REDEEM trial: The effect of individual and mixed REwards in DiabEtEs Management, a randomised controlled trial Studies in developed countries have demonstrated benefits to preventive care (diet modifications, exercise) among patients with diabetes. Despite this knowledge, patients often don't manage their diabetes properly. In a study that we conducted in Lima, 71% of subjects with diabetes were aware of their disease, 40% were receiving treatment, and only 7% had achieved therapeutic goals. In Latin America, diabetes has a great impact on the health system due to high costs of disease control (US$10.7 billion) and indirect costs (US$54.5 billion) related to loss of productivity, disability, and premature death.   Payment for achieving therapeutic goals, or "rewards," have been tested as a way to improve health. Several studies have shown the promise of this approach in encouraging and maintaining weight loss, which is an important way to control diabetes. One study found that paying people to lose weight led to significantly greater weight loss. In another study in which the payments were linked to the success of multiple members of a group achieving their weight loss goals, the participants not only lost more weight, but also maintained the weight loss. These results are intriguing, and suggest that the study of rewards in self-management of diabetes requires further research.  The approach of paying people to achieve health-related goals has also worked in developing countries. For example, Juntos is a program in Peru that pays pregnant women and mothers to utilize certain health services. On study found that Juntos increased the probability that children in households met their weight-height goals. In addition, families that were part of Juntos were more likely to seek professional health assistance in case of any disease, and the pregnant women were more likely to have their delivery attended by a skilled professional. This type of program takes advantage of the strong family structures in Latin America, and brings an element of group responsibility to the improvement of health. The individual responsible for fulfilling the requirements is not only encouraged to be responsible because of an individual reward, but to improve the situation of the family. This highlights the potential to use responsibility to others to design more effective policies.   In this project, our goal is to determine the effectiveness of two different economic reward programs in promoting preventive behaviors and improving the health of individuals with Type II diabetes in Peru. In addition to rewarding patients for their improved health outcomes,  we will go one step further and evaluate a cash incentive for a family or friend supporter, an approach we believe has great potential and may be more effective. In our study, we will enroll diabetes patients and randomly assign them to one of three groups. In one group, patients will receive cash rewards if they achieve certain goals related to management of their diabetes. In a second group, patients and a family or friend supporter will both receive a cash reward if the patient achieves their diabetes management goals. This will allow us to test whether or not the element of responsibility to others improves the ability of the patient to achieve their goals. Finally, a third group will not receive any cash reward. This is the "control" group to which the other groups will be compared to measure success of our approaches.     We expect that after nine months of rewards, patients will effectively improve the preventive behaviors. Six months later, we will also assess if these improvements have been maintained without the cash reward. If our study is successful, it could be a way to encourage people with diabetes to better manage their disease. While there are costs associated with this approach, it could save money in the long run by reducing the complications of diabetes that occur when people don't manage their disease. The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.