Motivating Patients to Engage in Evidence-Based Strategies to Prevent Diabetes: A Randomized Controlled Trial.
rct · Level II
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- Record sourced from PubMed, PMID 42107480.
- Also identified by DOI 10.1016/j.amepre.2026.108407.
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Abstract
Diabetes Prevention Programs (DPPs) and metformin can prevent or delay onset of type 2 diabetes mellitus (T2DM), yet uptake of these evidence-based preventive strategies is low. The objective was to test whether interventions that promote different types of motivation to engage in evidence-based strategies to prevent T2DM can reduce hemoglobin A1c (HbA1c) and weight, and increase engagement. Parallel four-arm randomized trial. Academic health system. 380 adult patients with prediabetes. Enhanced Usual Care (EUC) Arm participants received 12 months of usual care and educational text messages about T2DM prevention. Incentives Arm participants received 12 months of the EUC Arm intervention plus monthly financial incentives of $50 to $250 for DPP participation or metformin use. Tailored Arm participants received 12 months of the EUC Arm intervention plus tailored text messages promoting autonomous motivation for preventing T2DM. Combined Arm participants received 12 months of the Incentives Arm and Tailored Arm interventions plus additional texts to increase the salience of incentives. The primary outcome was 12-month change in HbA1c. Secondary outcomes were 12-month change in body weight and monthly engagement, defined based on online DPP participation or metformin use. Data were collected 2021 to 2023 and analyzed 2023 to 2026. There were no significant differences across arms in 12-month changes in HbA1c or weight. Mean months of engagement with the DPP or metformin were higher in the Incentives Arm [6.5, P < 0.0001] and the Combined Arm (7.2, P < 0.0001) compared to the EUC Arm (3.6). Interventions that use financial incentives for individuals with prediabetes to engage in evidence-based strategies to prevent T2DM can increase use of these strategies. However, such interventions may need to be modified to translate this increased engagement into improvements in clinical outcomes. ClinicalTrials.gov Identifier NCT04902326.