Episodic Future Thinking in a Fully Remote, Multi-Component Behavioral Intervention for Type 2 Diabetes: A Pilot/Feasibility Trial in Rural and Non-Rural Adults [Preprint]

Delay discounting (DD), or preference for immediate gratification, is a promising therapeutic target in type 2 diabetes (T2D). This fully-remote, 24-week randomized trial examined the feasibility and efficacy of episodic future thinking (EFT; n=46) compared to control (n=44) for reducing DD and improving T2D outcomes in non-rural and rural adults. All participants received T2D education, coaching, and self-monitoring resources (MyNetDiary). Recruitment, retention, engagement, and acceptability met or exceeded feasibility benchmarks, except for low rural recruitment and declining EFT engagement over time. EFT reduced DD more than control. Although EFT had no overall effect on HbA1c and weight loss, EFT was more effective than control for reducing HbA1c and DD at higher (vs. lower) levels of baseline DD. Together, these findings support targeted implementation of EFT in larger-scale trials based on baseline DD, consistent with a precision medicine framework. Future research, however, should focus on increasing rural recruitment and optimizing EFT engagement.