Financial incentives to improve glycemic control in African American adults with type 2 diabetes: a pilot randomized controlled trial

BackgroundFinancial 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.MethodsSixty adults with type 2 diabetes were randomized to one of three financial incentive structures: 1) single incentive (Group 1) at 3months for Hemoglobin A1c (HbA1c) reduction, 2) two-part equal incentive (Group 2) for home testing of glucose and HbA1c reduction at 3months, and 3) three-part equal incentive (Group 3) for home testing, attendance of weekly telephone education classes and HbA1c reduction at 3months. The primary outcome was HbA1c reduction within each group at 3months post-randomization. Paired t-tests were used to test differences between baseline and 3-month HbA1c within each group.ResultsThe mean age for the sample was 57.9years and 71.9% were women. Each incentive structure led to significant reductions in HbA1c at 3months 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.ConclusionFinancial 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 registrationTrial registration: NCT02722499. Registered 23 March 2016, url.

Automated summary

Financial incentives have shown to significantly reduce HbA1c levels in African American patients with type 2 diabetes, with the greatest reduction observed when incentives are set for multiple components.