The prevention of Type 2 diabetes in an obese person with pre-diabetes requires developing a healthier lifestyle. The rational approach for someone with pre-diabetes would be to eat healthier, be more active, lose weight, and manage their comorbidities. However, preliminary research suggests that individuals with Type 2 diabetes discount the future and engage in behaviors that maximize current pleasure and short-term gain; thus, daily choices needed to improve future health are rare in this population. Delay discounting (DD) describes the choice of smaller immediate versus larger delayed rewards. This behavioral process is related to a wide variety of health choices, ranging from preventive health to behavioral and medical regimen adherence, including regimens used for Type 2 diabetes. We believe that DD provides a target for one type of self- regulation that can improve a wide variety of health behaviors and medical adherence. Research from our laboratories has shown that episodic future thinking (EFT), a form of prospection which reduces the bias towards immediate gratification, activates brain regions involved in planning and prospection such that future rewards have increased value and the extent of delay discounting is reduced. Cueing individuals to think about future events during inter-temporal decision-making reduces the rate of DD, eating in and outside of the laboratory, and smoking behavior. The overarching goal of this grant is to use an experimental medicine approach to translate basic research on DD and EFT into clinical interventions to prevent the transition from pre-diabetes to a diagnosis of Type 2 diabetes. We are using the grant mechanism RFA-RM-14-020, Science of Behavior Change: Assay Development and Validation for Self-Regulation Targets (UH2/UH3) as this provides for the opportunity to integrate observational, laboratory and field studies to assess relationships between DD and disease self-management, understand mechanisms of these relationships across multiple levels of analysis, and refine interventions in preparation for a clinical trial. e propose a series of observational, laboratory and field studies to identify DD as a behavioral target to improve behavioral and medical adherence and metabolic control in adults with pre-diabetes who are at high risk for development of Type 2 diabetes.
Specific Aim 1 will examine the cross sectional relationship between DD, executive function, and fMRI-measured brain activation to predict adherence and metabolic control in persons diagnosed with pre-diabetes.
Specific Aim 2 will assess the effects of EFT on DD, fMRI measured brain activation and energy intake in participants with pre-diabetes in the laboratory.
Specific Aim 3 will assess the effects f EFT on DD and fMRI measured brain activation under simulations of poverty that increase discounting of the future.
Specific Aim 4 extends the study of the effects of EFT on DD, executive function, health behavior change, medication adherence for comorbid conditions and glycemic control after a 6-month target engagement with EFT versus control in a field study for the UH3 component of this application.
The proposed research will translate research on delay discounting to the prevention of Type 2 diabetes in persons with pre-diabetes. We propose using both observational and experimental designs to identify delay discounting as a self-regulation target for preventing progression towards diabetes, and demonstrate how delay discounting can be modified to improve behavioral and medication adherence and glycemic control using episodic future thinking. The use of multiple designs and methodologies across levels of analysis will provide a strong basis for targeting delay discounting and translating episodic future thinking into interventions to prevent Type 2 diabetes and improve control of comorbidities in those at risk for developing Type 2 diabetes.