Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes - FINANCE-DM

少数民族（非裔美国人-AA和西班牙裔-HA）2型糖尿病（T2 DM）患者 糖尿病的患病率，代谢控制较差，并发症和死亡的风险更大， 白色美国人;文献表明，有效的T2 DM干预措施需要有多个 组成部分包括：护士糖尿病教育和技能培训，家庭监测与反馈， 保持高强度。行为经济学研究的最新证据支持使用金融 改善健康相关行为的激励措施和改善健康的财政激励措施的有效性 行为已经在不同的疾病和行为中得到了证明，包括吸烟，减肥， 饮食行为、药物依从性和糖尿病自我管理，最有益的结果是持久的 干预后18个月。我们小组的初步数据表明， 结合护理教育和家庭远程监护在成人T2 DM患者中是可行和有效的。 然而，有三个重要的未回答的问题：1）是财政激励分层护士 教育和家庭远程监护上级优于护士教育和家庭远程监护单独改善 长期控制代谢？2)经济激励对代谢控制的影响是否持续， 激励措施被取消？3）经济激励措施在种族/族裔群体内部和跨种族/族裔群体是否有效？到 为了解决文献中的这些空白，我们提出了一项随机对照试验来测试金融 激励和护士指导，以提高糖尿病的结果（财务-DM）干预包括：1） 护士教育，2）家庭远程监护，3）结构化的经济激励;与主动控制相比 组（护士教育和家庭远程监护单独）在12个月。该研究还将评估是否 干预效果持续6个月后，财政奖励被撤销（即18个月后， 随机化）;以及干预是否在种族/民族组中具有差异有效性。

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control long term? 2) Are the effects of financial incentives on metabolic control sustained once the incentives are withdrawn?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.