Cogmed plus motivation and incentive interventions for adolescents with Type I Diabetes

Institution: Darmouth College

Investigator(s): Catherine Stanger, Alan Budney, Samuel J. Casella, Robert Roth, Craig Donnelly, Lisa Marsch, Judith Long

Program: Cogmed RM

Background & Aim: Type 1 diabetes in adolescents is a significant medical condition that is increasing in incidence, is associated with high economic costs, and can contribute to increased mortality when not properly controlled. Unfortunately, these adolescents have poorer adherence to self monitoring of blood glucose (SMBG) recommendations and poorer metabolic control than adults with type 1 diabetes. Some individual and family-based interventions have shown promise in improving metabolic control. However, there is a critical need to develop more effective interventions because, across tested interventions, outcomes for average glycosylated hemoglobin (HbA1c) remain high (>8.5%), SMBG frequency remains low (<3 times per day), and most treatment gains do not persist as long as 6 months. This project’s overall goal is to develop a novel family friendly intervention that will help teens with poor metabolic control of their type 1 diabetes (HbA1c>8%) increase and sustain daily SMBG and lower HbA1c by targeting their decision making with empirically-based components designed to improve executive function, reduce delay discounting, and enhance future orientation.

The proposed study will develop and pilot test a novel, multifaceted, developmentally appropriate intervention aimed at improving adolescent decision making. Intervention components target adolescents’ need for frequent positive feedback, improved future orientation, and motivational support. This new intervention, called MAxIM (MotivAtion, Incentives, Memory) will focus on three strategies: 1) motivation: motivational enhancement therapy (MET), an evidence-based treatment for adolescent diabetes, supplemented with cognitive behavior therapy (CBT) to further enhance behavior change; 2) incentives: teens will receive incentives contingent on documented blood glucose testing, and parents will be taught to use incentives at home to motivate their teens and provide frequent positive feedback; and 3) memory: Working Memory Training (WMT) will be used to improve cognitive function.

Population & Sample Size: N = 75 adolescents with Type 1 diabetes, ages 13 – 17 years
• n =15 adolescents in adaptive Cogmed training group (pilot)
• n = 30 adolescents adaptive Cogmed training group, including other MAxIM components
• n = 30 adolescents in usual care (passive) control group

Design: Randomized, controlled, test-retest