640 Can incentives improve self-glucose monitoring adherence in pregnancies complicated by diabetes? A randomized controlled trial

Abstract

Self-glucose monitoring is critical for management of diabetes in pregnancy, and increased adherence to testing is associated with improved obstetrical outcomes. Incentives have been shown to improve adherence to diabetes self-management. We hypothesized that use of financial incentives in pregnancies complicated by diabetes would improve adherence to self-glucose monitoring. We conducted a single-center randomized controlled trial (RCT) of women with pre-gestational or gestational diabetes requiring insulin. Women < 29 weeks gestation were randomized in a 1:1:1 ratio to one of three payment groups: control, positive incentive and loss aversion. The control group received $25 upon enrollment. The positive incentive group received 10 cents/test, and the loss aversion group received $100 for > 95% adherence and “lost” payment for decreasing adherence. The primary outcome was % adherence to recommended self-glucose monitoring where adherence was reliably quantified using a cellular-enabled glucometer. Adherence, calculated as the # tests per day/# recommended tests per day X 100%, was averaged over the course of study. The study was powered to detect a 10% difference in adherence rates with a 2-sided alpha 0.05 and 80% power. Anticipating a 30% withdrawal rate, we recruited 130 participants. From 3/2016 to 7/2019, we enrolled 130 women and 13 withdrew. Baseline demographics were similar across the three groups. Overall, the loss aversion group displayed higher rates of overall adherence to self-glucose monitoring. Average adherence in the loss aversion, control and positive incentive groups were 69% (+/- 24), 57% (+/- 31) and 58% (+/- 28), respectively (p=0.009). The loss aversion group averaged $50 compared to $38 (positive incentive) and $25 (control). This RCT suggests that loss aversion incentives improve adherence to self-glucose monitoring among women whose pregnancies are complicated by diabetes. Further studies are needed to determine whether use of incentives can improve maternal and neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)