Mobile Health Intervention Clinical Trial Aimed at Improving Activity Levels in Adolescents With Obesity and Type 2 Diabetes

February 4, 2022

Rates of obesity and type 2 diabetes (T2D) in children and adolescents in the United States have steadily increased during the last two decades and are approaching epidemic proportions. The long-term health complications and decreases in quality-of-life measures from obesity and T2D in childhood can be profound and devastating to the individual, to say nothing of the financial implications and burdens thrust on families, communities, and the entire national system of health care in the United States. The factors driving rates of obesity and T2D in childhood are many and complex, ranging from genetic and genomic predispositions, environmental influences, behavioral health comorbidities, lifestyle choices and socioeconomic factors, nutritional availability, and others.

There is no one solution to the problem of obesity and type 2 diabetes in children, and it requires a comprehensive approach that goes far beyond the individual patient and their immediate family. It requires concerted efforts at the societal level, one that engages educational and health care systems, communities, and governmental bodies. Because obesity and diabetes permeate all aspects of life, to manage it effectively and roll back the prevalence and incidence, we must approach the problem from this perspective.

Mary Ellen Vajravelu, MD, from the UPMC Children's Division of Pediatric Endocrinology, Diabetes, and Nutrition, is currently working under a National Institutes of Health K23 award testing a novel approach to help motivate behavioral change and increase levels of activity in children and adolescent with prediabetes and diabetes.

Helping patients implement healthy lifestyle changes is one of the biggest challenges for health care providers who treat youth with diabetes. Dr. Vajravelu's research focuses on finding ways for adolescents to become motivated and excited about being more physically active. 

“Teenagers with type 2 diabetes tend to spend very little time engaging in moderate and vigorous physical activity, often far below the recommended 60 minutes per day,” says Dr. Vajravelu. “My project is designed to test a variety of scenarios using behavioral economics theory and practice to motivate individuals to increase their activity levels.”

Dr. Vajravelu’s study, which is enrolling adolescents and young adults with prediabetes or type 2 diabetes, entails a 12-week factorial trial in which patients wear activity trackers to measure physical activity levels during the day. After conducting baseline physical activity assessment, study participants are randomized into one of 16 different scenarios where they will receive step count goals, text messages reminders, and behavioral economics-informed financial incentives.

"By using a factorial trial approach in this study, we will be able to test 16 separate motivational scenarios with our study populations to find out which options may provide the most benefit and why. Future work can then expand upon this approach to test and refine the measures with different and more extensive population studies. Finding solutions to increasing activity levels in this patient population could lead to significant improvements in overall health and management of diabetes to prevent long-term complications that we all recognize are significant, costly, and irreversible in some instances.

Dr. Vajravelu’s Behavioral Health Motivation in Adolescents (BEAM) trial is currently enrolling patients. To learn more about her research or to refer a patient for possible enrollment in the study, please call the Division of Pediatric Endocrinology, Diabetes, and Metabolism at 412-691-5170.

References and Further Reading

Behavioral Economics for Activity Motivation in Adolescents and Young Adults With Pediatric Diabetes and Type 2 Diabetes. NIH Project Number: 7K23DK125719. Principal Investigator: Mary Ellen Vajravelu, MD, MSHP.

Behavioral Economics for Activity Motivation in Adolescents (BEAM) Clinical Trial. ClinicalTrials.gov Identifier: NCT04874415. Principal Investigator: Mary Ellen Vajravelu, MD, MSHP.

More About Dr. Vajravelu

Mary Ellen Vajravelu, MD, MSHP, is an assistant professor of pediatrics in the Department of Pediatrics at the University of Pittsburgh School of Medicine. Dr. Vajravelu joined UPMC Children's in July 2021. Prior to joining UPMC Children's, Dr. Vajravelu was an assistant professor of pediatrics at the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.

Dr. Vajravelu’s clinical work involves the full spectrum of pediatric endocrine conditions, with an emphasis on type 2 diabetes and prediabetes in children and adolescents. Her research interests are primarily focused on type 2 diabetes and obesity in pediatric patients, where she studies best practices for using mobile health (mHealth) strategies to improve patient health and outcomes. Dr. Vajravelu combines her training and interests in epidemiology, biostatistics, quantitative research, and quality improvement to study and improve the effectiveness of therapies for children and adolescents with endocrine-related disorders.