Financial incentives could improve blood testing adherence in teens with type 1 diabetes

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A new study has shown financial incentives could encourage teenagers with type 1 diabetes to monitor their blood sugar levels more often.
Scientists from Duke University, North Carolina, discovered that while adherence to testing improved, the findings did not translate to improved blood sugar control.

The researchers say this is one of the first studies to demonstrate how money encouraged adolescents to change their behaviour, and believe this type of incentivisation could be useful in boosting diabetes control among adolescents.
“Identifying interventions that empower young people to manage their disease effectively is crucial. Financial incentives and smartphone-connected glucometers proved to be promising tools that deserve further exploration in adolescents and young adults with type 1 diabetes,” said the study authors.
They conducted the study because the transition from childhood to young adulthood can be hard, particularly when you have type 1 diabetes. By offering money to adolescents, the researchers hoped to motivate behaviour change.
Ninety participants aged 14-20 years were encouraged to check their blood glucose levels four times daily and to achieve at least one reading within 3.9-10 mmol/l. They were given monthly $60 (£46) virtual accounts, from which $2 was taken off for each day they didn’t achieve this task, with email or text messages informing them of their success rate and reminding them of their current balance.
The trial lasted three months, where at the end the participants received the money that had accrued. These incentives were then discontinued and they were monitored again for another three months.
Blood sugar monitoring and test results in target range both significantly increased with the financial incentive, but this didn’t have any significant impact upon HbA1c levels.
Dr Michelle Katz, Joslin Diabetes Center, Boston, Massachusetts, who wasn’t involved in the study, said: “The financial reward incentivized blood glucose monitoring and so this behaviour improved. However, [the intervention] was likely not enough to impact all the behaviours that bridge between blood glucose monitoring and improving glycemic control, like counting carbs and administering an insulin bolus.
“It can be really hard to turn a short-term behaviour change into a habit. Many of these teens were probably told to check their blood glucose monitoring at least four times per day for years before taking part in the trial. It’s great that the trial was able to motivate a temporary increase in blood glucose monitoring, but not surprising that teens slipped back into their old habits.”
Benedict Jephcote, Editor of Diabetes.co.uk, commented on the study: “Within the UK, £46 per month could be sufficient funding to replace many of those daily finger-pricking blood tests with use of continuous glucose monitoring or flash glucose monitoring.
“These systems provide a wealth of data beyond that which blood testing can give, which gives more power to the person with diabetes to control their sugar levels. In addition, these systems don’t require the risk of pain in order to get readings.”
The findings appear online in the journal JAMA Pediatrics.