A Reinforcement Approach to Improve Diabetes Management

改善糖尿病管理的强化方法

• 批准号: 8436683
• 负责人: NANCY M PETRY
• 金额: $ 221.57万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-21 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8436683
• 关键词: Adherence; Adolescence; Adolescent; Adoption; Adult; Adverse effects; Aftercare; Age-Years; Alcohol or Other Drugs use; Anxiety; Behavior; Behavioral; Blood Glucose; Blood Glucose Self-Monitoring; Body Weight decreased; Cellular Phone; Child; Clinic; Clinical; Cognitive; Combined Modality Therapy; Complex; Costs and Benefits; Data; Decision Making; Diabetes Mellitus; Diet; Dose; Economics; Education; Effectiveness of Interventions; Evaluation; Exercise; Family; Feedback; Frequencies; Future; Glycosylated hemoglobin A; Guidelines; Home environment; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Lead; Long-Term Effects; Longevity; Medical; Mental Depression; Metabolic Control; Motivation; Outcome; Patients; Persons; Population; Procedures; Process; Psychological reinforcement; Quality of life; Randomized; Registries; Reporting; Rest; Risk; Safety; Self Care; Self Efficacy; Self Management; Symptoms; Techniques; Testing; Text; Time; Weight; age group; base; behavior change; blood glucose regulation; college; cost effectiveness; design; diabetes management; efficacy testing; emerging adult; experience; follow-up; food consumption; glucose monitor; improved; intervention effect; medical complication; medication compliance; new technology; novel; outcome forecast; pilot trial; primary outcome; reinforcer; secondary outcome; standard care; success; theories; trait; treatment as usual; treatment duration; young adult

DESCRIPTION (provided by applicant): Glucose control is necessary to avoid the immediate and long-term adverse effects associated with type 1 diabetes (T1D), and frequent self-monitoring of blood glucose (SMBG) 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 SMBG 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 SMBG testing and metabolic control in emerging adults with T1D. We have extensive experience designing, adapting and testing interventions based on behavioral economic principles to improve adherence and outcomes in a variety of clinical populations. Our 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, pilot test, and refine an intervention based on behavioral economic principles for improving SMBG in young persons with T1D. Using well-established behavioral economic principles, the intervention will provide escalating financial reinforcement for SMBG. Initially, w will conduct a feasibility/pilot test of the intervention with 10 patients for 6 months. Patients wll send a text, via cell phones, each time they SMBG, and a return text will inform them of reinforcers earned. We will collect data on SMBG frequency and A1c levels preceding treatment initiation and throughout a 6 month treatment period. Based on experiences with the pilot, procedures may be adjusted before randomizing patients (N = 60) to one of two conditions for 6 months: standard care with diabetes self management education alone or with reinforcers. Primary outcomes will include SMBG frequencies and A1c levels. A 6- month follow-up will assess enduring effects. Data from this study will provide valuable information about the feasibility, safety, and acceptability of reinforcement-based interventions for improving adherence to SMBG and reducing A1c levels. If promising, this study 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. PUBLIC HEALTH RELEVANCE: Patients with type 1 diabetes in the 15-26 year age range have the highest mean A1c levels, necessitating novel interventions to improve outcomes in this group. Blood glucose monitoring is the diabetes self care activity with which patients report the lowest level of adherence, and the activity upon which all other diabetes management decisions rest. This study will test the efficacy of a new intervention integrating behavioral economic principles to increase glucose monitoring in these patients and reduce A1c.

描述（由申请人提供）：血糖控制是避免与1型糖尿病（T1 D）相关的即时和长期不良反应所必需的，频繁的血糖自我监测（SMBG）是实现血糖控制的第一个重要步骤。数据表明，大部分青少年和年轻人未能遵守SMBG测试的标准指南，并且血红蛋白A1 c水平> 7.5%。有限的代谢控制不良可能会导致个体生命周期内医疗并发症的风险增加，需要采取新的干预措施来改善新兴T1 D成人的SMBG检测和代谢控制。我们在设计、调整和测试基于行为经济学原则的干预措施方面拥有丰富的经验，以改善各种临床人群的依从性和结局。我们的治疗方法为行为改变的客观证据提供了直接的有形强化，在减少物质使用、减轻体重和提高药物依从性方面是有效的。 该项目的目的是开发，试点测试，并完善基于行为经济学原则的干预措施，以改善T1 D年轻人的SMBG。使用成熟的行为经济学原则，干预将为SMBG提供不断升级的财务强化。最初，我们将对10名患者进行为期6个月的干预可行性/试点测试。患者每次SMBG时都会通过手机发送短信，并返回短信通知他们获得的奖金。我们将收集治疗开始前和整个6个月治疗期间SMBG频率和A1 c水平的数据。根据试点的经验，在将患者（N = 60）随机分配到两种条件之一之前，可以调整程序，持续6个月：标准护理+糖尿病自我管理教育或糖尿病自我管理教育+糖尿病自我管理教育。主要结局将包括SMBG频率和A1 c水平。6个月的随访将评估持久的影响。本研究的数据将提供有关基于胰岛素的干预措施的可行性、安全性和可接受性的有价值信息，以提高SMBG依从性并降低A1 c水平。 如果有希望，这项研究将导致更大规模的评估强化干预单独或与多模式治疗方法相结合，它可能会被应用于其他临床问题，如坚持连续血糖监测。 重要的是，这种干预可以远程和自动化的方式管理，如果有效，可以广泛采用。 公共卫生相关性：年龄在15-26岁之间的1型糖尿病患者的平均A1 c水平最高，需要新的干预措施来改善该组的结局。血糖监测是糖尿病自我护理活动，患者报告的依从性最低，并且是所有其他糖尿病管理决策所依赖的活动。这项研究将测试一种新的干预措施的有效性，这种干预措施整合了行为经济学原则，以增加这些患者的血糖监测并降低A1 c。