The Effect Of Economics-based Incentives On Glycaemic Control For Newly Diagnosed Type 2 Diabetes: A Pilot Randomized Controlled Trial

Abstract

Purpose: To demonstrate proof-of-concept of behavioural economics-based interventions to improve lifestyle and health outcomes among adults newly diagnosed with type 2 diabetes. Methods: We conducted a two-arm pilot parallel assessor-blinded randomised controlled trial at two sites in Hong Kong from November 2020 to planned December 2021 (planned end date). Eligible participants aged 30-70 with newly diagnosed type 2 diabetes, drug-naïve, and with glycated haemoglobin (HbA1c) 6.5%-7.5% at enrolment were randomly assigned in a 3:1 ratio to intervention (in addition to standard care) and control (standard care alone) groups. The intervention to improve lifestyle and physical activity was a financial incentive framed around loss aversion and the endowment effect. Primary outcome was change in HbA1c at 6-months compared to baseline. We present preliminary results after half of participants completed the follow-up. Clinicaltrials.gov: NCT04443842. Results: Among 11 randomised participants aged 54 to 68 (mean 61, SD 3.9), 36.4% were female. Mean HbA1c at baseline were higher in intervention (n=8) than control group (n=3), 7.1% (SD 0.6) vs 6.4% (SD 0.1). Five participants completed 6-month follow-up, with HbA1c declining by 2.7% (-0.2 percentage points), 1.5% (-0.1 percentage points), 1.5% (-0.1 percentage points), 0% and 0%. Conclusions: Preliminary results of this pilot study demonstrated the feasibility of economicsbased incentives to improve glycaemic control among drug-naïve people with type 2 diabetes. A full-scale trial is underway to assess the impact of incentives on physical activity, HbA1c and other health outcomes.