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

患有2型糖尿病(T2 DM)的少数民族(非裔美国人-AA和西班牙裔-HA)有更高的 糖尿病患病率，代谢控制较差，并发症和死亡风险较大 美国白人；而且文献表明，对T2 DM的有效干预需要有多种 内容包括：糖尿病护士教育和技能培训，带反馈的家庭监测，以及 保持高强度。来自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 干预后长达18个月。我们小组的初步数据表明，结构化的财务激励 护理教育和家庭远程监护相结合，对成人T2 DM患者是可行和有效的。 然而，有三个重要的悬而未决的问题：1)经济激励是建立在护士之上的吗 教育和家庭远程监护在改善方面优于单独的护士教育和家庭远程监护 代谢控制是长期的吗？2)一旦经济刺激对代谢控制的影响持续 激励措施被取消了吗？3)经济激励措施在种族/民族群体内部和之间是否有效？至 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 改善糖尿病预后的激励措施和护士指导(FINE-DM)干预措施包括：1) 护士教育，2)家庭远程监护，3)结构化的经济激励；与主动控制相比较 12个月时组(单独接受护士教育和家庭远程监护)。这项研究还将评估 干预效果在财政奖励取消后6个月(即18个月后)持续 随机化)；以及干预措施在不同种族/民族群体中是否有不同的效果。

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control long term? 2) Are the effects of financial incentives on metabolic control sustained once the incentives are withdrawn?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