The effects of financial incentives on diabetes prevention program attendance and weight loss among low-income patients: the We Can Prevent Diabetes cluster-randomized controlled trial

Abstract

Background 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). Methods 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. Results 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. Conclusions Financial incentives can improve the proportion of Medicaid beneficiaries attending the 12-month DPP and achieving at least 5% weight loss. Trial registration ClinicalTrials.govNCT02422420; retrospectively registered April 21, 2015.

Facilitators and Barriers to Uptake of Community-Based Diabetes Prevention Program Among Multi-Ethnic Asian Patients With Prediabetes

“…Financial incentives might be also considered as a mechanism to improve engagement in at-risk individuals who are not ready to change behaviors. A community-based randomized controlled trial found that participation in a DPP was significantly higher for participants who received incentives compared to those who did not ( 58 ) and the intervention remained cost-effective even with the provision of direct financial incentives ( 59 ).…”

The impact of positive social reinforcement on time-to-attrition from the Diabetes Prevention Program in college students at high risk for Type II Diabetes: a study protocol for a phase 3, multicenter, cluster randomized trial

“…The primary outcome is time-to-attrition from the DPP, and secondary outcomes are the percentage of weight change, HbA1C reduction, and mean PA minutes. Time-to-attrition from the DPP is defined as missing two consecutive core sessions and make-up sessions within the Core Session Phase (1-6 months) or missing two consecutive core maintenance sessions and make-up maintenance sessions within the Core Maintenance Phase (7-12 months) (Desai et al, 2020;Cannon et al, 2020). A session is completed when the participant has finalized the lesson's activities and recorded weekly body weight and PA minutes.…”

A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes

“…Nonetheless, the study sample of women was ideal for an intervention to improve dietary and physical activity, with the majority having elevated weights, risk of diabetes, and less healthy diet and physical activity behaviors. The group averaged a level of weight loss across 16 weeks similar to other DPP trials (e.g., [68]). Consistent with the present study, adults with chronic disease risk factors have poorer quality diets [69].…”