glucose monitoring

Researchers from Duke University look to see how financial incentives for improved glucose monitoring might keep teens from developing complications caused by type 1 diabetes.

The transition from adolescence to adulthood can be a rough time for most people, but for kids with type 1 diabetes, it’s more than just dealing with teen angst.

Type 1 diabetes is a long-term condition that develops when the body is unable to produce sufficient amounts of insulin. Without it, sugar accumulates in the blood, leading to hyperglycemia. This can be particularly problematic for young teens, as poor blood-sugar management during young adulthood can have irreversible consequences including sexual dysfunction, cardiovascular diseases, and even blindness. To help teens better manage diabetes, a team of researchers from Duke University began investigating ways to encourage teens to improve their glucose monitoring. Their answer? Behavioral economics.

Behavioral Economics

Behavioral economics is a field of science that applies economic and psychological principles to promote certain types of behavioral changes. By providing financial incentives to young adults with diabetes, the researchers wanted to see whether they could encourage teens to regularly keep track of their blood sugar.

In their study, published in JAMA Pediatrics, the researchers recruited 90 adolescents with type 1 diabetes between the ages of 14 to 20 at the Children’s Hospital of Philadelphia. The teens were randomly split up into control and treatment groups and given daily monitoring goals of four glucose readings per day – separated by at least two hours each – for three months. Each participant was promised a $60 reward at the end of the study and was encouraged to aim for a healthy blood-sugar level of between 70-80 mg/dL. For teens in the treatment group, their glucometers were synced with a smartphone app via Bluetooth, so that for every day the teen failed to meet the requirements, $2 were subtracted from their $60 reward.

Frequent Blood Tests Do Not Mean Healthy Glucose Levels

The research team found that the financial incentive did help to encourage teens’ glucose monitoring and to measure their blood sugar at least four times a day. Fifty percent of the participants in the treatment group met their daily monitoring requirements, whereas only nineteen percent of the participants in the control group did. However, the scientists quickly realized that frequent blood tests didn’t necessarily mean healthier glucose levels. While financial incentives helped encourage strict glucose monitoring regimens, it did little to lower their average blood-glucose levels. When researchers tested for glycated hemoglobin—a measure of how much sugar the average blood cell was exposed to over the three-month period—they found no statistical difference. The treatment group’s glycated hemoglobin levels were only a marginal 0.17% lower than their control counterparts.

It seems that scientists will have to do a lot more than just giving away money to encourage teens to control their blood sugar. Participants suggested adding a multiplier effect, such that consecutive days where conditions weren’t met would lead to larger penalties. Or possibly adding social incentives such as social rankings that might encourage teens to do more than just measure their blood sugar. While financial incentives do seem to be a promising tool, the scientists are looking to further refine their methods to help teens keep their diabetes in check.

Written by Calvin J. Chan, B.Sc.

Wong, C.A. et al. (2017). Effect of financial incentives on glucose monitoring adherence and glycemic control among adolescents and young adults with type 1 diabetes: a randomized clinical trial. JAMA Pediatrics. 3233.

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