Preliminary study reveals health coaches and incentives help young people with type 1 diabetes

The life of a patient with type 1 diabetes – take daily injections of insulin or carry an insulin pump, monitor his blood sugar, prioritize healthy food choices and adapt to Daily exercises – can be difficult at the age of 5 or 15, especially during vacations, excursions and evenings pajamas can disrupt diabetes treatment routines and create compliance issues. That's why endocrinologists from the National Child Health System have been experimenting with the use of health coaches over a 10-week period to help families manage the care provided to children with type 1 diabetes.

By bringing together a team of diabetes educators, dietitians, social workers, psychologists and health care providers, Fran Cogen, MD, CDE, Director of Diabetes Care at Children & # 39; s National, has helped pediatric patients with type 1 diabetes manage their blood glucose status or blood sugar levels. control.

Starting Saturday, June 8, Dr. Cogen will share the results of the pilot program in the form of a 1260 poster entitled "Clinical Care Enhancement Pilot Program: Individualized Health Coaching and Using Incentives for Affected Youth". Type 1 diabetes and their caregivers ", at the following address: the 79th Scientific Sessions of the American Diabetes Association, which will be held June 7-11 at the Moscone Center in San Francisco.

Dr. Cogen's study was offered free to caregivers of 179 Children's Nationals patients seeking treatment for type 1 diabetes. The pilot program consisted of two components: 1. weekly phone calls or emails directed by a health coach to a health care provider with personalized insulin adjustments, based on the patient's blood glucose level submitted via continuous glucose monitoring applications; and 2. Encourage patients to participate in the program and achieve their health goals.

Twenty-five participants aged 4 to 18, whose average age was 11.6 years and whose average life cycle age was between 8.6 and 10%, joined the # 39; study. The average A1C rate was 9.4% at the start of the program and had decreased by an average of 0.5% by the end of the test. Twenty of the 25 participants, 80%, improved their A1C level by 0.5%. Seventeen participants, 68%, improved A1c rates by more than 0.5%, while seven participants, 28%, improved A1c rates by more than 1%.

"Chronic illness is like a marathon," says Dr. Cogen. "It takes constant reinforcement and coaching to get people to do their best, sometimes pushing them to get people on the other end to say," Keep it up, you do a good job, keep sending us information so that we can make changes to improve your child's blood sugar management, which gives a human touch to these new applications and monitoring devices blood sugar. "

Instead of waiting three months between appointments to discuss ways in which a family can make changes to help control and function of a child's insulin, caregivers received the coaches' reactions every week. Health coaches also benefited from this: they reported feeling greater empathy for patients, while being more involved in personalizing care plans.

Families who participated received a gift card at a local grocery store, supporting the nutritional goals of the child. The children who participated also participated in a draw on iPad. Improvements in A1c levels generated additional raffle tickets per child, which motivated participants, especially teenagers.

"These incentives are useful for engaging children in their health and in an immediate way," says Dr. Cogen. "Adolescents are not always interested in long-term health outcomes, but what is happening right now." Fluctuating blood sugars can cause depression and learning difficulties, while increasing the risk of future complications, including eye problems, kidney problems and circulation As health care providers, we know that the choices children make today can affect their future health outcomes, which is why for which we designed this study. "

In the future, Dr. Cogen and the endocrinologists at Children's National would like to study the impact of using this model over several months, especially for high-risk patients, while targeting asynchronously information to change behavior – taking into account the needs of families, specific recommendations of health care providers.

Dr. Cogen added, "We are moving away from desktop-centric research models and creating interventions where they matter – at home and with families in real time."

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