Ethnic minorities (African Americans ?AA and Hispanics -HA) with Type 2 diabetes (T2DM) have higher prevalence of diabetes, poorer metabolic control and greater risk for complications and death compared to White Americans; and the literature shows that effective interventions for T2DM need to have multiple components including: nurse diabetes education and skills training, home monitoring with feedback, and maintain high intensity. Recent evidence from behavioral economics research supports the use of financial incentives to improve health-related behaviors and the effectiveness of financial incentives to improve health behaviors has been demonstrated across different diseases and behaviors including smoking, weight loss, dietary behavior, medication adherence, and diabetes self-management, with the most beneficial result lasting up to 18 months post-intervention. Preliminary data from our group suggest that structured financial incentives in combination with nurse education and home telemonitoring is feasible and effective in adults with T2DM. However, there are three important unanswered questions: 1) Are financial incentives layered upon nurse education and home telemonitoring superior to nurse education and home telemonitoring alone in improving metabolic control long term? 2) Are the effects of financial incentives on metabolic control sustained once the incentives are withdrawn? and 3) Are financial incentives efficacious within and across racial/ethnic groups? To address these gaps in the literature, we propose a randomized controlled trial to test the efficacy of a Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes (FINANCE-DM) intervention comprised of: 1) nurse education, 2) home telemonitoring, and 3) structured financial incentives; compared to an active control group (nurse education and home telemonitoring alone) at 12 months. The study also will evaluate whether intervention effects are sustained 6 months after the financial incentives are withdrawn (i.e. 18 months post randomization); and whether the intervention is differentially efficacious across racial/ethnic groups.
Given the huge burden of diabetes in ethnic minorities and emerging data on the effectiveness of financial incentives in Type 2 diabetes (T2DM), it is critical to examine the effectiveness of financial incentives across racial/ethnic groups as well as within racial/ethnic groups. The proposed study, which will be the largest study to date, will provide novel data on whether financial incentives layered upon nurse education and home telemonitoring is superior to nurse education and home telemonitoring alone in improving metabolic control long term, whether financial incentives are effective within different racial/ethnic groups, and whether they have the potential to reduce the disproportionate burden of diabetes in ethnic minorities.
