Abstract
BackgroundFinancial incentives is emerging as a viable strategy for improving clinical outcomes for adults with type 2 diabetes. However, there is limited data on optimal structure for financial incentives and whether financial incentives are effective in African Americans with type 2 diabetes. This pilot study evaluated impact of three financial incentive structures on glycemic control in this population.MethodsSixty adults with type 2 diabetes were randomized to one of three financial incentive structures: 1) single incentive (Group 1) at 3 months for Hemoglobin A1c (HbA1c) reduction, 2) two-part equal incentive (Group 2) for home testing of glucose and HbA1c reduction at 3 months, and 3) three-part equal incentive (Group 3) for home testing, attendance of weekly telephone education classes and HbA1c reduction at 3 months. The primary outcome was HbA1c reduction within each group at 3 months post-randomization. Paired t-tests were used to test differences between baseline and 3-month HbA1c within each group.ResultsThe mean age for the sample was 57.9 years and 71.9% were women. Each incentive structure led to significant reductions in HbA1c at 3 months with the greatest reduction from baseline in the group with incentives for multiple components: Group 1 mean reduction = 1.25, Group 2 mean reduction = 1.73, Group 3 mean reduction = 1.74.ConclusionFinancial incentives led to significant reductions in HbA1c from baseline within each group. Incentives for multiple components led to the greatest reductions from baseline. Structured financial incentives that reward home monitoring, attendance of telephone education sessions, and lifestyle modification to lower HbA1c are viable options for glycemic control in African Americans with type 2 diabetes.Trial registrationTrial registration: NCT02722499. Registered 23 March 2016, url.
Highlights
Financial incentives is emerging as a viable strategy for improving clinical outcomes for adults with type 2 diabetes
African Americans experience a disproportionate burden of diabetes through higher prevalence, poorer metabolic control, increased risk for complications, and higher rates of mortality compared to nonHispanic Whites [1]
Recent evidence drawn from behavioral economics research suggests that financial incentives as a component of lifestyle interventions for African Americans with diabetes may further reduce health disparities through targeting self-care behaviors and improving glycemic control [23]
Summary
Financial incentives is emerging as a viable strategy for improving clinical outcomes for adults with type 2 diabetes. Components of effective lifestyle interventions for African Americans with diabetes includes targeting self-care behaviors that influence glycemic control through telephone delivered nurse coaching, telemonitoring, and skills training [16,17,18,19,20,21,22]. Evidence shows that culturally tailoring telephone delivered diabetes education and skills interventions that emphasize self-care goal setting are effective in improving glycemic control among African Americans [5, 13]. Recent evidence drawn from behavioral economics research suggests that financial incentives as a component of lifestyle interventions for African Americans with diabetes may further reduce health disparities through targeting self-care behaviors and improving glycemic control [23]
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