Incentives, Cognitive Training and Internet Therapy for Teens With Poorly Controlled Type 1 Diabetes
Condition: Type 1 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional

Summary: 
      The overall goal of this project is to develop a novel family friendly intervention that will
      help teens with poor metabolic control of their type 1 diabetes increase and sustain daily
      self monitoring of blood glucose and lower HbA1c. This is important because poor metabolic
      control has long-term health implications. This project will provide important information
      regarding new effective ways to improve outcomes among teens with poorly controlled type 1
      diabetes.

      Primary hypotheses are that the intervention, MAxIM, will: (1) help teens improve and
      maintain glucose control, and (2) improve decision making (improve executive function and
      reduce delay discounting), which will predict treatment outcome.
    

Detailed description: 
      Type 1 diabetes in adolescents is a significant medical condition associated with high
      economic costs and increased mortality, and its incidence is increasing. Unfortunately,
      adolescents show poorer adherence to self monitoring of blood glucose (SMBG) recommendations
      and poorer metabolic control than adults. Although some individual and family-based
      interventions have shown promise in improving metabolic control, there is a critical need to
      develop more effective interventions. The overall goal of this DP3 project is to develop a
      new innovative intervention that targets decision making to help teens with poor diabetic
      metabolic control increase the frequency of SMBG and improve HbA1c. The target population
      will be teens aged 13-17 with type 1 diabetes and HbA1c >8%. Based on our prior work and a
      conceptual model, the proposed study will develop and pilot test a novel, multifaceted,
      developmentally appropriate intervention aimed at improving adolescent decision making. An
      integrated set of components target adolescents' need for frequent positive feedback,
      improved future orientation, and motivational support. While past research indicates that
      behavioral interventions are frequently more successful when they include multiple elements,
      no previous intervention has combined multiple empirically-based components that target key
      decision making levers in one intervention. This new intervention, called MAxIM (MotivAtion,
      Incentives, Memory) uses: 1) motivation enhancement therapy (MET) (an existing evidence-based
      treatment for adolescent with diabetes) supplemented with cognitive behavior therapy (CBT) to
      enhance behavior change; 2) financial incentives for daily blood glucose testing and parental
      monitoring to provide frequent positive feedback; and 3) working memory training (WMT), an
      efficacious method for strengthening specific cognitive processes that support
      decision-making and future orientation. The interventions will be delivered to families at
      home via the internet to increase the reach of the intervention to families living distant
      from their treating endocrinologist. MAxIM will be teen and parent friendly and designed to
      increase engagement and compliance with the intervention. Primary hypotheses are that MAxIM
      will: (1) help teens improve and maintain glucose control, and (2) improve decision making
      (improve executive function and reduce delay discounting), which will predict treatment
      outcome. The unique set of interventions holds promise for improving adherence by affecting
      multiple basic mechanisms that determine poor decision making. The project will develop a
      novel, highly transportable, home based intervention designed to maximize and sustain HbA1c
      reductions and SMBG frequency over time in adolescents. Innovations include the targeting of
      multiple levers specific to adolescent decision making, use of technology to deliver the
      intervention to families at home, and testing cognitive predictors of treatment outcome for
      teens with diabetes. Successful achievement of this study's aims will bring the field closer
      to a cost effective, long-lasting intervention to improve outcomes among these high-risk
      youth.
    

Intervention name(s): MAxIM; Usual Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This new intervention, called MAxIM (MotivAtion, Incentives, Memory) uses: 1) motivation enhancement therapy (MET) (an existing evidence-based treatment for adolescent with diabetes) supplemented with cognitive behavior therapy (CBT) to enhance behavior change; 2) financial incentives for daily blood glucose testing and parental monitoring to provide frequent positive feedback; and 3) working memory training (WMT), a method for strengthening specific cognitive processes that support decision-making and future orientation. The interventions will be delivered to families at home via the internet.; Usual Care reflects the standard treatment currently provided at the Children's Hospital at Dartmouth. Teens will be followed by their treating endocrinologist and receive the following standard services as part of that treatment-quarterly outpatient clinic visits, including an interval medical history and physical examination; routine laboratory assessment; review of glycemic control, medication adjustment, medical nutrition therapy, and diabetes self-management education; telephone consultations with a nurse/certified diabetes educator in their treating clinic are available as often as necessary between clinic visits.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care