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

> **NIH NIH R18** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $558,936

## Abstract

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 ...

## Key facts

- **NIH application ID:** 10006879
- **Project number:** 5R18DK122418-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** JEFFREY KULLGREN
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $558,936
- **Award type:** 5
- **Project period:** 2019-09-15 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10006879

## Citation

> US National Institutes of Health, RePORTER application 10006879, Integrating Behavioral Economics and Self-Determination Theory to Advance Patient Engagement in Diabetes Prevention (5R18DK122418-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10006879. Licensed CC0.

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