Abstract
Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to
their medical regimen and fail to achieve good glycemic control. However, few interventions have been
developed specifically for this age group. In the proposed study, we will provide an app (SweetGoals) to all
participants as a “core” intervention. The app prompts participants to upload their diabetes devices weekly to a
device-agnostic uploader (Glooko), will automatically retrieve uploaded data and apply decision rules about
daily and weekly self-management goals, and will generate feedback messages about goal attainment.
Further, the proposed study will test two unique intervention components designed to support and optimize
digital self-monitoring, goal setting, and goal achievement. These components include (1) incentives to
promote consistent daily adherence to goals, and (2) web health coaching to teach effective problem solving
focused on personalized barriers to self-management. We will use a novel digital direct-to-patient recruitment
method and intervention delivery model that transcends the clinic. Instead of relying on the clinic to transform
its system of care, our intervention will directly assist young adult patients in developing skills to improve their
utilization of the health care system. A prior pilot RCT (N=61) comparing this intervention approach to usual
care among adolescents showed significant and sustained impact on A1c. These results were very promising,
and we believe this intervention is well suited to young adults. In the proposed study, 300 young adults ages
19-25 with T1D and above target (Hb)A1c (≥ 8.0%) will be recruited via social media. All participants will
receive the SweetGoals app built on an open-source intervention platform MobileCoach (www.Mobile-
Coach.eu). The app automates many features of our piloted intervention, greatly increasing disseminability.
These include automatic retrieval of diabetes device data “digested” by Glooko and prompting and providing
feedback on adherence goals. Adherence targets include (a) daily glucose monitoring; and (b) mealtime
behaviors. A 22 factorial design will be used to test the main and interactive effects of (1) modest financial
incentives for meeting adherence targets and (2) web health coaching. Coaches will teach a problem-solving
approach that generates personalized solutions to adherence challenges. The intervention will last 6 months.
The primary outcome will be reduction in A1c. We hypothesize greater sustained A1c improvements in
participants who receive coaching and who receive incentives. Further, we hypothesize a synergistic
interaction between these components, resulting in greater positive outcomes among those receiving both. We
will also test four key self-regulation mechanisms and app engagement metrics as predictors of outcomes.
Successful completion of these aims will support dissemination and effectiveness studies of this intervention
that seeks to improve glycemic control in this high-risk and understudied population of young adults with T1D.
Public Health Relevance Statement
Project Narrative
This project addresses a key public health issue with broad applicability to many diseases and health
behaviors: how to help people follow a complicated medical regimen and achieve better health outcomes. We
will test the role of coaching support focused on problem solving and incentives to help young adults with type
1 diabetes feel better and be healthier. We expect that the things we learn about helping young adults with
type 1 diabetes will apply to many other health problems.
NIH Spending Category
No NIH Spending Category available.
Project Terms
AchievementAddressAdherenceAdolescentAftercareAgeAlgorithmsBehaviorChronic DiseaseClinicClinicalCollectionComplexDataDevicesDiabetes MellitusDiseaseEducational process of instructingEnsureFeedbackFutureGoalsHealthHealth behaviorHealthcare SystemsIncentivesIncidenceInformal Social ControlInjectionsInsulinInsulin Infusion SystemsInsulin-Dependent Diabetes MellitusInternetInterventionIntervention StudiesLearningMediationMedicalMental DepressionMethodsModelingMonitorOutcomeParticipantPatient RecruitmentsPatientsPersonsPlayPopulationPopulations at RiskProblem SolvingPublic HealthRandomizedRandomized, Controlled TrialsRegimenRetrievalRoleSelf EfficacySelf ManagementSeriesTechnologyTestingThinkingTranscendage groupcare systemsclinical carecomparison interventiondesigndigitaldigital healtheconomic costeffectiveness studyefficacy testingempowermentexperimental studyfinancial incentiveglucose monitorglycemic controlhealth care service utilizationhigh riskimprovedimproved outcomeinnovationintervention deliverymedical complicationmeetingsmodel designmortalitymultiphase optimization strategynovelopen sourceoutcome predictionpilot testprimary outcomerecruitsexskillssocial mediatherapy designtraditional caretreatment as usualyoung adult
National Institute of Diabetes and Digestive and Kidney Diseases
CFDA Code
847
DUNS Number
041027822
UEI
EB8ASJBCFER9
Project Start Date
01-April-2020
Project End Date
31-March-2026
Budget Start Date
01-April-2024
Budget End Date
31-March-2026
Project Funding Information for 2024
Total Funding
$566,043
Direct Costs
$361,075
Indirect Costs
$204,968
Year
Funding IC
FY Total Cost by IC
2024
National Institute of Diabetes and Digestive and Kidney Diseases
$566,043
Year
Funding IC
FY Total Cost by IC
Sub Projects
No Sub Projects information available for 5R01DK124428-05
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The Project Outcomes shown here are displayed verbatim as submitted by the Principal Investigator (PI) for this award. Any opinions, findings, and conclusions or recommendations expressed are those of the PI and do not necessarily reflect the views of the National Institutes of Health. NIH has not endorsed the content below.
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