Department of Pediatrics, Yale University School of Medicine, One Long Wharf Drive, New Haven, Connecticut.
Department of Behavioral Health Sciences and Community Health, University of Connecticut, Farmington, Connecticut.
Endocr Pract. 2021 Jun;27(6):545-551. doi: 10.1016/j.eprac.2020.11.017. Epub 2020 Dec 15.
Many youth do not use the hybrid closed-loop system for type 1 diabetes effectively. This study evaluated the impact of financial incentives for diabetes-related tasks on use of the 670G hybrid closed-loop system and on glycemia.
At auto mode initiation and for 16 weeks thereafter, participants received a flat rate for wearing and calibrating the sensor ($1/day), administering at least 3 mealtime insulin boluses per day ($1/day), and uploading ($5/week). Weekly bonuses were given for maintaining at least 70% of the time in auto mode, which were increased for persistent auto mode use from $3/week to a maximum of $13/week. If a participant failed to maintain auto mode for a week, the rewards were reset to baseline. Data from 17 participants aged 15.9 years ± 2.5 years (baseline hemoglobin A1c [HbA1c] 8.6% ± 1.1%) were collected at 6, 12, and 16 weeks. The reinforcers were withdrawn at 16 weeks, with a follow-up assessment at 24 weeks.
With reinforcers, the participants administered an average of at least 3 mealtime insulin boluses per day and wore the sensor over 70% of the time. However, auto mode use waned. HbA1c levels decreased by 0.5% after 6 weeks, and this improvement was maintained at 12 and 16 weeks (P < .05). Upon withdrawal of reinforcers, HbA1c levels increased back to baseline at 24 weeks.
Compensation for diabetes-related tasks was associated with lower HbA1c levels, consistent administration of mealtime insulin boluses, and sustained sensor use. These results support the potential of financial rewards for improving outcomes in youth with type 1 diabetes.
许多年轻人无法有效地使用 1 型糖尿病的混合闭环系统。本研究评估了与糖尿病相关任务的财务激励对 670G 混合闭环系统的使用和血糖的影响。
在自动模式启动后和随后的 16 周内，参与者佩戴和校准传感器（每天 1 美元）、每天至少给予 3 次餐时胰岛素推注（每天 1 美元）和上传（每周 5 美元），可获得固定费率。每周给予至少 70%的时间处于自动模式的奖金，对于持续使用自动模式的奖金从每周 3 美元增加到最多每周 13 美元。如果参与者一周未能保持自动模式，则奖励将重置为基线。从 17 名年龄为 15.9 岁±2.5 岁（基线糖化血红蛋白 [HbA1c] 8.6%±1.1%）的参与者中收集了第 6、12 和 16 周的数据。在第 16 周撤销奖励，并在第 24 周进行随访评估。
有了奖励，参与者平均每天至少给予 3 次餐时胰岛素推注，传感器佩戴时间超过 70%。然而，自动模式的使用减少了。HbA1c 水平在 6 周后下降了 0.5%，这种改善在 12 和 16 周时得以维持（P<.05）。撤销奖励后，HbA1c 水平在 24 周时又回到基线。
与糖尿病相关任务的补偿与较低的 HbA1c 水平、一致给予餐时胰岛素推注和持续的传感器使用有关。这些结果支持财务奖励在改善 1 型糖尿病青少年患者结局方面的潜力。
