Chin Jo-Yu, Matson Jacqueline, McCauley Susan, Anarella Joseph, Gesten Foster, Roohan Patrick
New York State Department of Health, Albany, NY, USA.
Albany, NY, USA.
Contemp Clin Trials. 2020 Apr;91:105960. doi: 10.1016/j.cct.2020.105960. Epub 2020 Feb 19.
Diabetes prevalence has risen rapidly and has become a global health challenge. The Diabetes Prevention Program (DPP) has been shown to prevent or delay the development of diabetes among individuals with prediabetes. Yet, diabetes prevention studies within the Medicaid population are limited and results are mixed. This study aimed to evaluate the impact of different financial incentive strategies on the utilization of the DPP for Medicaid managed care adults in New York State. A four-arm randomized controlled trial was conducted among Medicaid managed care adult enrollees diagnosed with prediabetes and/or obesity. Study participants were offered a 16-week DPP with various incentive strategies based on class attendance and weight loss as follows: Attendance-Only, Weight-Loss Only, and both Attendance and Weight-Loss. A control group was offered DPP with no incentives for attendance or weight loss. We evaluated the impact of incentives on achievement of the program completion and weight-loss milestone. Participants who received incentives for the Attendance-Only class were least likely to be lost to follow-up, more likely to complete the program, and had two times higher percentage of meeting the weight-loss milestone compared to the control group. Results for the other incentive cohorts were mixed. A strong positive association was observed for participants who attended 9 or more classes and weight-loss regardless of incentive strategies. Providing monetary incentives for DPP class attendance had a positive impact on program completion and achieving the weight-loss milestone. However, the results from this study indicate that participant enrollment and retention remained challenges despite the incentives.
糖尿病患病率迅速上升，已成为一项全球健康挑战。糖尿病预防计划（DPP）已被证明可预防或延缓糖尿病前期个体患糖尿病。然而，医疗补助人群中的糖尿病预防研究有限，结果也参差不齐。本研究旨在评估不同经济激励策略对纽约州医疗补助管理式医疗成年人群体参与DPP的影响。对诊断为糖尿病前期和/或肥胖的医疗补助管理式医疗成年参保者进行了一项四臂随机对照试验。根据出勤情况和体重减轻情况，为研究参与者提供了为期16周的DPP，并采用了各种激励策略，如下所示：仅出勤、仅减重以及出勤和减重两者兼顾。为一个对照组提供了无出勤或体重减轻激励措施的DPP。我们评估了激励措施对完成项目和达到减重里程碑的影响。与对照组相比，仅出勤组获得激励的参与者失访可能性最小，更有可能完成项目，达到减重里程碑的百分比高出两倍。其他激励队列的结果参差不齐。无论激励策略如何，对于参加9节或更多课程并减重的参与者，观察到了强烈的正相关。为DPP课程出勤提供金钱激励对项目完成和达到减重里程碑有积极影响。然而，本研究结果表明，尽管有激励措施，但参与者的招募和留存仍然是挑战。
