Testing for rewards: a pilot study to improve type 1 diabetes management in adolescents

To evaluate the effectiveness of monetary reinforcement to increase the frequency of self-monitoring blood glucose (SMBG). Ten adolescents with poorly controlled diabetes enrolled in a 12-week program in which they earned monetary reinforcers based on SMBG frequency ($0.10 per test, with bonuses for ≥4 tests per day, and $251.40 maximum). SMBG increased from 1.8 ± 1.0 to 4.9 ± 1.0 tests per day (P < 0.001) with 90% completing four or more tests per day. Mean A1C fell from 9.3 ± 0.9% to 8.4 ± 1.5% (P = 0.05). Adolescents and parents reported high satisfaction with procedures. Reinforcing adolescents for SMBG may increase testing and improve A1C.