Can a Digital Health Intervention Increase Heart-Healthy Behaviors in Youth With Type 1 Diabetes?

The aim of this feasibility study was to determine whether digital health use via smartphones, a platform that adolescents are more engaged with than other age groups, could aid in teaching youth more about cardiovascular risks, and promote uptake of this knowledge so individuals increase heart healthy behaviors, said Tara Kaushal, MD, physician and clinical researcher at Joslin Diabetes Center.

Transcript:

Why did you decide to test a digital health intervention specifically in youth with type 1 diabetes (T1D), and what were the main findings of your study?

I think what's important to understand about this study at the outset is that it's a feasibility study. So, to backtrack a little bit, we know that adolescents and young adults with T1D struggle with glycemic control, or control of their blood sugars, more than any other age group. We also know that cardiovascular or heart disease is a major risk factor for morbidity and mortality in our patients with diabetes and certainly with T1D. What I was hoping to do with this study is to understand whether we could use digital health, which is certainly a platform that adolescents and young adults are more engaged with than other age groups, to use that relationship with their devices to try to see if there's a way we could teach them more about cardiovascular risks, and then secondarily promote the uptake of this knowledge so that they can apply it to increase heart healthy behaviors.

When we do technology studies, I think one of the main things we need to do is make sure that the technology works. So that's the point of the feasibility part of the study. We need to know does the study work, do the teenagers participate in activities, and what feedback do we get from them about what they felt about doing this study, and whether they enjoy doing the study. In terms of those outcomes, certainly we did find that teenagers in both the control and intervention groups did engage with the study in general, and that those in the intervention group who did use the mobile app and participate in the activities reported high satisfaction. In fact, most of them reported that 3 months were too short for the study. That's a really nice thing to hear from teenagers that they would have wanted to spend more time doing the activities.

Can you explain the educational/goal-setting modules and team challenges teens enaged with, and how the financial reward system worked?

We divided the group into intervention and control participants. The intervention at baseline did a module that basically taught them about heart healthy eating, hypertension and lipid or cholesterol knowledge, and then had some teach back components and basically just gave them knowledge and engaged them with the basic concepts behind heart healthy behaviors. Then halfway through this study at one and a half months, there was a second module that was done over video, that were approaches to managing high blood pressure and lipids. The entire time, those in the intervention group used an app called Pacer to be placed in teams and they would complete challenges. Some examples of the challenges were: text a picture of a high-fiber food that you're eating at least 4 days a week, or walk over 7000 steps in a day. The Pacer app had the ability to actually track the steps. The participants got points if they completed the challenge. They lost points if they did not complete the challenge, and they gained extra points if the whole team completed the challenge. There's kind of a layered reward system built in. At the end, they got a certain amount of money for every 30 points in the study, so the financial reward was was at the end of the study.