Incentives for Internet-based Adherence to SMBG for Teens With T1D
Condition: Contingent Versus Noncontingent Incentives
Study type: Interventional

Summary: 
      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.
    

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.).
    

Intervention name(s): Internet-delivered, Incentive-based intervention + Motivational Interviewing; Internet-delivered, non-contingent incentives + Motivational Interviewing
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment