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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

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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).

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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.

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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