Young diabetics may check sugar more when money’s at stake

30 October 2017: Teens and young adults with diabetes may do a better job of checking their blood sugar when they get daily financial incentives than when there’s no cash on the line, a recent experiment suggests.

Researchers tested out the potential for money to motivate young people to test blood sugar daily by offering $60 a month up front and then subtracting $2 for each day a participant didn’t follow through on required testing. For three months, researchers randomly selected 90 teens and young adults to get these cash incentives or no reward at all.

Overall, the youth with money at stake met their daily blood sugar testing goals half of the time, while without rewards, participants only met their testing goals 19 percent of the time.

“The young people felt motivated and empowered to find ways to check their glucoses more with money on the line,” said lead study author Dr. Charlene Wong of Duke University in Durham, North Carolina.

“They were especially motivated by the increasing losses if they missed the goal multiple days in a row,” Wong said by email.

All of the study participants had what’s known as type 1 diabetes. This chronic condition, typically diagnosed in children and young adults, occurs when the pancreas produces little or no insulin, a hormone needed to allow blood sugar, or glucose, to enter the body’s cells.

People with type 1 diabetes typically have to test their own blood sugar levels throughout the day and inject insulin to manage it. Poorly controlled diabetes can lead to cardiovascular disease, kidney complications and death.

While young children typically manage their blood sugar with a lot of help and supervision from their parents, daily blood sugar monitoring often gets worse in adolescence as children start to take over responsibility for their own care, researchers note in JAMA Pediatrics.

To see if cash could help improve the odds of teens doing these daily tests, researchers turned to what’s known as behavioral economics to see if the threat of losing prize money might be a more powerful motivator than the promise of winning money.

Study participants were 16 years old on average, and most of them were full-time students living at home.

All of them were given daily blood sugar monitoring goals of testing at least four times a day with at least one result within a safe or normal range.

The teens who could get cash did better at testing during the three months when the financial incentives were offered. But when researchers followed participants for an extra three months without any cash on the line, the differences between the groups disappeared.

There also wasn’t a meaningful difference in blood sugar levels based on whether or not the youth could receive cash rewards, either at three months or at six months.

“The intervention was designed for the teenage brain, as it provided short-term monetary rewards for health behaviors,” said Dr. Joyce Lee, author of an accompanying editorial and a researcher at the University of Michigan Medical School in Ann Arbor.

“However, the study did not necessarily translate to better controlled blood sugar in the long-term,” Lee said by email. “Checking blood sugars is important for diabetes care, but taking insulin is also really important and the study did not incentivize behavior related to insulin dosing.”

That doesn’t mean there is no place for behavioral economics in trying to motivate teens to take charge of their health, Lee said. The idea of loss aversion, or offering a prize that can go away, may have potential to get youth to meet testing goals.

“This study shows that there are new opportunities to “nudge” healthy behaviors teens with in type 1 diabetes using connected diabetes devices and mobile technology,” Lee added. “But I would caution parents that we need more studies to determine the long-term efficacy of these behavioral economics interventions.”