A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus

Kullgren, Jeffrey T.; Hafez, Dina; Fedewa, Allison; Heisler, Michele

doi:10.1007/s11892-017-0894-z

Cited by 33 publications

(20 citation statements)

References 88 publications

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“…If it is possible to identify time preferences in practice, interventions such as reinforcement or commitment devices may be powerful tools to accommodate individual preferences and improve diabetes self‐management behaviour, including the use of diabetes technologies . Reinforcement interventions that rearrange an individual's choice environment so that benefits of engaging in activities that carry a cost occur more immediately have shown promising results in relation to appointment attendance, weight loss, exercise, medication‐taking and self‐monitoring of blood glucose in diabetes .…”

Section: Discussionmentioning

confidence: 99%

“…Although they may be perceived as controversial, commitment devices in which individuals incur a financial or psychological cost if agreed‐upon goals are not met may also be an effective means of mitigating suboptimal behaviours arising from time‐inconsistent preferences . Examples include committing to a goal by depositing money that will be added to or forfeited depending on results, or by signing a social contract to perform group‐based activities.…”

Section: Discussionmentioning

confidence: 99%

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Time preferences, diabetes self‐management behaviours and outcomes: a systematic review

et al. 2019

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Aim Time preferences, i.e. individuals’ degree of patience/impatience in intertemporal choice, have been found to be associated with suboptimal health behaviours and health outcomes such as smoking, physical inactivity, unhealthy food intake and obesity. In this systematic review, we aimed to synthesise reported associations between time preferences, diabetes self‐management behaviours, including use of diabetes technology, and outcomes. Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, EconLit and all databases in the Web of Science Core Collection. Peer‐reviewed studies of people with diabetes that included at least one diabetes‐related behaviour or outcome and a measure of time preferences were included. Non‐English language studies were excluded. Results A total of 961 records were identified, of which 12 articles were included. Three studies analysed both time‐consistent and time‐inconsistent preferences, three studies solely analysed time‐inconsistent preferences and six studies did not explicitly define a time preference model. Measured outcomes across studies included self‐care activities, such as medication‐taking, exercising and eating a healthy diet, and biomedical outcomes, such as HbA1c and diabetes‐related complications. There were 10 cross‐sectional studies and two panel‐data studies. No studies explicitly analysed the relationship between time preferences and diabetes technology use. Conclusions Associations between measures of time preferences, diabetes self‐management behaviours and clinical outcomes exist. Higher discount rates determined by both time‐consistent and time‐inconsistent models predict less diabetes‐related self‐care and worse outcomes. These findings may add to explanations of the observed variation in diabetes‐related health and provide new insights for tailoring interventions and policies aimed at improving diabetes self‐management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Time preferences, diabetes self‐management behaviours and outcomes: a systematic review

et al. 2019

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“…Targeting these biases to develop more effective interventions has been of increasing interest, especially in the health domain . Known as nudges , these interventions have shown promising results in helping people change their behaviour, including people with T2DM …”

Section: Background and Objectivesmentioning

confidence: 99%

“…2 Known as nudges, these interventions have shown promising results in helping people change their behaviour, including people with T2DM. 3 In recent years, several systematic biases underlying health behaviour have been documented. For example, people tend to discount delayed rewards, such as avoiding cancer or heart disease, relative to more immediate, smaller rewards, such as having a cigarette or an extra dessert now ("present biasedness").…”

Section: Backg Round and Objec Tive Smentioning

confidence: 99%

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Rouyard

Leal

Baskerville

et al. 2018

Endocrino Diabet & Metabol

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SummaryObjectives: To assess the feasibility in routine primary care consultation and investigate the effect on risk recall and self-management of a new type of risk communication intervention based on behavioural economics ("nudge-based") for people with Type 2 diabetes mellitus (T2DM).Methods: Forty adults with poorly controlled T2DM (HbA1c > 7.5%) were randomized to receive a personalized, nudge-based risk communication intervention (n = 20) or standard care (n = 20). Risk recall and self-management were evaluated at baseline and 12 weeks after the intervention.Results: Both in terms of feasibility and acceptability, this new risk communication intervention was very satisfactory. Study retention rate after 12 weeks was very high (90%) and participants were highly satisfied with the intervention (4.4 out of 5 on the COMRADE scale). Although not powered to identify significant between-group effects, the intervention significantly improved risk recall after 12 weeks and intentions to make lifestyle changes (dietary behaviour) compared to standard care. Conclusions:This pilot study provides the first evidence of the feasibility of implementing in primary care a nudge-based risk communication intervention for people with T2DM. Based on the promising results observed, an adequately powered trial to determine the effectiveness of the intervention on long-term self-management is judged feasible. As a result of this feasibility study, some minor adaptations to the intervention and study methods that would help to facilitate a definitive trial are also reported. K E Y W O R D Sbehavioural economics, pilot randomized trial, primary care, risk communication, selfmanagement, Type 2 diabetes

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“…A recent scoping review of behavioral economic interventions for the prevention and treatment of Type 2 diabetes uncovered six studies that tested the impact of financial incentives on either selfmanagement recommendations or outcomes [9]. Only two studies specifically addressed using financial incentives to reach A1c goals and the results were Health modest at best [10] [11].…”

Section: Introductionmentioning

confidence: 99%

Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes

O'Leary¹,

Howe²,

Rich³

et al. 2018

Health

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Objectives: While the value of glycemic control to minimize adverse health outcomes among patients with diabetes is clear, achieving hemoglobin A1c (A1c) goals remain a challenge. We evaluated the use of financial incentives to increase enrollment and improve glycemic control among patients invited to participate in a monthly diabetes group appointment (DGA) as part of their enrollment in DaVita HealthCare Partners, a large southern California managed care organization. Methods: Adult diabetes patients (≥18 years) with a currently uncontrolled hemoglobin A1c level (>8.0% if <65 years and >9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater Los Angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. Over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. On average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, −1.2%) versus non-incentive DGA (9.7% to 9.0%, −0.7%) versus no DGA group (9.1% to 8.7%, −0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under "real-world" conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications.How to cite this paper:

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A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus

Cited by 33 publications

References 88 publications

Time preferences, diabetes self‐management behaviours and outcomes: a systematic review

Time preferences, diabetes self‐management behaviours and outcomes: a systematic review

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes

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