A Reinforcement Approach to Improve Diabetes Management

描述(申请人提供)：血糖控制是必要的，以避免与1型糖尿病(T1D)相关的即时和长期不良反应，而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。数据显示，很大一部分青少年和年轻人没有遵守SMBG测试的标准指南，并有7.5%的血红蛋白水平。代谢控制不良的有限时期可能会导致个人一生中医疗并发症风险的增加，这就需要新的干预措施来改善患有T1D的新发成人的SMBG测试和代谢控制。我们拥有丰富的经验，根据行为经济学原则设计、调整和测试干预措施，以提高各种临床人群的依从性和结果。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，在减少药物使用、减轻体重和提高用药依从性方面是有效的。本项目的目的是根据行为经济学原理开发、试点测试和改进干预措施，以改善患有T1D的年轻人的SMBG。利用成熟的行为经济学原理，此次干预将为SMBG提供不断升级的财务强化。最初，w将对10名患者进行为期6个月的干预可行性/试点测试。每次SMBG时，患者都会通过手机发送一条短信，一条回复短信将告知他们获得了增强剂。我们将在治疗开始前和整个6个月的治疗期间收集SMBG频率和A1c水平的数据。根据试验的经验，在将患者(N=60)随机分为两种情况之一(为期6个月)之前，可以对程序进行调整：单独使用糖尿病自我管理教育的标准护理或使用强化剂。主要结果将包括SMBG频率和A1c水平。为期6个月的随访将评估持久的效果。这项研究的数据将为改善SMBG依从性和降低A1c水平的基于强化的干预措施的可行性、安全性和可接受性提供有价值的信息。如果前景看好，这项研究将导致对强化干预措施的更大规模的评估，或与多模式治疗方法相结合，并可能应用于其他临床问题，如坚持持续血糖监测。重要的是，这种干预可以远程管理，并以自动方式进行，如果有效，就允许广泛采用。 公共卫生相关性：15-26岁的1型糖尿病患者的平均A1c水平最高，需要新的干预措施来改善这一群体的预后。血糖监测是糖尿病患者报告的遵守程度最低的自我护理活动，也是所有其他糖尿病管理决策所依据的活动。这项研究将测试一种结合行为经济学原理的新干预措施的有效性，以增加这些患者的血糖监测并降低A1c。

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.