Background: Diabetes increases cardiovascular disease (CVD) risk, yet many youth with T1D are not effectively managed for hypertension (HTN) or hyperlipidemia (HPL). Lifestyle management remains 1st-line pediatric therapy, creating a need for effective clinical interventions. As digital health and financial incentives may help motivate behavior change, we sought to test feasibility of a scalable digital health intervention to motivate heart healthy behaviors in youth with T1D.
Methods: We recruited 44 teens (ages 14-19 years; T1D duration ≥6 months; and either HTN, HPL, overweight/obesity, or A1C ≥8%) into a 3-month pilot RCT. Teens were randomized 1:1 to intervention (INT) or control (C) groups. INT received educational/goal-setting modules and bi-weekly team challenges using a smartphone with participants earning points leading to financial rewards; C group received educational/goal-setting modules after 3 months. Primary outcome was the Adolescent Food Habits Checklist (AHFC), a 23-item questionnaire (higher score = healthier food habits), administered at baseline and after 3 months. Participants completed a satisfaction survey after the RCT.
Results: At entry, the sample was 30% male, 88% non-Hispanic white, aged 17±1.6 (X±SD) yrs with T1D duration 8.7±3.3 yrs; 82% were pump-treated, 63% used CGM, A1C was 9.3±1.6%; BMI %ile was 84±17, BP 106±9/66±6, LDL 99±33 mg/dL. Groups only differed in BMI %ile (INT 90 vs. C 77, p<.03). Both groups increased their AHFC scores over time (INT +3.5, p<.01; C +2.3, p<.03); change in AHFC did not differ between groups (p=.33) when adjusting for baseline score. In INT group, 64% found materials/activities engaging and 79% were glad to participate.
Conclusions: An intervention with educational materials supplemented by a smartphone app using a point-based financial reward structure was feasible and acceptable for teens with T1D at increased CVD risk. Further research is needed to assess durability of the intervention and its impact on CVD risk factors.
T. Kaushal: None. C.O. Charmant: None. L.K. Volkening: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. M. Katz: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.
National Institutes of Health (5K12DK094721-09, P30DK036836, K23HL125976)