Behavioral economic incentives to improve glycemic control among adolescents and young adults with diabetes


Each year in the United States, over 200,000 children are affected by type 1 diabetes. As children reach adolescence and young adulthood, they often face challenges in their diabetes care, specifically in sticking with their glucose monitoring plan. Many glucometers sync with smartphones and can be used in digital health interventions to both monitor and motivate behavior. Financial incentives designed to leverage insights from behavioral economics have been used successfully to improve healthy behaviors in adults in a variety of contexts but have not been well tested in adolescents or young adults.


We designed a digital health intervention using wireless glucometers and financial incentives to improve diabetes control. We conducted a 6-month clinical trial, enrolling 90 adolescents and young adults with type 1 diabetes from the Children’s Hospital of Philadelphia. All participants received a wireless glucometer and were given a glucose monitoring goal. 

Participants had a baseline HbA1c and then were randomly assigned to a control or incentive arm. Participants in the control arm received no additional interventions. Participants in the incentive arm received a loss-framed financial incentive and daily feedback on performance for three months and were then followed for another three months.


Glucometer adherence increased from 19% in the control arm to 50% in the incentive arm during the 3-month intervention period. However, there were no differences in HbA1c at three or six months. These findings demonstrate the potential opportunity of using insights from behavioral economics with wireless glucometers in adolescents and young adults with type 1 diabetes.   


The Children's Hospital of Philadelphia


National Center for Advancing Translational Science
Institute for Translational Medicine and Therapeutics