The effect of economics-based incentives on physical activity for newly diagnosed Type 2 Diabetes: A pilot randomised controlled trial

Abstract

Background: Behavioural economics-based incentives have been shown to increase physical activity in Western populations though evidence of improved health outcomes is limited. We sought to establish the generalisability of behavioural economics-based incentives on physical activity and health among people with diabetes in an Asian setting. 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. Eligible participants were aged 30-70 with newly diagnosed type 2 diabetes, drug-naïve, and with glycated haemoglobin (HbA1c) 6.5%-7.5%. Participants were randomly assigned in a 3:1 ratio to intervention (financial incentive framed around loss aversion and the endowment effect plus standard care) and control (standard care alone) groups. Prespecified outcome was a change in average daily step count at 26-weeks. We present preliminary results at 20-weeks. Results: Among 11 randomised participants (age 54 to 68, mean 61, SD 3.9) 36.4% were female. Among intervention (n=8) and control (n=3), 6 had completed 26-weeks follow-up as of June 2021. Mean daily step counts at baseline were higher in the intervention than the control group, 11,743 (SD 5071) vs 9,700 (SD 2768). Mean daily step count increased by 5.0% in the intervention group (mean 475.7 steps, 95% CI, -101.5 to 1052.8) but declined by 5.9% in the control group (mean -138.0 steps; 95% CI, -559.7 to 283.7) at 20 weeks. No adverse event was reported. Conclusions: This pilot study demonstrated the feasibility of economics-based incentives to increase physical activity in Asia, consistent with Western studies. Behavioural economics-based interventions to improve lifestyle as part of chronic disease management programmes may be easily implemented and applicable to many settings. A full-scale trial is underway to assess any improvements in health outcomes. Trial Registration: clinicaltrials.gov: NCT04443842-PILOT Funding: Research Grants Council (17607619) of the Hong Kong SAR, China