Incentives for Internet-based glucose testing in adolescent Type 1 diabetes

描述（由申请人提供）：本申请是先前提案（R21 HD 061683 - 01 A1）“青少年1型糖尿病患者基于互联网的血糖检测激励措施”的最终修订版，该提案是针对“儿童和青少年慢性疾病自我管理”（PA 07 -099）项目公告而编写的。 糖尿病患者中强化血糖控制可降低与糖尿病相关的许多医学并发症的发生和进展的风险（DCCT，1993）。自我监测血糖是糖尿病自我管理的重要组成部分，与血糖控制改善相关（ADA，2008）。然而，血糖监测的依从性通常较差，尤其是在青少年中，一项研究报告称，只有约25%的青少年坚持推荐的血糖检测频率（Kyngas，2000）。 目前的研究将使用一种强大的、以科学为基础的行为干预--应急管理（CM），以增加1型糖尿病青少年的血糖自我监测和改善血糖控制。CM涉及对目标行为的客观证据给予激励，并已被证明在促进行为改变方面具有强大而可靠的影响。我们之前的研究使用互联网来客观地监测吸烟情况并加强戒烟（通过视频记录一氧化碳提交），这导致戒烟率大幅增加。目前的提案扩展了这种有效的基于互联网的CM干预，以解决青少年中不坚持血糖检测和血糖控制的重大健康问题。将招募两组未依从的青少年。其中一组将通过互联网获得奖励，因为他们提交了网络摄像头录制的视频，显示他们测试血糖。不同的组将获得血糖检测和管理的标准护理建议，并鼓励提交血糖监测视频，但不会根据提交情况提供激励（相反，他们将获得独立于视频提交的货币激励，但总金额与另一组参与者的收入相匹配）。本研究的目的是评估使用基于互联网的CM增加青少年1型糖尿病患者血糖监测的可行性、便利性和有效性。 将互联网的可访问性与强大的循证行为干预相结合，可以对这一重要人群坚持糖尿病自我管理产生深远的影响。改善青少年对糖尿病管理的依从性是一个重要的公共卫生问题-可以避免血糖控制不良可能发生的严重医学并发症，如心脏病和神经损伤（DCCT/EDIC，2001）。重要的是，目前的研究提供了一种基于科学的行为干预，可以应用于一系列与糖尿病治疗方案依从性相关的人群和行为（例如，成人、药物依从性、碳水化合物计数、胰岛素剂量调整等）。 公共卫生相关性：糖尿病的自我管理可以带来长期益处，例如延迟或预防许多不必要的健康并发症的发展，甚至可以降低过早死亡的机会（糖尿病控制和并发症试验[DCCT]，1993; DCCT/EDIC，2005）。因为坚持糖尿病自我管理往往在青春期下降（Bryden等人，2001; Svoren等人，2007），至关重要的是要制定干预措施，增加坚持糖尿病自我管理技能在这一人群中。

DESCRIPTION (provided by applicant): This application is the final revision of a previous proposal (R21HD061683-01A1), "Incentives for Internet-based glucose testing in adolescent Type 1 diabetics," which was written in response to the program announcement "Chronic Illness Self-Management in Children and Adolescents" (PA07-099). Intensive glycemic control among diabetics decreases the risk of both the development and progression of a number of medical complications associated with diabetes (DCCT, 1993). Self-monitoring blood glucose is a critical component of diabetes self-management and is correlated with improvements in glycemic control (ADA, 2008). Nevertheless, adherence to blood glucose monitoring is generally poor, particularly among youth, with one study reporting that only ~ 25% of adolescents adhered to the recommended frequency of blood glucose testing (Kyngas, 2000). The current study will use a powerful, scientifically-based behavioral intervention - contingency management (CM) to increase self-monitoring of blood glucose and improve glycemic control among adolescents with Type 1 diabetes. CM involves giving incentives for objective evidence of a target behavior and has been shown to have a robust and reliable impact in promoting behavior change. Our previous research used the Internet to objectively monitor smoking and reinforce smoking cessation (via video recorded carbon monoxide submissions), which resulted in robust increases in smoking abstinence. The current proposal extends this effective Internet-based CM intervention to address the significant health issue of non- adherence to blood glucose testing and glycemic control among youth. Two groups of non-adherent adolescents will be recruited. One group will earn incentives over the Internet for submitting webcam recorded videos that show them testing their blood glucose. A different group will be given standard care recommendations for blood glucose testing and management and will be encouraged to submit glucose monitoring videos, but incentives will not be delivered contingent on submissions (instead, they will earn monetary incentives independent of video submissions, but in an overall amount that matches the earnings of a participant in the other group). The purpose of the study is to evaluate the feasibility, convenience, and efficacy of using Internet-based CM to increase blood glucose monitoring in adolescent Type 1 diabetics. Combining the accessibility of the Internet with a powerful, evidence-based behavioral intervention can have profound effects on adherence to diabetes self-management in this important population. Improving adherence to diabetes management in adolescents is a significant public health issue - serious medical complications, such as heart disease and nerve damage, that would develop with poor glycemic control can be avoided (DCCT/EDIC, 2001). Importantly, the current study offers a scientifically-based behavioral intervention that could be applied to a range of populations and behavior relevant to adherence with diabetes regimens (e.g., adults, medication adherence, carbohydrate counting, insulin dose adjustment, etc.). PUBLIC HEALTH RELEVANCE:: Self-management of diabetes can result in long-term benefits, such as delaying or preventing the development of a number of unnecessary health complications, and can even reduce the chances of premature death (Diabetes Control and Complications Trial [DCCT], 1993; DCCT/EDIC, 2005). Because adherence to diabetes self-management often declines during adolescence (Bryden et al., 2001; Svoren et al., 2007), it is critically important to develop interventions that increase adherence of diabetes self-management skills in this population.