Background: Behavioral economics research has identified several decision-making patterns that contribute to poor adherence to medical regimens, however, few studies have investigated the possible influence of financial incentives on diabetes outcomes.

Methods: We randomized 60 African Americans with type 2 diabetes to one of three financial incentive structures: 1) single incentive at 3 months for A1c reduction, 2) two-part incentive for home testing of glucose and A1c reduction at 3 months, and 3) multiple component incentive for home testing, attendance of weekly telephone education classes and A1c reduction at 3 months. The primary outcome was A1c reduction within each arm at 3 months. As a pilot, this study was not powered to test between group differences.

Results: The mean age for individuals was 57.9, with 71.9% women. Each incentive structure led to significant reductions in A1c at 3 months with the greatest magnitude of change 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.

Conclusion: Financial incentives across three separate structures led to significant decrease in A1c over 3 months. The magnitude of this effect was large and, in the range, found with diabetes medication trials, rather than smaller effects often seen in behavioral interventions. Therefore, this pilot randomized controlled trial suggests that structured incentives has significant impact on A1c reduction beyond what is typically seen with behavioral interventions and may be an important focus of future interventional studies to improve metabolic control and hence reduce diabetes complication and mortality rates in African Americans with type 2 diabetes.


L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. R.J. Walker: None. H.L. Prigmore: None. J.S. Williams: None. J.A. Campbell: None. A. Dawson: None.


National Institutes of Health

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