Motivating Patients to Engage in Evidence-Based Strategies to Prevent Diabetes: An RCT.

INTRODUCTION

Diabetes Prevention Programs and metformin can prevent or delay the onset of Type 2 diabetes mellitus, yet the uptake of these evidence-based preventive strategies is low. The objective of this study was to test whether interventions that promote different types of motivation to engage in evidence-based strategies to prevent Type 2 diabetes mellitus can reduce HbA1c and weight and increase engagement.

STUDY

DESIGN

This was a parallel 4-arm randomized trial.

SETTING

This study was conducted in an academic health system.

PARTICIPANTS

A total of 380 adult patients with prediabetes participated.

INTERVENTIONS: Enhanced usual care arm participants received 12 months of usual care and educational text messages about Type 2 diabetes mellitus prevention. Incentives arm participants received 12 months of the enhanced usual care arm intervention plus monthly financial incentives of $50-$250 for Diabetes Prevention Program participation or metformin use. Tailored arm participants received 12 months of the enhanced usual care arm intervention plus tailored text messages promoting autonomous motivation for preventing Type 2 diabetes mellitus. Combined arm participants received 12 months of the incentives arm and tailored arm interventions plus additional texts to increase the salience of the incentives.

MAIN OUTCOME MEASURES: The primary outcome was 12-month change in HbA1c. Secondary outcomes were 12-month change in body weight and monthly engagement, defined on the basis of online Diabetes Prevention Program participation or metformin use. Data were collected from 2021 to 2023 and analyzed from 2023 to 2026.

RESULTS

There were no significant differences across arms in 12-month changes in HbA1c or weight. Mean months of engagement with the Diabetes Prevention Program or metformin were higher in the incentives arm (6.5, p<0.0001) and the combined arm (7.2, p<0.0001) than in the enhanced usual care arm (3.6).

CONCLUSIONS

Interventions that use financial incentives for individuals with prediabetes to engage in evidence-based strategies to prevent Type 2 diabetes mellitus can increase the use of these strategies. However, such interventions may need to be modified to translate this increased engagement into improvements in clinical outcomes.

REGISTRATION: This study was registered at ClinicalTrials.gov Identifier NCT04902326.