# REFLECT2D: Real-time Engagement For Learning to Effectively Control Type 2 Diabetes

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2024 · $594,591

## Abstract

ABSTRACT
Youth-onset type 2 diabetes (T2D) represents a growing threat to health equity. Continuously increasing in
incidence, T2D is up to 9-fold more common among racial-ethnic minoritized youth, and approximately half of
affected youth live in poverty. T2D diagnosis in childhood often results in severe complications by early
adulthood, as well as reduced life expectancy. Modification of diabetes-related health behaviors, including
nutrition and physical activity, is central to management, but several barriers exist for adolescents and young
adults (AYA) with T2D. These include hyperglycemia unawareness, delayed or burdensome glycemic feedback,
and the difficulty of attending intensive in-person interventions. Fortunately, wearable continuous glucose
monitors (CGMs) enable the development of remote just-in-time adaptive interventions that use real-time data
at the right time, in the right context to promote behavior change. With the transition to adult care, AYA with T2D
are particularly well suited to benefit from a CGM-supported intervention that supports development of diabetes
self-management skills and engagement in health behaviors. To lay the foundation for such an intervention, we
have developed Healthmine, a mobile app that integrates CGM, activity trackers, and diet logging for use by
individuals with diabetes. The objective for this R01 proposal, REFLECT2D, is to evaluate the time-dependent
glycemic impact of Healthmine app-based prompts. Aligned with the COM-B Model for Behavior Change,
Healthmine prompts are designed to foster motivation and actual engagement in health behaviors by providing
of an opportunity to review real-time data and by supporting the development of an improved capability to
interpret and act on such data. We will enroll 100 AYA ages 16-24 with T2D in a clinical trial, beginning with a
baseline study visit and educational session led by a certified diabetes education and care specialist and
registered dietitian. After a 10-day run-in with CGM to evaluate baseline glycemic control, we will conduct a 90-
day micro-randomized trial (MRT), in which each AYA will be randomized with equal (1/3) probability once daily
to receive a physical activity-focused prompt, a nutrition-focused prompt, or no prompt. In MRT, each participant
acts as their own control. After MRT, AYA will attend a second study visit to assess intermediate outcomes and
will continue to wear CGM for a 90-day observational period without app prompts, followed by final study visit,
to assess duration of effect on motivation and glycemic outcomes. Our approach will allow us to determine the
effects of prompts on short-term CGM-measured glycemia during MRT (Aim 1), characterize ongoing CGM and
app use and longer-term impact on glycemia during an observational period (Aim 2), and evaluate changes in
outcomes from baseline to follow-up, including glycemia and behavioral measures, as well as the role of
motivation as a mediator (Aim 3). Findings will infor...

## Key facts

- **NIH application ID:** 10980006
- **Project number:** 1R01DK137803-01A1
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Mary Ellen Vajravelu
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $594,591
- **Award type:** 1
- **Project period:** 2024-07-01 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10980006

## Citation

> US National Institutes of Health, RePORTER application 10980006, REFLECT2D: Real-time Engagement For Learning to Effectively Control Type 2 Diabetes (1R01DK137803-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10980006. Licensed CC0.

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