Trial to Incentivise Adherence for Diabetes

Summary

Type II diabetes is associated with a host of adverse and costly complications, including heart attacks, strokes, blindness, kidney failure, and severe neuropathy that may result in amputations. For those with diabetes, glycemic control is essential to minimize complications but many fail at being sufficiently adherent to their treatment. The investigators propose to test two incentive-based intervention strategies aimed at improving diabetes outcomes amongst patients with uncontrolled glycemic levels. The incentives are tied either to processes aimed at improving blood sugar levels (glucose testing, physical activity and medication adherence) or directly to the intermediary outcome (blood glucose in the acceptable range). While process incentives are likely to provide more motivation for treatment adherence, as these goals may be comparably easier to meet, these incentives only reward intermediary outcomes and it might be more effective to reward successfully achieving a health outcome directly.

Conditions

• Type 2 Diabetes Mellitus

Interventions

BEHAVIORAL

Diabetes Educational Program (DEP)

Participants in this Arm will receive the Diabetes Educational Program (DEP), as required, which is part of usual care at the Polyclinic. It is delivered by a Health Counsellor at the point of diagnosis and focused education is provided during doctor visits for medication. The program at the Polyclinic comprises information on a series of diabetes-related issues. The participant will receive the 2 or 3 study devices (patients will receive a glucometer if they do not already have one). The Site Study Coordinator will provide education on the use of the Fitbit Zip™ and the eCAP™. As part of usual care, patients who have difficulties with their glucometer will be referred to a Health Counsellor at the Polyclinic.

BEHAVIORAL

DEP + Process Incentive

Participants will receive the DEP as required. In addition, participants will have the opportunity to earn financial incentives (in vouchers) for meeting specified goals: * SGD3.50 weekly for meeting Glucose testing goals: measuring blood glucose on three non-consecutive days each week. * SGD0.50 daily for Medication adherence: taking medications daily as prescribed, monitored by eCAP device. Assessed based on medication-taking times within specified time windows. Participants should be adherent at all specified mealtimes to be fully adherent for the day. * SGD1.00 daily for Regular Physical activity: taking 8,000 steps during the day as recorded by Fitbit.

BEHAVIORAL

DEP + Outcome Incentive

Participants will receive the DEP as required. In addition, participants will have the opportunity to earn financial incentives (in vouchers) for recording glucose readings within the normal range (i.e. between 4 to 7mmols/L two before a meal) on 3 non-consecutive days within the week using the glucometer. * SGD 2 weekly if one glucose readings falls within the normal range, * SGD 7 weekly if two glucose readings fall within the normal range, * SGD 14 weekly if all three glucose readings fall within the normal range.

Sponsors & Collaborators

• Duke-NUS Graduate Medical School

  lead OTHER

Principal Investigators

• Marcel Bilger · Duke-NUS Graduate Medical School

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

21 Years

Max Age

70 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2015-03-31

Primary Completion

2018-10-25

Completion

2018-10-31

Countries

• Singapore

Study Locations