Trial to Incentivise Adherence for Diabetes (TRIAD): study protocol for a randomised controlled trial

Area of Science:

• Behavioral economics
• Health services research
• Diabetes management

Background:

• Suboptimal glycemic control in diabetes is often linked to poor treatment adherence.
• Behavioral economics suggests near-term rewards can bridge the gap between treatment costs and benefits.
• Financial incentives are a potential strategy to improve adherence and health outcomes in diabetes.

Purpose of the Study:

• To evaluate if financial incentives improve HbA1c levels in patients with diabetes.
• To determine if process-based incentives (adherence to testing, medication, activity) or outcome-based incentives (blood glucose within range) are more effective.
• To assess the cost-effectiveness and benefit incidence of financial incentive interventions.

Main Methods:

• A randomized, controlled, open-label, superiority trial (TRIAD) involving 240 patients with HbA1c ≥ 8%.
• Three arms: usual care (UC), UC with process incentive, and UC with outcome incentive (2:3:3 ratio).
• Primary outcome: change in HbA1c at 6 months. Secondary outcomes include adherence metrics and blood glucose monitoring.

Main Results:

• This section is not yet available as the study is ongoing or results have not been published.

Conclusions:

• The study will provide evidence on the cost-effectiveness of financial incentives for improving glycemic control.
• Findings will inform the design of future incentive strategies for chronic disease management.
• Comparison of process vs. outcome incentives will clarify optimal intervention design.