Small Monetary Rewards May Help Teens Control Type 1 Diabetes

Providing modest financial rewards to teens with Type 1 diabetes for testing their blood sugar may help them better control their condition, according to a small new study out of Yale University. An estimated 1.25 million Americans are living with Type 1 diabetes.

People with diabetes who are diagnosed as children typically begin to take responsibility for managing the condition in their teen years, generally resulting in a decrease in blood sugar monitoring and an increase in HbA1c levels (an indicator of blood sugar control over the previous 2–3 months) during adolescence. In fact, according to lead study author Nancy Petry, PhD, 70% of American teenagers with Type 1 diabetes do not meet their blood sugar goals.

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To determine the effectiveness of monetary rewards at increasing the frequency of blood glucose monitoring in this population, the researchers recruited 10 adolescents from ages 12–19 with Type 1 diabetes who were having difficulty controlling the condition. Over the course of the 12-week study, the teens were given 10 cents every time they tested their blood sugar up to six times per day and received an additional bonus of 25 or 50 cents a day if they tested at least four times a day spread evenly throughout the day and kept the pattern up for more than a week. The frequency of blood sugar tests was verified by uploads from the teens’ blood glucose monitors.

Prior to starting the study, the participants were checking their blood sugar levels less than twice a day. Over the course of the study, this increased to almost five times a day, on average, with nine of the 10 teens monitoring four or more times a day for the entire study. The subjects earned an average of $122 over the three months of the study, with more than two-thirds of that amount resulting from cash bonuses for maintaining desired testing patterns.

During the experiment, the teenagers’ average HbA1c levels fell from 9.3% to 8.4%, and among the eight teens who were tested again a year later, the average level was still 8.4%, indicating that the benefits achieved by the study were maintained over the long term.

Nearly all of the participants and their parents reported being very satisfied with the program. According to Petry, this may be because it eliminated a common source of disagreement, allowing parents to “quit worrying about arguing with their child about testing and diabetes management.”

According to Bethany Raiff, PhD, a psychologist who was not involved in the research, monetary rewards are not necessarily the only effective option. “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 noted in an e-mail to Reuters.

For more information, read the article “Mini payments may help teens manage type 1 diabetes” or see the study’s abstract in the journal Diabetes Care. And for more information about helping adolescents manage their diabetes, see the article “When Your Teen Just Quits” by Pediatric Nurse Pracitioner Jean Betschart Roemer.