PROJECT ABSTRACT Over 80% of adolescents with type 1 diabetes (T1D) struggle to achieve good glycemic control, placing them at risk for acute and chronic complications. Instilling good T1D management practices in adolescence can set a pattern into adulthood, improving long-term health while reducing future burden on patient and family quality of life, adolescent psychosocial development, and the health care system. Health psychology and economics research suggest that financial incentives can increase adolescent adherence to T1D self-management regimens. We developed InvesT1D, a flexible, patient centered incentives intervention based on rigorous developmental research that included qualitative, ethical, and stated preference analyses. A pilot randomized controlled trial (RCT) demonstrated that InvesT1D was effective at improving adherence to self-management goals and time-in-range among continuous glucose monitor users. We propose a larger, more comprehensive study to determine the most efficacious financial incentive structure and to evaluate InvesT1D’s impact on time-in-range, HbA1c, adverse events, long-term health, diabetes distress, family conflict, health care utilization, and adolescent and caregiver quality of life. In this hybrid effectiveness-implementation study, we will use mixed methods to evaluate InvesT1D’s efficacy, long-term health benefits, cost-effectiveness, and implementation feasibility. Our interdisciplinary team’s innovative approach includes an RCT, trial- and model- based economic evaluations (from the payer, health care, and societal perspectives), a policy analysis, the development of a decision support dashboard, and qualitative interviews with patient, health care payer, and health care delivery system stakeholders. Methodologic contributions of the InvesT1D study can make a significant contribution to the scientific approach for developing incentive interventions for a range of behavioral health-related conditions.

PROJECT NARRATIVE We propose a comprehensive study to evaluate the efficacy and feasibility of implementing InvesT1D, an innovative, ethically-sensitive, patient- and stakeholder-centered intervention that aims to improve management of type 1 diabetes by offering adolescents financial incentives for engagement in diabetes self- care behaviors. If this intervention is effective and cost-effective, it could have a significant impact on the health and quality of life for the over 80% of adolescents with type 1 diabetes who are struggling to meet glycemic targets. The development and evaluation of this intervention can also serve as a model for health interventions targeting other health conditions.