Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 701 Watertown Plank Rd, Milwaukee, WI, 53226-3596, USA.
Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
BMC Health Serv Res. 2021 Jan 13;21(1):57. doi: 10.1186/s12913-020-06029-0.
Financial incentives is emerging as a viable strategy for improving clinical outcomes for adults with type 2 diabetes. However, there is limited data on optimal structure for financial incentives and whether financial incentives are effective in African Americans with type 2 diabetes. This pilot study evaluated impact of three financial incentive structures on glycemic control in this population.
Sixty adults with type 2 diabetes were randomized to one of three financial incentive structures: 1) single incentive (Group 1) at 3 months for Hemoglobin A1c (HbA1c) reduction, 2) two-part equal incentive (Group 2) for home testing of glucose and HbA1c reduction at 3 months, and 3) three-part equal incentive (Group 3) for home testing, attendance of weekly telephone education classes and HbA1c reduction at 3 months. The primary outcome was HbA1c reduction within each group at 3 months post-randomization. Paired t-tests were used to test differences between baseline and 3-month HbA1c within each group.
The mean age for the sample was 57.9 years and 71.9% were women. Each incentive structure led to significant reductions in HbA1c at 3 months with the greatest reduction 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.
Financial incentives led to significant reductions in HbA1c from baseline within each group. Incentives for multiple components led to the greatest reductions from baseline. Structured financial incentives that reward home monitoring, attendance of telephone education sessions, and lifestyle modification to lower HbA1c are viable options for glycemic control in African Americans with type 2 diabetes.
Trial registration: NCT02722499 . Registered 23 March 2016, url.
经济激励措施正逐渐成为改善 2 型糖尿病成人临床结局的可行策略。然而，关于经济激励的最佳结构以及经济激励对 2 型糖尿病非裔美国人是否有效的数据有限。本试点研究评估了三种经济激励结构对该人群血糖控制的影响。
60 名 2 型糖尿病患者被随机分配至以下三种经济激励结构中的一种：1）单一激励（第 1 组），即 3 个月时因糖化血红蛋白（HbA1c）降低而获得奖励；2）两部分等额激励（第 2 组），即 3 个月时因家庭血糖检测和 HbA1c 降低而获得奖励；3）三部分等额激励（第 3 组），即家庭检测、每周电话教育课程和 3 个月时 HbA1c 降低而获得奖励。主要结局是每组患者在随机分组后 3 个月时的 HbA1c 降低量。采用配对 t 检验检验每组内基线与 3 个月时 HbA1c 的差异。
样本的平均年龄为 57.9 岁，71.9%为女性。每种激励结构在 3 个月时均导致 HbA1c 显著降低，其中多重激励组的降低幅度最大：第 1 组平均降低量为 1.25，第 2 组平均降低量为 1.73，第 3 组平均降低量为 1.74。
每组内经济激励均导致 HbA1c 从基线显著降低。多重激励的效果最佳。针对家庭监测、电话教育课程参与和生活方式改变以降低 HbA1c 的结构化经济激励措施，是 2 型糖尿病非裔美国人血糖控制的可行选择。
试验注册：NCT02722499。注册日期：2016 年 3 月 23 日，网址。
