1032-P: Behavioral Economics-Based Financial and Social Incentives for Glycemic Control in Newly Diagnosed Type 2 Diabetes—A Randomized Control Trial

Introduction & Objective: To assess the effectiveness of financial and social incentives using behavioral economics to improve glycemic control in patients with newly diagnosed type 2 diabetes.

Methods: We conducted a pragmatic randomized clinical trial with a 6-month intervention period from June 2021 to December 2023. Adults with newly diagnosed type 2 diabetes (glycated hemoglobin [HbA1c] 48-75 mmol/mol) were recruited at public primary care clinics. Participants were randomly assigned to three groups to incentivize physical activity: financial incentive, financial and social incentive, and control. Participants in the incentive groups received personalized weekly step targets along with loss-framed financial incentives starting at $128 USD. Participants lost $5 USD each week if their step target was not met. For the social incentive, participant weekly step performance was shared with their nominated supporters to provide peer encouragement. Intent-to-treat analysis using weighted generalized estimating equations (WGEE) was performed to assess changes in HbA1c. ClinicalTrials.gov identifier: NCT0491792.

Results: Among 104 adults newly diagnosed with type 2 diabetes, the mean age was 55.0 (53.9% female). Median baseline HbA1c for the financial incentive, financial and social incentive, and control group was 51.9, 53.0, and 50.8mmol/mol respectively. While step count increased, participants in the financial incentive group had a non-significant decrease in HbA1c (-0.8 mmol/mol) and no improvement in the financial and social incentive group compared to the control group.

Conclusion: The interventions using financial and social incentives had no significant impact on improving HbA1c in patients newly diagnosed with type 2 diabetes.