Effectiveness of Incentives for Improving Diabetes-Related Health Indicators in Chronic Disease Lifestyle Modification Programs: a Systematic Review and Meta-Analysis

• Published in: Preventing chronic disease 2022-10, Vol.19, p.E66, Article 220151
• Main Authors: Hulbert, LaShonda R, Michael, Shannon L, Charter-Harris, Jasmine, Atkins, Charisma, Skeete, Renée A, Cannon, Michael J
• Format: Article
• Language: English
• Subjects: Blood pressure; Body mass index; Cholesterol; Chronic Disease; Chronic illnesses; Diabetes; Diabetes Mellitus; Health care; Humans; Incentives; Life Style; Lifestyles; Meta-analysis; Motivation; Prevention programs; Systematic Review; Weight Loss
• ISSN: 1545-1151; 1545-1151
• DOI: 10.5888/pcd19.220151

We examined the effectiveness of providing incentives to participants in lifestyle modification programs to improve diabetes-related health indicators: body weight, body mass index (BMI), blood pressure, cholesterol, and hemoglobin A (HbA ). We also examined the potential effect of 4 different incentive domains (ie, type, monetary value, attainment certainty, and schedule) on those indicators. We searched Medline, Embase, PsycINFO, and Cochrane Library to identify relevant studies published from January 2008 through August 2021. We used a random-effects model to pool study results and examine between-study heterogeneity by using the I statistic and the Cochran Q test. We also conducted moderator analyses by using a mixed-effects model to examine differences between subgroups of incentive domains (eg, incentive type [cash vs other types]). Our search yielded 10,965 articles, of which 19 randomized controlled trials met our selection criteria. The random-effects model revealed that, relative to the control group, the incentive group had significant reductions in weight (-1.85kg; 95% CI, -2.40 to -1.29; P < .001), BMI (-0.47kg/m ; 95% CI, -0.71 to -0.22; P < .001), and both systolic blood pressure (-2.59 mm HG; 95% CI, -4.98 to -0.20; P = .03) and diastolic blood pressure (-2.62 mm Hg; 95% CI, -4.61 to -0.64; P = .01). A reduction in cholesterol level was noted but was not significant (-2.81 mg/dL; 95% CI, -8.89 to -3.28; P = .37). One study found a significant reduction in hemoglobin A (-0.17%; 95% CI, -0.30% to -0.05%; P < .05). The moderator analyses showed that the incentive effect did not vary significantly between the subgroups of the incentive domains, except on weight loss for the attainment certainty domain, suggesting that a variety of incentive subgroups could be equally useful. Providing incentives in lifestyle modification programs is a promising strategy to decrease weight, BMI, and blood pressure.