251-OR: COIN2DOSE—Proof of Concept That a Behavioral Economics Intervention Can Increase Mealtime Insulin Use in Adolescents with Type 1 Diabetes

Many adolescents with type 1 diabetes (T1D) miss or skip mealtime insulin boluses, contributing to higher glycated hemoglobin (HbA1c). We designed a novel mHealth intervention, called COIN2DOSE, that uses behavioral economics theories to promote mealtime insulin use among adolescents. Here, we present preliminary data evaluating COIN2DOSE. We enrolled 10 adolescents with T1D in a 12-week mHealth intervention that included weekly data sharing and automated remote patient monitoring via a digital dashboard. Adolescents earned money (up to $1.50/day or $15.50/week) based on their daily mealtime BOLUS score, a valid measure of insulin use during predetermined meal windows. Parents and adolescents completed surveys assessing diabetes distress and diabetes family conflict and adolescents completed a valid HbA1c home kit pre- and post-treatment. We measured treatment satisfaction post-treatment. Adolescents were [mean±SD] 13.4±1.01 years old, 50% boys, 80% Non-Hispanic White, 100% using a personal continuous glucose monitor (CGM), 60% using hybrid closed loop (HCL), and 40% using standard open pump therapy (open pump). Daily BOLUS scores increased from 1.50±1.10 to 2.14±0.72 (p=0.053) pre- to post-treatment. Mean HbA1c decreased from 8.8±2.8% to 8.2±1.6% for adolescents on HCL and increased slightly for adolescents on open pump (7.1±1.6 and 7.3±1.6%). We found no changes in parent- and adolescent-reported diabetes distress and parent-reported diabetes family conflict, though adolescent-reported diabetes family conflict decreased (p<0.01). Parent- and adolescent-reported satisfaction with COIN2DOSE was moderately high. We provide proof of concept that COIN2DOSE and its supporting technology can promote mealtime insulin use, achieve reductions in adolescent-reported diabetes family conflict, and clinically reduce HbA1c in adolescents with T1D. Disclosure S.R. Patton: None. B. Lockee: None. K. Morga: None. R. McDonough: Speaker's Bureau; Provention Bio, Inc. L.A. Fox: Advisory Panel; Ki Health. Research Support; Dexcom, Inc. M.A. Clements: Research Support; Abbott. Consultant; Glooko, Inc. Research Support; Dexcom, Inc. Funding National Institutes of Health (R01DK128862)