Background: Children and adolescents with diabetes mellitus (DM) are faced with a unique set of challenges associated with the management of their disease. There is evidence that extrinsic rewards can help patients to meet health goals. Gift cards were used as incentives.

Objective: Assess the incentive program’s impact on patient hemoglobin A1c (HbA1c) during the program’s first year.

Methods: A retrospective chart review was conducted of all clinic patients with DM with clinic visits between February 24, 2018 and December 31, 2019. Any patient with DM seen in the TMCOne Pediatric Endocrinology clinic who set a behavioral modification and achieved that goal were included. Patients set two goals at each visit. In phase 1, if two goals were met patients received a $5 gift card or a small prize. In phase 2, if two subsequent goals were met, a$10 gift card or a larger prize was awarded. In phase 3, if four subsequent goals were met, a \$20 gift card was rewarded. HbA1C values were recorded at baseline and after goals 2, 4, and 8.

Results: At baseline N=123 (45% F; ages 1-22), with a mean HbA1c of 8.3% (SD= 2.2). In phase 1, the change after the first two behavior modification goals were achieved was -0.19 (P = 0.43; SD=2.6). Only 37 were able to achieve goals 3 and 4. In phase 2, the mean HbA1c was 7.7% (SD= 1.9) and the change in HbA1c was -0.19 (P = 0.66y; SD=1.16). In phase 3, only 4 of the 123 patients were able to achieve goals 5, 6, 7 and 8. The mean HbA1c was 6.5% (SD=0.98). The change in HbA1c was +0.73 (P = 0.17; SD=0.66).

Conclusion: This study demonstrates the potential of extrinsic incentives to achieve the behavioral goals did not result in improvement of HbA1c values. The number of children who were able to achieve goals 3 and 4 dropped drastically compared to the those who are able to achieve goals 1 and 2. In addition, the mean HBA1c value dropped which with each phase. The SD of each phase also decreased. We surmise patients who maintained excellent control were more likely to start and complete the behavior change goals over an extended period of time.

Disclosure

C.K. Wu: None. P.G. Patel: None. J. Lai: None. A. Bashar: Other Relationship; Self; Medtronic. K.M. Siderewicz: None. R. Tiwari: None. N.J. Cuzman: None. K. Payton: None. S. Goral: None. C.M. Patel: None.

Funding

TMC Foundation