HealthPartners Institute, Bloomington, MN, USA.
Minnesota Department of Health, 85 East 7th Place, P.O. Box 64882, St. Paul, MN, 55164, USA.
BMC Public Health. 2020 Oct 21;20(1):1587. doi: 10.1186/s12889-020-09683-5.
Penetration and participation of real life implementation of lifestyle change programs to prevent type 2 diabetes has been challenging. This is particularly so among low income individuals in the United States. The purpose of this study is to examine the effectiveness of financial incentives on attendance and weight loss among Medicaid beneficiaries participating in the 12-month Diabetes Prevention Program (DPP).
This is a cluster-randomized controlled trial with two financial incentive study arms and an attention control study arm. Medicaid beneficiaries with prediabetes from 13 primary care clinics were randomly assigned to individually earned incentives (IND; 33 groups; n = 309), a hybrid of individual- and group-earned incentives (GRP; 30 groups; n = 259), and an attention control (AC; 30 groups; n = 279). Up to $520 in incentives could be earned for attaining attendance and weight loss goals over 12 months. Outcomes are percent weight loss from baseline, achieving 5% weight loss from baseline, and attending 75% of core and 75% of maintenance DPP sessions. Linear mixed models were used to examine weight change and attendance rates over the 16 weeks and 12 months.
The percent weight change at 16 weeks for the IND, GRP, and AC participants were similar, at - 2.6, - 3.1%, and - 3.4%, respectively. However, participants achieving 5% weight loss in the IND, GRP, and AC groups was 21.5, 24.0% (GRP vs AC, P < 0.05), and 15.2%. Attendance at 75% of the DPP core sessions was significantly higher among IND (60.8%, P < 0.001) and GRP (64.0%, P < 0.001) participants than among AC (38.6%) participants. Despite substantial attrition over time, attendance at 75% of the DPP maintenance sessions was also significantly higher among IND (23.0%, P < 0.001) and GRP (26.1%, P < 0.001) participants than among AC (11.0%) participants.
Financial incentives can improve the proportion of Medicaid beneficiaries attending the 12-month DPP and achieving at least 5% weight loss.
ClinicalTrials.gov NCT02422420 ; retrospectively registered April 21, 2015.
将生活方式改变计划的实际实施渗透并推广到预防 2 型糖尿病的领域，一直具有挑战性。在美国，这对于低收入人群来说尤其如此。本研究的目的是检验财务激励措施对参加为期 12 个月的糖尿病预防计划（DPP）的医疗补助受助人的出勤率和体重减轻的效果。
这是一项具有两个财务激励研究臂和一个注意控制研究臂的聚类随机对照试验。来自 13 个初级保健诊所的前驱糖尿病的医疗补助受助人被随机分配到个人赚取激励（IND；33 组；n=309）、个人和团体赚取激励的混合（GRP；30 组；n=259）和注意控制（AC；30 组；n=279）。在 12 个月内达到出勤率和体重减轻目标，最多可获得 520 美元的激励。结果是从基线开始的体重减轻百分比、从基线开始体重减轻 5%、以及参加核心和维持 DPP 课程的 75%。线性混合模型用于检查 16 周和 12 个月内的体重变化和出勤率。
在第 16 周时，IND、GRP 和 AC 参与者的体重减轻百分比相似，分别为-2.6%、-3.1%和-3.4%。然而，IND、GRP 和 AC 组中体重减轻 5%的参与者比例分别为 21.5%、24.0%（GRP 与 AC 相比，P<0.05）和 15.2%。IND（60.8%，P<0.001）和 GRP（64.0%，P<0.001）参与者参加 DPP 核心课程的比例明显高于 AC（38.6%）参与者。尽管随着时间的推移大量参与者流失，但 IND（23.0%，P<0.001）和 GRP（26.1%，P<0.001）参与者参加 DPP 维持课程的比例也明显高于 AC（11.0%）参与者。
财务激励措施可以提高参加 12 个月 DPP 并至少减轻 5%体重的医疗补助受助人的比例。
ClinicalTrials.gov NCT02422420；2015 年 4 月 21 日回顾性注册。
