Endocrine Abstracts

Introduction: Adolescence is recognised as a period where compliance to diabetes treatment is challenging and adolescents assume increasing responsibility for their diabetes self-management. In this study we investigated whether giving modest financial rewards motivated teenagers with type 1 diabetes to improve glycaemic control.

Methods: Population; young people with type 1 diabetes, age 13–16 years at entry, duration of diabetes of >2 years and sustained HbA1c level of >9% for >6 months. Retinal screening and an educational refresher on hypoglycaemia was provided. At each clinic visit patients received a £10 gift voucher for every 0.5% drop in HbA1c. This reward was summative until an HbA1c of 7.5% was achieved. A maintenance voucher of £10 was given if HbA1c continued to be <8.0%. If the HbA1c increased participants were only eligible for further financial rewards after they returned to their previous best HbA1c level. The patients were eligible for payments for one year and data was collected over the following year to assess for sustained improvements.

Results: The study included 17 participants (ten males and seven females) aged 13–15 years (median 14 years). Mean HbA1c at the start of the study 10.4% (range 9–12.1%) and at 2 years 10.4% (range 7.7–14.9%). At 9 months the cohort reached the lowest mean HbA1c (9.6%, P=0.03) however this was not sustained. No patients received a maintenance payment. Receivers of vouchers (n=11) showed an overall fall in HbA1c (10.8–9.8%) and for non-receivers (n=6) the HbA1c increased (9.6–11.6%).

Conclusions: In this cohort financial incentive did not improve HbA1c. In current practice good education at diagnosis and throughout is important as when glycaemic control deteriorates it can be difficult to instigate behaviour change.