Stanger C, Lansing A, Scherer E, et al. (2018). A web-delivered multicomponent intervention for adolescents with poorly controlled type 1 diabetes: A pilot randomized controlled trial. Annals of Behavioral Medicine. 52(12): 1010–1022. doi: 10.1093/abm/kay005
Researchers compared effects of a web-delivered intervention, WebRx, to usual care (UC) on blood glucose monitoring behavior over 6 months among adolescents with poorly controlled type 1 diabetes (HbA1c ≥ 8%) and their parents. Recruitment occurred at New Hampshire endocrinology clinics. Researchers randomized eligible adolescents and at least one of their parents to receive WebRx (n = 30) or UC (n = 31). WebRx harnessed 3 main components (web-delivered motivational and cognitive behavioral therapy, working memory training, and monetary incentives) to address adolescent glucose self-monitoring, executive functioning, and parent monitoring of adolescent glucose checking behavior. Adolescents and parents earned high-magnitude incentives (up to $11 per day) for frequent glucose monitoring and daily parental reports about adolescent glucose checks, respectively. At baseline, 6-, and 12-months, adolescents completed assessments of glucose monitoring, working memory, and inhibitory control, while parents completed assessments of family conflict and whether they had reviewed adolescent glucose monitoring. Most participating parents and adolescents (93%) completed at least 12/15 therapy sessions, and most adolescents (83%) completed at least 20/25 working memory training sessions. There were significant between-group differences in glucose monitoring frequency, family conflict, parent monitoring frequency, inhibitory control, and working memory favoring WebRx at 6-month follow-up. WebRx group differences in glucose monitoring, family conflict, and working memory were maintained at 12 months. Results suggest WebRx may promote adolescent and parent blood glucose monitoring behavior better than UC. WebRx incentives for adolescents and parents may have increased adherence to glucose monitoring but also increased cost. Future research could explore how individual components of WebRx impact intervention mechanisms, to identify effective components.