研究方案：行为经济学和自我决定理论改变糖尿病风险（BESTChange）。

Study protocol: Behavioral economics and self-determination theory to change diabetes risk (BEST Change).

机构信息

Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.

出版信息

Contemp Clin Trials. 2023 Jan;124:107038. doi: 10.1016/j.cct.2022.107038. Epub 2022 Nov 30.

DOI:10.1016/j.cct.2022.107038

PMID:36460265

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10259647/

Abstract

BACKGROUND

The Diabetes Prevention Program (DPP) and metformin can prevent or delay the onset of type 2 diabetes mellitus (T2DM) among patients with prediabetes. Yet, even when these evidence-based strategies are accessible and affordable, uptake is low. Thus, there is a critical need for effective, scalable, and sustainable approaches to increase uptake and engagement in these interventions.

METHODS

In this randomized controlled trial, we will test whether financial incentives and automated messaging to promote autonomous motivation for preventing T2DM can increase DPP participation, metformin use, or both among adults with prediabetes. Participants (n = 380) will be randomized to one of four study arms. Control Arm participants will receive usual care and educational text messages about preventing T2DM. Incentives Arm participants will receive the Control Arm intervention plus financial incentives for DPP participation or metformin use. Tailored Messages Arm participants will receive the Control Arm intervention plus tailored messages promoting autonomous motivation for preventing T2DM. Combined Arm participants will receive the Incentives Arm and Tailored Messages Arm interventions plus messages to increase the personal salience of financial incentives. The primary outcome is change in hemoglobin A1c from baseline to 12 months. Secondary outcomes are change in body weight, DPP participation, and metformin use.

DISCUSSION

If effective, these scalable and sustainable approaches to increase patient motivation to prevent T2DM can be deployed by health systems, health plans, and employers to help individuals with prediabetes lower their risk for developing T2DM.

摘要

背景

糖尿病预防计划（DPP）和二甲双胍可以预防或延迟前驱糖尿病患者 2 型糖尿病（T2DM）的发生。然而，即使这些基于证据的策略是可及和负担得起的，其采用率仍然很低。因此，迫切需要有效的、可扩展的和可持续的方法来提高这些干预措施的采用率和参与度。

方法

在这项随机对照试验中，我们将测试财务激励和自动信息传递以促进预防 T2DM 的自主动机是否可以提高前驱糖尿病成年人对 DPP 的参与度、二甲双胍的使用或两者兼而有之。参与者（n=380）将随机分配到四个研究组之一。对照组参与者将接受常规护理和关于预防 T2DM 的教育短信。激励组参与者将接受对照组干预措施，并获得 DPP 参与或二甲双胍使用的财务激励。定制信息组参与者将接受对照组干预措施和促进自主预防 T2DM 的动机的定制信息。综合组参与者将接受激励组和定制信息组的干预措施，以及增加财务激励的个人显著性的信息。主要结果是从基线到 12 个月时血红蛋白 A1c 的变化。次要结果是体重变化、DPP 参与和二甲双胍使用。