A Pilot Study Examining a Reinforcement Approach to Improve Diabetes Management

Glucose control is necessary to avoid the immediate and long-term adverse effects associated
with type 1 diabetes, and frequent self-monitoring of blood glucose is the first important
step to achieving glucose control. Data suggest that large proportions of adolescents and
young adults fail to adhere to standard guidelines of self-monitored of blood glucose
testing and have hemoglobin A1c levels >7.5%. A finite period of poor metabolic control can
lead to increased risk of medical complications over an individual's lifespan, necessitating
novel interventions to improve self-monitored blood glucose testing and metabolic control in
emerging adults with type 1 diabetes. The investigators treatment approach, which provides
direct tangible reinforcement for objective evidence of behavior change, is efficacious in
decreasing substance use, reducing weight, and improving medication adherence.

The purpose of this project is to develop and pilot test an intervention based on behavioral
economic principles for improving self-monitored blood glucose testing in young persons with
type 1 diabetes. In this pilot study, patients will text in, via cell phones, each time they
test, and a return text will inform them of reinforcer vouchers earned. The investigators
will collect data on self-monitored blood glucose testing frequency and A1c levels preceding
treatment initiation and throughout a 6 month treatment period. If promising, a randomized
trial will lead to larger scale evaluations of reinforcement interventions alone, or in
combination with multimodal treatment approaches, and it may be applied to other clinical
issues such as adherence to continuous glucose monitoring. Importantly, this intervention
can be administered remotely and in an automated fashion, allowing for widespread adoption
if efficacious.