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Motivating Patients to Engage in Evidence-Based Strategies to Prevent Diabetes: A Randomized Controlled Trial
Jeffrey T Kullgren1, Shelley Stoll2, Eli W Carter2
1VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, PO Box 130170, 152, Ann Arbor, MI 48113; Department of Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, 3110 Taubman Center SPC 5368, Ann Arbor, MI 48109-5368; Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI 48109.
American Journal of Preventive Medicine
|May 10, 2026
Summary
Financial incentives increased engagement with type 2 diabetes mellitus (T2DM) prevention strategies for prediabetes patients. However, this engagement did not significantly improve clinical outcomes like HbA1c or weight.
Area of Science:
- Endocrinology
- Preventive Medicine
- Behavioral Science
Background:
- Type 2 diabetes mellitus (T2DM) prevention strategies, including Diabetes Prevention Programs (DPPs) and metformin, have low uptake.
- Prediabetes management is crucial for preventing T2DM onset.
- Novel interventions are needed to improve adherence to preventive strategies.
Purpose of the Study:
- To evaluate the effectiveness of interventions promoting autonomous motivation and financial incentives on T2DM prevention.
- To assess the impact of these interventions on reducing hemoglobin A1c (HbA1c) and body weight.
- To determine if interventions increase engagement with DPPs or metformin.
Main Methods:
- A parallel four-arm randomized trial involving 380 adult patients with prediabetes.
- Interventions included Enhanced Usual Care (EUC), EUC with financial incentives, EUC with tailored motivational messages, and a combined approach.
- Primary outcome was the 12-month change in HbA1c; secondary outcomes included weight change and engagement duration.
Main Results:
- No significant differences in 12-month changes in HbA1c or body weight were observed across the four arms.
- Engagement with DPPs or metformin was significantly higher in the Incentives Arm (6.5 months) and Combined Arm (7.2 months) compared to the EUC Arm (3.6 months).
Conclusions:
- Financial incentives effectively increase engagement with T2DM preventive strategies among individuals with prediabetes.
- Current incentive-based interventions may require modification to translate increased engagement into measurable clinical improvements.
- Further research is needed to optimize interventions for sustained T2DM prevention.
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