Thinking Outside the Clinic: A Digital Health Approach for Young Adults with Type 1 Diabetes

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), R01DK124428

4/1/2020 – 3/31/2025

Catherine Stanger, PhD (Geisel School of Medicine at Dartmouth)

Haiyi Xie, PhD (Co-Investigator); Frances Lim-Liberty, MD (DHMC, Co-Investigator); Tobias Kowatsch, PhD (ETH/St. Gallen, Co-Investigator);
Prabhakaran (Prabhu) Santhanam, Msc (ETH, Software Engineer)

Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and face challenges achieving glycemic control at target levels. 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. 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 study 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 automatically retrieves diabetes device data “digested” by Glooko and prompts and provides feedback on adherence goals. Adherence targets include (a) daily glucose monitoring; and (b) mealtime behaviors. Participants will be randomized to receive (1) modest financial incentives for meeting adherence targets (yes vs. no) and (2) web health coaching (yes vs. no). 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. 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.

Postdoctoral position available

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.