A Trial of Incentives and Peer Mentors to Improve Diabetic Outcomes
Condition: Diabetes Mellitus
Study type: Interventional

Summary: 
      In recent years, social networks have garnered attention in both academic journals and the
      lay press because of strong associations demonstrated in retrospective studies between social
      networks and incidence of major health problems such as obesity and smoking. Financial
      incentives have also been demonstrated to improve health behaviors in obesity, smoking, and
      medication adherence. We propose to conduct a randomized controlled trial among a
      predominantly African American population with persistently poor diabetes mellitus (DM)
      control to examine whether two novel interventions, lottery based financial incentives and
      telephone based one-on-one peer mentoring (the 'buddy system'), can significantly ameliorate
      disparities in poor DM control.

      The intervention is based on epidemiologic evidence, randomized controlled trials, and pilot
      studies demonstrating: 1) Lottery based financial incentives are a powerful motivator of
      behavior change; 2) One-on-one peer mentoring is a flexible, cost-efficient means of
      increasing DM specific social support and may be particularly salient in minority
      communities; and 3) Matching patients with poorly controlled DM with a similar individual
      from their community who has gained control of their DM draws on existing community assets in
      creating an inherently culturally competent intervention. DM patients with poor DM control
      will be randomized to 1 of 4 arms: usual care; telephone based one-on-one peer mentoring;
      lottery based financial incentives; and peer mentoring plus financial incentives.

      The Specific Aims are to test: 1) The effectiveness of telephone based one-on-one peer
      mentoring in improving glycemic control relative to usual care; 2) The effectiveness of
      lottery based financial incentives in improving glycemic control relative to usual care; 3)
      The effectiveness of combining peer mentoring and financial incentives relative to control;
      and 4) The relative cost effectiveness of all four approaches. In exploratory analyses, we
      will examine whether African American patients enrolled in intervention arms have greater
      improvement in glycemic control than white patients, whether intervention group patients
      experience greater improvements in blood pressure (BP) and lipid control, and whether peer
      mentors experience improvements in their own health. We will pair mentors with mentees based
      on race, gender, age, and disease severity. The active intervention will be run for a 6-month
      time period, with participants followed for an additional 6 months to determine if effects
      persist post intervention.

      The proposed interventions address multiple barriers to effective disease management common
      among patients with DM. If effective, these interventions could provide important models for
      improving glycemic control in general and, in particular, for addressing racial disparities
      in DM outcomes.
    


Intervention name(s): Incentives; Education; Peer mentoring
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Incentives will be offered for checking blood glucose each morning and for control of blood glucose (between 80-140 mg/dL).; Standard brochure about improving blood sugar control plus warnings about dangers of persistently high sugars and hypoglycemia; Participant is assigned a peer mentor who is matched on gender, race and age and who achieved good glucose control after previously having poor glucose control.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: diabetes; glucose; peer mentor; incentives; behavioral economics; cost-effectiveness