Incentives, Cognitive Training and Internet Therapy for Teens With Poorly Controlled Type 1 Diabetes
| Status: | Completed |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 13 - 17 |
| Updated: | 6/8/2018 |
| Start Date: | January 2014 |
| End Date: | September 2016 |
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.
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.
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.
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.
Inclusion Criteria:
- 13-17 years old
- Diagnosis of type 1 diabetes
- Average HbA1c > or = to 8% for the past 6 months (mean of two values)
- Most recent HbA1c is > or = to 8%
- Duration of disease is > 18 months
- Teen must live at home
- Family must have broadband internet in the home
Exclusion Criteria:
- Pregnancy/breast feeding
- Active psychosis
- Severe medical or psychiatric illness that will limit participation
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