Successful management of type 2 diabetes requires adhering to physician-recommended medication, dietary, and exercise regimens. Most of these adherence-related behaviors provide little to no short-term benefit and rather may be aversive (e.g., caloric restriction and physical exertion). However, treatment adherence provides critical health benefits in the future, allowing patients to halt or reverse disease progression and avoid diabetes-related complications (e.g., renal disease or diabetic retinopathy). Thus, successful management of type 2 diabetes requires one's present behavior to be guided by future outcomes. Unfortunately, accumulating evidence indicates that individuals with type 2 diabetes and those at risk for this disorder rapidly devalue the future (a phenomenon known as delay discounting), which past and present data suggest contributes to treatment nonadherence. Thus, interventions shown to increase valuation of the future are likely to improve adherence. One such intervention is episodic future thinking (EFT), a form of prospection in which participants vividly imagine events that might occur in their future. Recent and ongoing work indicate that EFT, which activates neural systems associated with both planning and prospection, improves valuation of the future and reduces a wide range of maladaptive health behaviors (e.g., dietary intake in overweight/obese populations and cigarette smoking in smokers). The overall goal of this project is to use a remotely delivered EFT intervention to improve treatment adherence and adherence-related outcomes in type 2 diabetes.
In Specific Aim 1, participants with poorly controlled type 2 diabetes (defined as hemoglobin A1C ?8%) will engage in either EFT or a control thinking condition in the natural environment during a four-week trial. Outcome measures will be assessed at baseline, as well as 4-week and 6-month follow-up laboratory visits, and will include medication adherence, dietary intake, body mass index, glycemic control, blood pressure, and delay discounting. During the trial, we will also remotely assess physical activity, medication adherence, dietary intake, and delay discounting.
In Specific Aim 2, we will examine acceptability of the remotely delivered EFT intervention. For an intervention to be effective in clinical settings, it should be easy to use and its helpfulness should be clear to patients. Thus, participants will rate the EFT or control conditions along several dimensions of acceptability, including ease of use, usefulness, and helpfulness. Ratings will be obtained separately for components of both the intervention and measurement to isolate acceptability of the intervention itself. High intervention ratings would suggest that EFT may be implemented with high treatment fidelity in clinical settings and is more likely to be disseminated among treatment providers and adopted by patients.
Diet, exercise, and glucose-lowering medication are first-line treatments for type 2 diabetes, but morbidity and mortality remain high because many patients do not adequately adhere to these treatments. Treatment adherence provides its greatest health benefits (e.g., avoidance of diabetes-related complications such as renal disease) only after months or years of sustained lifestyle change; however, accumulating evidence demonstrates that individuals suffering from type 2 diabetes and related disorders (e.g., obesity) rapidly devalue the future and show a bias for immediate gratification. The overall goal of this project is to improve treatment adherence in type 2 diabetes using an episodic future thinking intervention (i.e., mental prospection) designed to increase valuation of the future.
