ORIGINAL ARTICLE Effect of reward-based motivation on metabolic control in children and adolescents with type 1 diabetes mellitus Cemil Koçyiğit 1 & Gönül Çatlı 1 & Bumin N. Dündar 1 Received: 7 September 2015 /Accepted: 17 January 2016 # Research Society for Study of Diabetes in India 2016 Abstract The aim of this study was to investigate the impact of reward-based motivation on metabolic control in children and adolescents with type 1 diabetes mellitus (DM). Forty- four children and adolescents (female/male: 21/23 and prepu- bertal/pubertal: 17/27) with type 1 diabetes mellitus with a mean age of 12.3 ± 2.8 years (8–18 years) and a mean diabetes duration of 4.7 ± 2.7 years (2–11 years) were enrolled in the study. Before the study, patients were informed that three pa- tients who will have the best metabolic control at the end of 1 year would be rewarded. Number of control visits and hy- poglycemic episodes, daily insulin requirement and mean he- moglobin A1c (HbA1c) values were compared before and 1 year after study. During the study period, a statistically sig- nificant decrease in the mean HbA1c value, number of hypo- glycemic attacks, and daily insulin requirement were deter- mined (p < 0.05). Decrease in the mean HbA1c value was significant in both sexes and especially in the pubertal group (p < 0.05). It was observed that the patients had more frequent control visits during the motivation study. While 56 % of the patients had regular control visits before the motivation activ- ity, during the motivation period, regular follow-up ratio im- proved and increased up to 81 %. The positive impact of motivation has been maintained throughout 6 months after completion of the study. This study showed that motivating activities might provide significant improvement in the meta- bolic control of children and adolescents with type 1 DM with a more evident effect in the pubertal group. Keywords Type 1 diabetes . Reward . Motivation . Metabolic control Introduction Type 1 diabetes mellitus (DM) is a chronic metabolic disease characterized by insulin deficiency and hyperglycemia due to autoimmune damage of the pancreatic beta cells [1]. Type 1 DM may cause microvascular (nephropathy, retinopathy, neu- ropathy) and macrovascular (peripheral artery disease, coro- nary artery disease, cerebrovascular events) complications as- sociated with poor metabolic control in the long term. Good metabolic control at younger age is important in prevention and delay of such complications [2]. Current approach for improved metabolic control in type 1 DM includes intensive or flexible insulin treatment models, continuous diabetes ed- ucation for patients, and close monitoring of blood glucose and HbA1c levels. However, it is well known that psycholog- ical disorders such as depression, anxiety, and eating disorders as well as a lack of motivation may negatively affect self-care and metabolic control in subjects with type 1 DM [3]. Therefore, motivational therapy and psychological support can be needed as a part of medical treatment to improve met- abolic control in patients with type 1 DM [4]. However, in the literature, there are only a few studies on this issue [5–9]. The purpose of this study was to investigate the effect of reward-based motivation on metabolic control in children and adolescents with type 1 DM. * Gönül Çatlı gonulcatli@gmail.com Cemil Koçyiğit dr.cmlkcygt@gmail.com 1 Department of Pediatric Endocrinology, Faculty of Medicine, Katip Çelebi University, İzmir, Turkey Int J Diabetes Dev Ctries DOI 10.1007/s13410-016-0470-0