Integrating Behavioral Economics and Self-Determination Theory to Advance Patient Engagement in Diabetes Prevention

据估计，8400万患有糖尿病前期的美国成年人可以显著降低他们患2型糖尿病的风险 通过参与糖尿病预防计划(DPP)或使用二甲双胍来治疗糖尿病(T2 DM)。虽然 这些以证据为基础的干预措施随处可见，几乎没有受益的患者使用它们。一个 增加糖尿病前期患者对预防T2 DM策略的参与度的时机是在他们 是通过筛查检测出来的。一种可扩展和可持续的方式来提高患者的参与度 筛查将为参与DPP或使用二甲双胍的患者提供经济激励。是这样的 通过将行为经济学的见解与经济激励相结合，可以使财务激励更加有效 自决理论原则(SDT)。这种整合可以通过增加激励措施来实现。 自动定制消息，将激励措施和T2 DM预防与人们的角色、价值观和 强项。我们的T2 DM预防、行为经济学和SDT专家团队将进行为期12个月的 一项实用的随机对照试验，我们将380名糖尿病前期患者随机分为4人中的1人 小组：(1)财政奖励加上基于SDT原则的量身定制的信息；(2)仅财政奖励； (3)仅基于SDT原则的定制信息；或(4)增强的控制组。目标1：比较 财务激励的有效性加上基于SDT原则的量身定制的信息，财务 在降低血红蛋白A1c、体重和体重方面，基于SDT原则的激励和定制信息 腰围和增加对DPP的参与或使用二甲双胍。我们将评估 血红蛋白A1c一级结局和体重和腰围次级结局的变化 6个月和12个月时的周长。我们将使用健康保险索赔数据来衡量次要的 参与DPP或使用二甲双胍的结果。目标2：确定调解人和主持人 财务激励的有效性加上基于SDT原则的量身定制的信息，财务 激励措施，以及基于SDT原则的定制信息。为了衡量这些，我们将对参与者进行调查 在基线、6个月和12个月。目标3：评估可伸缩性、可接受性和 财务激励的可持续性加上基于SDT原则的量身定制的信息，财务 激励措施，以及基于SDT原则的定制信息。我们将采访患者，工作场所健康 促进工作人员和卫生系统工作人员对计划实施情况进行全面评估 通过整合覆盖范围、有效性、采用、实施和 实施研究框架的维护和综合框架。如果有效的话，这部小说 利用行为经济学和SDT的见解的方法可以作为健康如何 护理系统和社区组织可以合作，帮助高危患者预防和修改T2 DM 慢性病和健康状况差的其他行为危险因素。

The estimated 84 million US adults with prediabetes can significantly reduce their risk of developing type 2 diabetes mellitus (T2DM) by engaging in a Diabetes Prevention Program (DPP) or using metformin. Although these evidence-based interventions are widely available, few patients who would benefit use them. An opportune time to increase engagement of patients with prediabetes in strategies to prevent T2DM is after they are detected through a screening. One scalable and sustainable way to increase patient engagement after screenings would be to offer patients financial incentives for participating in a DPP or using metformin. Such financial incentives could be made more effective by integrating insights from behavioral economics with principles of self-determination theory (SDT). This integration could be achieved by adding to incentives automated tailored messages that link incentives and T2DM prevention to people's roles, values, and strengths. Our team of experts in T2DM prevention, behavioral economics, and SDT will conduct a 12-month pragmatic randomized controlled trial in which we will randomize 380 patients with prediabetes to 1 of 4 groups: (1) financial incentives plus tailored messages based on SDT principles; (2) financial incentives alone; (3) tailored messages based on SDT principles alone; or (4) an enhanced control group. Aim 1: Compare the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles in decreasing hemoglobin A1c, weight, and waist circumference and in increasing participation in a DPP or use of metformin. We will assess changes in the primary outcome of hemoglobin A1c and in secondary outcomes of weight and waist circumference at 6 and 12 months. We will use health insurance claims data to measure the secondary outcome of participation in a DPP or use of metformin. Aim 2: Identify mediators and moderators of the effectiveness of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. To measure these, we will survey participants at baseline, 6, and 12 months. Aim 3: Evaluate facilitators of and barriers to scalability, acceptability, and sustainability of financial incentives plus tailored messages based on SDT principles, financial incentives, and tailored messages based on SDT principles. We will interview patients, workplace health promotion staff, and health system staff to conduct a comprehensive evaluation of program implementation and sustainability using an integration of the Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research frameworks. If effective, this novel approach that leverages insights from behavioral economics and SDT could serve as a model for how health care systems and community organizations can partner to help at-risk patients prevent T2DM as well as modify other behavioral risk factors for chronic disease and poor health.