Behavioral Economic Incentives to Improve Glycemic Control Among Adolescents and Young Adults

Study Overview
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Brief Summary
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In this study the investigators will compare a novel approach using daily financial incentives and a tiered sponsor network to motivate adolescents and young adults with type 1 diabetes to improve glycemic control.

Detailed Description
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Participants will be given daily glucose monitoring goals of ≥4 glucose checks per day with ≥1 readings within goal range (70-180 mg/dL) and provided with iHealth wireless glucometers. Half of the study participants will be randomized to the 3-month intervention arm on Way to Health. The intervention includes daily financial incentives ($60 in an account at beginning of each month with $2 daily loss if non-adherent) and a 2-level tiered sponsor network (youth select 2 people who will be notified of non-adherence after 2 and 5 consecutive days). The primary outcome will be HbA1c at 3 months compared to baseline. Secondary outcomes will include HbA1c at 6 months and the proportion of participants adherent to daily glucose monitoring goals. Exit interviews will elicit intervention feasibility and feedback from a youth perspective.

Official Title
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Behavioral Economic Incentives to Improve Glycemic Control Among Adolescents and Young Adults

Conditions
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Diabetes, Type 1 Diabetes

Intervention / Treatment
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* Behavioral: Daily feedback
* Behavioral: Financial incentive


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of type 1 diabetes HbA1c of 8 or greater Receiving care from the Childrens Hospital of Philadelphia Diabetes Center English-speaking Owns a smartphone Exclusion Criteria: New diagnosis of type 1 diabetes within past year Unable to provide informed consent Already participating in another study to improve glycemic control Any medical conditions that would prevent completion of the study

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Daily feedback<br>Participants receive daily feedback from wireless glucometers that transmit data on glucose monitoring adherence. | Behavioral: Daily feedback<br>* Daily feedback on glucose levels from wireless glucometers<br>|
| Experimental: Daily Feedback, incentives<br>Participants receive daily feedback from wireless glucometers that transmit data on glucose monitoring adherence. Participants are eligible for a financial incentive if adherent. | Behavioral: Daily feedback<br>* Daily feedback on glucose levels from wireless glucometers<br>Behavioral: Financial incentive<br>* Participant receive a $2 daily financial incentive framed as a loss with money allocated upfront and taken away each day of non-adherence to goal<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in HbA1c by 3 months | Change in HbA1c from baseline to 3 months | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in HbA1c by 6 months | Change in HbA1c from baseline to 6 months | 6 months | 
| Glucose Monitoring Adherence by 3 months | Proportion of time adherence to glucose monitoring during 3 month intervention | 3 months | 
| Glucose Monitoring Adherence by 6 months | Proportion of time adherence to glucose monitoring during 3 month follow-up period | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diabetes, adolescent, young adult, behavioral economics, financial incentives, social incentives