Texts Plus Cash Improves Self-Care For Teenagers With Type 1 Diabetes

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It’s been a difficult year for a lot of people but juggling all the Covid-19 restrictions with managing a chronic condition like Type 1 diabetes makes life even more of a challenge.

This is particularly true for teenagers with the autoimmune condition. According to research, more than 70% of people with Type 1 diabetes in this age group do not have optimal control of their blood sugar, even without current global circumstances.

To try and improve diabetes control and self-care in teenagers with Type 1 diabetes, Terri Lipman, a professor at the University of Pennsylvania School of Nursing, and colleagues carried out a study to find out if regular texts combined with financial incentives could make a difference.

“Poor diabetes control in youth is associated with multiple long-term complications of diabetes in adults that include blindness, kidney disease and coronary heart disease,” she emphasized.

“It is essential that we evaluate interventions to improve self-care behaviors and diabetes control while complications of diabetes can be prevented.”

The researchers recruited 166 young people with Type 1 diabetes, aged 12 to 18 years to take part in a 6-month study. Participants were randomly assigned to an intervention or a control group.

Those in the intervention group received one text a day either relating to their own self-care behavior or quiz type questions about Type 1 diabetes. They were asked to respond in some way to show the text had been read.

“We chose text messaging as many of our patients from low income families have limited data plans or no internet service that would preclude their ability to access apps,” explained Lipman.

Every 2 weeks those who had the longest consecutive response record to the text messages were entered into a lottery to win $10. There were also cash rewards ranging between $5 and $15 for filling out a self-care inventory form at the beginning of the study and at 3 and 6 months.

Overall, the teenagers in the intervention group were responsive and the average text message reply rate was 58%, although it declined over time. Most (80%) of the participants in this group said that the messages helped improve their self-care.

Average blood glucose level in the group, as measured by HbA1C, decreased during the study. However, there was not a statistically significant difference in the degree of reduction between the intervention and the control group during the 6 months of the study.

The team wants to extend their research to improve the effectiveness of their intervention for improving blood sugar levels in teens with the condition. But they plan to stick with cellphone related methods.

“Interventions… must be tailored to the goals and preferences of the population to be effective. Adolescents are highly engaged with mobile technology and prefer interventions that utilize mobile technology to manage diabetes,” says Lipman.

“We are continually evaluating innovative methods to address diabetes management… Future research will combine mobile technology with personal follow up and increased compensation.”



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