Researchers aim to improve diabetes management in rural and urban communities with low-cost intervention

Mental time travel — transporting someone from the present through imagining a personal, positive future event — has been proven to help reduce alcohol, tobacco, and drug use.

Now, researchers at Virginia Tech’s Fralin Biomedical Research Institute at VTC have received a $990,000 grant from the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, to study a low-cost way to help patients with Type 2 diabetes better manage the disease by thinking about personal experiences that will occur in the future, a technique researchers call episodic future thinking.

Jeff Stein, assistant professor and co-associate director of the Center for Health Behaviors Research at the Fralin Biomedical Research Institute, leads the study.

“We want to help patients with Type 2 diabetes by providing an easily accessible, low-cost intervention that may motivate healthy lifestyle changes and improve management of the disease,” Stein said.

Episodic future thinking is a technique that helps people make healthier decisions by valuing future rewards more than immediate gratification.

“This intervention can change how people value their future," Stein said. "And, in the process, this can reduce the motivation to engage in short-term, unhealthy behaviors that may jeopardize that future."

Study participants will receive evidence-based dietary and physical activity support, tailored to the management of Type 2 diabetes. They’ll regularly weigh themselves, check their blood sugar levels, track their calorie and macronutrient intake, log physical activity, and self-report how often they’re able to take their medicine as prescribed. Research equipment, including a smartphone, apps, Wi-Fi-enabled body weight scale, and blood sugar monitor are provided.

Some study volunteers also will receive daily prompts to imagine personally significant future events they are looking forward to — such as a gathering with friends or family, a vacation, or the birth of a grandchild. They’ll be asked to envision how they’ll feel, who will be there, and what they’re doing.

“These don’t need to be big milestones, or even health-oriented events, but the act of pre-experiencing the future has been shown to be a powerful motivational tool that can help people curb self-harming behaviors,” Stein said. 

This study could improve accessibility of this potentially life-changing intervention, while also providing an easy-to-use remote system that allows study participants to track their overall health at home.

“Because the intervention is fully remote, we can reach patients living in both rural and non-rural areas across the state,” Stein said.

Stein is joined on this study by a multidisciplinary research team of co-investigators, including Warren Bickel, professor and director of the institute’s Center for Health Behaviors Research and Addiction Recovery Research Center; John Epling, professor of family and community medicine at the Virginia Tech Carilion School of Medicine and Carilion Clinic; Michelle Rockwell, assistant professor at the Virginia Tech Carilion School of Medicine and senior research associate at Carilion Clinic; Julia Basso, assistant professor in Virginia Tech’s Department of Human Nutrition, Foods, and Exercise; and Len Epstein, SUNY Distinguished Professor at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.

The researchers will evaluate 120 participants who have been diagnosed with Type 2 diabetes — half in rural and half in urban communities — over a 24-week study period.

Jeremiah Brown, a graduate student in Virginia Tech’s Department of Human Nutrition, Foods, and Exercise, mentored by Stein, will help steer the project, along with Megan Stuart, a research associate in Stein’s lab.