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Effectiveness of Incentives for Improving Diabetes-Related Health Indicators in Chronic Disease Lifestyle Modification Programs: a Systematic Review and Meta-Analysis
CME ACTIVITY — Volume 19 — October 27, 2022
PEER REVIEWED
Initial database searches from January 2008 through August 2021 identified 10,965 records. Of these, 2,725 were duplicates and removed. We screened the remaining 8,240 titles and abstracts and excluded 8,146. The remaining 94 articles were screened for eligibility. Of these, 76 full-text articles were excluded because they duplicated another study (n = 10), did not describe a randomized controlled study (n = 14), did not have a structured lifestyle modification program (n = 14), did not provide an incentive to participants (n = 3), did not include results for the outcomes of interest (n = 9), were noncomparative studies (n = 6), or results were not available (n = 20). One relevant article was found by manual search. A total of 19 studies were included in review and meta-analysis.
Figure 1.
A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the study selection process and literature search from 4 databases: Medline, Embase, PsycINFO, and Cochrane Library, from January 2008 through August 2021. We chose this date range to identify the most up-to-date and culturally and economically relevant information in close proximity to the time period surrounding the US Congressional mandate for the National Diabetes Prevention Program (https://www.congress.gov/bill/111th-congress/house-bill/4124).
Figure 2.
Meta-analysis of the effects of incentives (ie, cash or nonfinancial incentives) on improving diabetes-related health indicators in chronic disease lifestyle modification programs. A, the effect of incentives on body weight (kg); calculations were based on 23 comparisons reported in 19 studies (25–43). B, the effect of incentives on body mass index (kg/m2); calculations were based on 7 comparisons reported in 7 studies (25–28,31,32,38). C, the effect of incentives on systolic blood pressure (mm Hg); calculations were based on 4 comparisons reported in 4 studies (25,27,32,38). D, the effect of incentives on diastolic blood pressure (mm Hg); calculations were based on 4 comparisons reported in 4 studies (25,27,32,38). Values <0 indicate an incentive effect, and values >0 indicate no incentive effect.
| Study | Difference in means (BMI in kg/m2) | Lower limit | Upper limit |
|---|---|---|---|
| A. Effect of incentives on body weight, kg | |||
| Almeida et al, 2015 (26) | –0.440 | –1.087 | 0.207 |
| Bennett et al, 2012 (27) | –1.030 | –2.027 | –0.033 |
| Desai et al., 2020 (30) | –2.965 | –9.762 | 3.832 |
| Dombrowski et al, 2020 (31) | –2.290 | –5.481 | 0.901 |
| Faghri and Li, 2014 (32) | –2.300 | –4.074 | –0.526 |
| Finkelstein et al, 2017 (33) | –1.500 | –2.740 | –0.260 |
| John et al., 2011 (34) | –3.420 | –6.499 | –0.341 |
| Leahey et al, 2016 (29) | −5.400 | –9.914 | –0.886 |
| Leahey et al, 2015 (35) | –2.070 | –3.925 | –0.215 |
| Morgan et al, 2011 (25) | –4.300 | –6.030 | –2.570 |
| Petry et al, 2011 (36) | –2.299 | –4.440 | –0.158 |
| Rounds et al, 2020 (37) | –2.960 | –20.425 | 14.505 |
| Shin et al, 2017 (38) | –2.000 | –3.619 | –0.381 |
| Teychenne et al, 2015 (28) | –1.000 | –1.598 | –0.402 |
| VanEpps et al, 2019 (39) | –0.990 | –2.821 | 0.841 |
| Voils et al, 2020(40) | –4.250 | –7.496 | –1.004 |
| Volpp et al, 2008 (41) | –4.385 | –7.389 | –1.381 |
| West, 2020 (42) | –1.700 | –2.996 | –0.404 |
| Yancy et al, 2018 (43) | –1.500 | –3.701 | 0.701 |
| Overall effect | –1.849 | –2.404 | –1.294 |
| B. Effect of incentives on body mass index (kg/m2), | |||
| Almeida et al, 2015 (26) | –0.160 | –0.395 | 0.075 |
| Bennett et al, 2012 (27) | –0.380 | –0.752 | –0.008 |
| Dombrowski et al, 2020 (31) | –0.750 | –1.757 | 0.257 |
| Faghri and Li, 2014 (32) | –1.730 | –3.327 | –0.133 |
| Morgan et al, 2011 (25) | –1.400 | –2.211 | –0.589 |
| Shin et al, 2017 (38) | –0.500 | –0.991 | –0.009 |
| Teychenne et al, 2015 (28) | –0.400 | –0.599 | –0.201 |
| Overall effect | –0.466 | –0.709 | –0.223 |
| C. Effect of incentives on systolic blood pressure (mm Hg) | |||
| Bennett et al, 2012 (27) | –3.730 | –7.894 | 0.434 |
| Faghri and Li, 2014 (32) | 3.600 | –9.655 | 16.855 |
| Morgan et al, 2011 (25) | –1.200 | –4.710 | 2.310 |
| Shin et al, 2017 (38) | –5.300 | –11.039 | 0.439 |
| Overall effect | –2.590 | –4.981 | –0.199 |
| D. Effect of incentives on diastolic blood pressure, mm Hg | |||
| Bennett et al, 2012 (27) | –1.440 | –4.115 | 1.235 |
| Faghri and Li, 2014 (32) | –1.780 | –11.939 | 8.379 |
| Morgan et al, 2011 (25) | –6.000 | –11.142 | –0.858 |
| Shin et al, 2017 (38) | –3.300 | –7.175 | 0.575 |
| Overall effect | –2.620 | –4.605 | –0.636 |
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