MINDD 3: Prediabetes and Delay Discounting
MINDD 3: Prediabetes and Delay Discounting
The proposed research will translate research on delay discounting to the prevention of Type
 2 diabetes (T2D) in persons with prediabetes. In this study, the investigators will verify
 target engagement (DD) by examining if EFT improves DD under conditions shown to increase
 discounting of the future. Prediabetics will be randomized to receive EFT/ERT in a factorial
 design when experiencing simulated poverty/neutral conditions, respectively. The effects will
 be measured on DD. The investigators predict that poverty conditions will increase
 discounting of the future for ERT subjects, but those receiving EFT will show levels of DD
 similar to levels observed for participants in the wealth condition.
The prevention of Type 2 diabetes in an obese person with prediabetes requires developing a
 healthier lifestyle. The rational approach for someone with prediabetes 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. The investigators 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 research is to use an
 experimental medicine approach to translate basic research on DD and EFT into clinical
 interventions to prevent the transition from prediabetes to a diagnosis of Type 2 diabetes.
Inclusion Criteria:

 -  Prediabetes: Participants must have a diagnosis of prediabetes within the last 2 years
 or meet criteria for prediabetes. The American Diabetes Association guidelines defines
 prediabetes as Fasting Plasma Glucose (FPG) 100-125 mg/dl, 2h glucose 140-199 mg/dl
 after Oral Glucose Tolerance Test (OGTT), or hemoglobin A1c (HbA1c) approximately
 5.7-6.4%.

 -  Comorbidities: Participants must have a history of comorbid diagnosis such as
 hypertension and/or hyperlipidemia to participate in the behavioral portion of this
 study. Hypertension is defined as blood pressure greater than 140/90 on two separate
 occasions at least one week apart, or medical management for hypertension (i.e.
 medications including Lisinopril and Diovan). Dyslipidemia is defined by LDL greater
 than 130 mg/dl, or non-fasting non HDL cholesterol ≥160mg/dL or medical management for
 dyslipidemia (medications including Niacin, Lovastatin).

 Exclusion Criteria:

 -  Type 2 Diabetes: Individuals will be excluded if they have Type 2 Diabetes.

 -  Pregnancy: Women who are pregnant or lactating will be excluded from participation.

 -  Conditions that affect adherence: Participants should not have a condition that would
 limit participation which include medical conditions that would affect individuals'
 ability to use the computer for prolonged period of time; leave the individual unable
 to ambulate; or current diagnoses of an eating disorder (anorexia, bulimia,),
 unmanaged psychiatric disorder (depression, anxiety, attention deficit hyperactivity
 disorder (ADHD), schizophrenia), or an intellectual impairment that would impact study
 adherence.

 -  Abnormal glucose related to medications: Participants should not be taking medications
 that would limit participation and cause abnormal glucose levels (e.g. atypical
 antipsychotic medications or glucocorticoids) including diabetic drugs such as
 Metformin.

 -  Unwilling or unable to eat study food: Participants who are unwilling or not able to
 eat the study food (a PowerBar) will not be able to take part in this study.

 Prior participation in similar studies: Individuals who have recently participated in a
 laboratory study using similar methods may also be excluded.

 -  Do not meet discounting criteria: Individuals who do not meet discounting criteria
 (e.g. nonsystematic discounting) on a delay discounting task may be excluded.