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 At the end of a three-month pilot study, teens with type 1 diabetes
who got 10 cents every time they tested their blood sugar did so
more often and had lower blood sugar levels.
And their A1C levels, a common measure of longer-term blood sugar
control, remained lower for a year after treatment, the study team
reports in Diabetes Care.
Lead author Nancy Petry noted that 70 percent of U.S. teens with
type 1 diabetes do not meet their blood sugar goals. Testing blood
sugar more frequently can help, as it helps people balance their
insulin doses with their food consumption and exercise, she said.
The teen years are when diabetes patients begin to take charge of
their own care, often with negative consequences, said Petry, a
professor of medicine at the University of Connecticut School of
Medicine in Farmington.
“During adolescence blood sugar testing decreases, and A1Cs begin to
rise in the vast majority of patients,” Petry told Reuters Health in
an email.
The study, Petry noted, was inspired by her own experience having a
young child with type 1 diabetes. “I figured I have about 5-7 more
years to develop a way to improve management of this disease in
adolescents before she will be taking over many of the
responsibilities.”
At Yale University in New Haven, Connecticut, the researchers
recruited 10 adolescents, ages 12 to 19, who were having trouble
controlling their condition.
During the 12-week study, the teens earned 10 cents each time they
tested their blood sugar, up to six times per day. They received
additional cash bonuses of 25 or 50 cents a day if they tested at
least four times per day, spread evenly throughout the day, and
sustained that pattern for more than a week.
Before entering the program, the adolescents were testing their
blood sugar less than twice a day. During the program, this
increased to nearly five times per day, on average. Nine out of the
10 participants tested their blood sugar four or more times per day
during the entire study.
The teens’ average earnings were $122 during the three-month study,
with over two-thirds of that amount coming from cash bonuses for
sustaining the desired testing patterns over many days running.
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The participants’ average A1C levels fell from 9.3 to 8.4 during the
experiment. A common goal for diabetes patients is an A1C level of
7.0 or less. Among the eight teens who were tested one year after
the study, the average A1C level was 8.4, suggesting that the health
benefits were sustained in the long term.
Nearly all of the teens and parents reported high satisfaction with
the program - perhaps, Petry said, because it eliminated a source of
controversy between parents and children. Parents were able to “quit
worrying about and arguing with their child about testing and
diabetes management,” she said.
Bethany Raiff, an assistant professor of psychology at Rowan
University in Glassboro, New Jersey, pointed out that while this
program shows a lot of promise, parents who seek to use it at home
must take care to do it correctly and be consistent with the
incentives.
Raiff, who studies incentive-based health interventions, advises
parents to rely on evidence of testing and not just on teens’
self-reports. In the study, testing was verified by uploads from
glucose monitors.
Raiff also noted that while monetary rewards seem effective, this
may not be an option for all families. “It is possible to get
creative and use other kinds of incentives (e.g., staying out a
little later, getting extra time on the computer, etc),” she said in
an email.
Petry said the approach of rewarding kids can help them develop
better diabetes management habits and give them the chance to
experience some success.
SOURCE: bit.ly/1KM8a8F Diabetes Care, online July 22, 2015.
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