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 diabetes care, like sticking with their glucose monitoring plan. Many glucometers sync with smartphones and can be used in digital health interventions to monitor and motivate behavior. Financial incentives that leverage insights from behavioral economics have been used successfully to improve healthy behaviors in adults in various 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 six-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 were then 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 followed for another three months.


Glucometer adherence increased from 19 percent in the control arm to 50 percent in the incentive arm during the three-month intervention period. However, there were no differences in HbA1c at three or six months. These findings demonstrate the potential to use 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