Quotation Bilger, Marcel, Shah, Mitesh, Tan, Ngiap Chuan, Tan, Cynthia, Bundoc, Fillipinas, Bairavi, Joann, Finkelstein, Eric. 2021. Process- and Outcome-Based Financial Incentives to Improve Self-Management and Glycemic Control in People with Type 2 Diabetes in Singapore: A Randomized Controlled Trial. The Patient: Patient-Centered Outcomes Research.


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Abstract

Sub-optimally controlled diabetes increases risks for adverse and costly complications. Self-management including glucose monitoring, medication adherence, and exercise are key for optimal glycemic control, yet, poor self-management remains common. The main objective of the Trial to Incentivize Adherence for Diabetes (TRIAD) study was to determine the effectiveness of financial incentives in improving glycemic control among type 2 diabetes patients in Singapore, and to test whether process-based incentives tied to glucose monitoring, medication adherence, and physical activity are more effective than outcome-based incentives tied to achieving normal glucose readings. TRIAD is a randomized, controlled, multi-center superiority trial. A total of 240 participants who had at least one recent glycated hemoglobin (HbA1c) being 8.0% or more and on oral diabetes medication were recruited from two polyclinics. They were block-randomized (blocking factor: current vs. new glucometer users) into the usual care plus (UC +) arm, process-based incentive arm, and outcome-based incentive arm in a 2:3:3 ratio. The primary outcome was the mean change in HbA1c at month 6 and was linearly regressed on binary variables indicating the intervention arms, baseline HbA1c levels, a binary variable indicating titration change, and other baseline characteristics. This study suggests that both incentive types may be part of a successful self-management strategy. Process-based incentives can improve adherence to intermediary outcomes, while outcome-based incentives focus on glycemic control and are simpler to administer.

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Publication's profile

Status of publication Published
Affiliation WU
Type of publication Journal article
Journal The Patient: Patient-Centered Outcomes Research
Language English
Title Process- and Outcome-Based Financial Incentives to Improve Self-Management and Glycemic Control in People with Type 2 Diabetes in Singapore: A Randomized Controlled Trial
Year 2021
URL http://link.springer.com/content/pdf/10.1007/s40271-020-00491-y.pdf
DOI http://dx.doi.org/10.1007/s40271-020-00491-y
Open Access Y
Open Access Link https://doi.org/10.1007/s40271-020-00491-y

Associations

People
Bilger, Marcel (Details)
External
Bairavi, Joann (Duke-NUS Medical School, Singapore)
Bundoc, Fillipinas (Duke-NUS Medical School, Singapore)
Finkelstein, Eric (Duke-NUS Medical School, Singapore)
Shah, Mitesh (SingHealth Polyclinics, Singapore)
Tan, Cynthia (SingHealth Polyclinics, Singapore)
Tan, Ngiap Chuan (SingHealth Polyclinics, Singapore)
Organization
Health Economics and Policy Group AB (Details)
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