Abstract
Background: Incentives play a role in introducing health-related benefits, but no interventions using mixed incentives, i.e. a combination of individual and group incentives, have been tested in individuals with type 2 diabetes mellitus (T2DM). We evaluated the feasibility of implementing individual- and mixed-incentives, with and without a supportive partner, on glycated haemoglobin (HbA1c) control and weight loss among patients with T2DM. Methods: This is a feasibility, sex-stratified, single-blinded, randomized controlled study in individuals with T2DM. All participants received diabetes education and tailored goal setting for weight and glycated haemoglobin (HbA1c). Participants were randomly assigned into three arms: individual incentives (Arm 1), mixed incentives-altruism (Arm 2), and mixed incentives-cooperation (Arm 3). Participants were accompanied by a diabetes educator every other week to monitor targets, and the intervention period lasted 3 months. The primary outcome was the change in HbA1c at 3 months from baseline. Weight and change body mass index (BMI) were considered as secondary outcomes. Results: Out of 783 patients screened, a total of 54 participants, 18 per study arm, were enrolled and 44 (82%) completed the 3-month follow-up. Mean baseline HbA1c values were 8.5%, 7.9% and 8.2% in Arm 1, Arm 2, and Arm 3, respectively. At 3 months, participants in all three study arms showed reductions in HbA1c ranging from -0.9% in Arm 2 to -1.4% in Arm 1. Weight and BMI also showed reductions. Conclusions: Individual and mixed cash incentives show important reductions in HbA1c, weight and BMI in patients with type 2 diabetes mellitus after 3 months. Recruitment and uptake of the intervention were successfully accomplished demonstrating feasibility to conduct larger effectiveness studies to test individual and mixed economic incentives for diabetes management. Registration: ClinicalTrials.gov Identifier NCT02891382.
Highlights
Evidence indicates that there are major benefits to be achieved by preventive care among patients with diabetes[1,2,3,4], yet adherence to healthy behaviors and pharmacological treatment remains a challenge worldwide[5,6,7,8]
The questionnaires helped us determine a reasonable amount for the cash rewards, which ended up being 80 PEN if the participant lost one kilogram after two weeks, approximately 10% of minimum wage (Peru’s minimum salary wage for year 2017 was 850 PEN/~$264 USD), and 400 PEN (~$124 USD) if the HbA1c was reduced by 1% or more after 3 months
Intervention This study explored the role of cash rewards, with or without a “supportive” partner, in changing the behavior of individuals with type 2 diabetes mellitus, by promoting healthy lifestyles through tailored nutritional advice, delivered by a diabetes educator, attached to individual goal-setting with cash rewards
Summary
Evidence indicates that there are major benefits to be achieved by preventive care among patients with diabetes[1,2,3,4], yet adherence to healthy behaviors and pharmacological treatment remains a challenge worldwide[5,6,7,8]. Non-monetary and monetary rewards may play a role in introducing health-related benefits by incentivizing behavior changes among individuals with type 2 diabetes mellitus[9]. Incentives play a role in introducing health-related benefits, but no interventions using mixed incentives, i.e. a combination of individual and group incentives, have been tested in individuals with type 2 diabetes mellitus (T2DM). We evaluated the feasibility of implementing individualand mixed-incentives, with and without a supportive partner, on glycated haemoglobin (HbA1c) control and weight loss among patients with T2DM. At 3 months, participants in all three study arms showed reductions in HbA1c ranging from -0.9% in Arm 2 to -1.4% in Arm 1. Conclusions: Individual and mixed cash incentives show important reductions in HbA1c, weight and BMI in patients with type 2 diabetes mellitus after 3 months. Recruitment and uptake of the intervention were successfully accomplished demonstrating feasibility to conduct larger
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