommendations for blood glucose testing and management and will be encouraged to submit glucose monitoring videos, but incentives will not be delivered contingent on submissions (instead, they will earn monetary incentives independent of video submissions, but in an overall amount that matches the earnings of a participant in the other group). The purpose of the study is to evaluate the feasibility, convenience, and efficacy of using Internet-based CM to increase blood glucose monitoring in adolescent Type 1 diabetics.

Combining the accessibility of the Internet with a powerful, evidence-based behavioral intervention can have profound effects on adherence to diabetes self-management in this important population. Improving adherence to diabetes management in adolescents is a significant public health issue - serious medical complications, such as heart disease and nerve damage, that would develop with poor glycemic control can be avoided. Importantly, the current study offers a scientifically-based behavioral intervention that could be applied to a range of populations and behavior relevant to adherence with diabetes regimens (e.g., adults, medication adherence, carbohydrate counting, insulin dose adjustment, etc.).

• Study Type: Interventional
• Enrollment (Actual): 52
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosed with Type 1 diabetes for at least one year
• Self-reported self-monitoring blood glucose less than four times per day
• Lived in a home with Internet access
• No travel plans within 2 months of enrolling in the study
• Read and spoke English

Exclusion Criteria:

• Diagnosis other Type 1 diabetes within one year of screening
• Not attending regular clinic appointment within 3 months of screening

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Contingent; Participants in this group received incentives contingent on meeting pre-specified daily blood-glucose testing adherence goals.	Behavioral: Internet-delivered, Incentive-based intervention + Motivational Interviewing; Blood glucose monitoring was verified by videos uploaded to a secure server. Participants in the experimental group received incentives for adherence whereas participants in the control group received adherence independent of adherence.
Active Comparator: Noncontingent; Participants in this group received incentives independent of meeting pre-specified daily blood glucose testing adherence goals.	Behavioral: Internet-delivered, non-contingent incentives + Motivational Interviewing

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Daily frequency of self-monitoring blood glucose	45 days
Percentage of days conducted at least 4 tests per day.	45 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability of the intervention	This was measured using a Treatment Acceptability Questionnaire	45 days
Feasibility	Feasibility was based on willingness to participate (recruitment), adherence with the video submission protocol, and attrition	45 days

Collaborators and Investigators

• Sponsor: Rowan University
• Collaborators: National Development and Research Institutes, Inc.
• Investigators: Principal Investigator: Bethany Raiff, PhD, Rowan University

Study record dates

Study Major Dates

• Study Start: April 1, 2011
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: December 17, 2015
• First Submitted That Met QC Criteria: December 18, 2015
• First Posted (Estimate): December 23, 2015

Study Record Updates

• Last Update Posted (Estimate): December 23, 2015
• Last Update Submitted That Met QC Criteria: December 18, 2015
• Last Verified: December 1, 2015

More Information

Terms related to this study

• Other Study ID Numbers: R21HD061683-02 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Only upon request