Teenagers with type 1 diabetes might take better care of themselves if they’re rewarded, new research suggests.
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.
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.