Effects of the DPP. Prediabetes. These slides are the property of the presenter. Do not duplicate without express written consent.

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1 Financial s for Weight Loss and Physical Activity: Can They Enhance Diabetes Prevention? Effects of the DPP Jeffrey T. Kullgren, MD, MS, MPH VA Center for Clinical Management Research Ann Arbor VA Healthcare System Division of General Medicine University of Michigan Medical School October 22, 2013 Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6): Prediabetes Higher than normal glucose levels Fasting plasma glucose = 100 to 125 mg/dl or 75-gram OGTT 2-hour glucose =140 to 199 mg/dl or HbA1c = 5.7 to 6.4% 30% progressed to type 2 diabetes in 3 years in the Diabetes Prevention Program (DPP) trial Elevated risk of cardiovascular disease Affects nearly 1 in 3 US adults duplicate without express written consent. 1

2 So what is preventing diabetes prevention? Only about 10% of patients with prediabetes are aware they have prediabetes Probably insufficient provider engagement Screening Recognition Communication Low rates of patient engagement in recommended behaviors to prevent diabetes duplicate without express written consent. 2

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4 Individual vs. group-based financial incentives for weight loss Weigh-ins $ allocated as incentive Kullgren JT, Troxel AB, Loewenstein G, et al. Individual- Versus Group-Based Financial s for Weight Loss: A Randomized, led Trial. Ann Intern Med 2013;158(7): design Study design Enrollment (n = 105) Randomization Weigh-ins Monthly group (n = 35) Individual incentive (n = 35) Group incentive (n = 35) $ allocated as incentive Interventions for 24 weeks Follow-up at 36 weeks (12 weeks after end of incentive interventions) design duplicate without express written consent. 4

5 24 week weight change Individual Δ Weigh-ins Monthly Monthly $ allocated as incentive $100 per person per month Pounds Individual 206 design $100 if weight below monthly target Baseline 24 weeks * Group *P < compared to control arm and P = compared to individual arm Individual Group Weigh-ins Monthly Monthly Monthly $ allocated as incentive design $100 per person per month $100 if weight below monthly target $100 per person per month Participants placed into anonymous groups of 5 Participants below monthly target weight split $500 Pounds 36 week weight change Baseline 24 weeks 36 weeks Δ Individual -7.5* Group *P = compared to control arm and P = compared to individual arm duplicate without express written consent. 5

6 Financial s and Peer Networks to Promote among Older Adults Study design Enrollment (n = 92) Randomization (n = 25) (n = 20) Peer Network (n = 22) Combined (n = 25) Interventions for 16 weeks Follow-up at 24 weeks (8 weeks after end of interventions) duplicate without express written consent. 6

7 Peer network Combined 50 or 200 (EV 21) 50 or 200 (EV 21) 50 or 200 (EV 21) Yes Yes Peer network Proportion of days step s met 50 or 200 (EV 21) Intervention Period* Yes *No significant differences between arms duplicate without express written consent. 7

8 Proportion of days step s met Mean change in daily steps Intervention Period* Follow-up Period* Intervention Period* Follow-up Period** *No significant differences between arms **Difference between and Peer Network arm = -0.17; P =.025 *No significant differences between arms Mean change in daily steps Conclusions Intervention Period* Financial incentives target present-bias preferences that can impede behavior change Growing enthusiasm for using incentives to promote healthy behaviors Many unanswered questions about optimal design, frequency, and magnitude of incentives Financial incentive programs have potential to enhance diabetes prevention but must be carefully designed in order to be effective *No significant differences between arms duplicate without express written consent. 8

9 Questions? duplicate without express written consent. 9