Background: Costs are a barrier to medication adherence in patients living with Type 2 Diabetes (PLWD). Financial incentives may lower costs and increase adherence.

Methods: PubMed, Scopus, and Embase were searched for articles published before March 2022 assessing the impact of financial incentives on medication adherence in PLWD. Search terms included “medication adherence,” “T2D,” “financial incentive,” incentive types, and associated Medical Subject Headings. Two pooled analyses - the mean difference in proportion days covered (PDC) or mean possession ratio (MPR) and the mean difference in percent adherent (PDC/MPR ≥80%) - were conducted. Coehn's d Treatment Effect was calculated for each study using mean difference and standard errors. The overall treatment effect for each pooled analysis was calculated using Bayesian meta-analysis.

Results: The review included 25 studies. Medication adherence always improved in 21 studies, three indicated they increased adherence only in some populations, and incentives had no effect in one study. Figure 1 illustrates the meta-analysis results for studies with appropriate outcome data. Both pooled analyses demonstrate a small but statistically significant increase in adherence due to financial incentives (d=0.02, p<0.01).

Conclusion: Financial incentives have the potential to increase medication adherence to antidiabetic drugs.


D.Winberg: Employee; Janssen Scientific Affairs, LLC. T.Tang: None. Z.Ramsey: None. A.N.Bazzano: None. J.Li: None. Y.Lin: None. E.Nauman: None. L.Shi: None.


Centers for Disease Control and Prevention (U18DP006523)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at