# Behavioral Nudges for Diabetes Prevention (BEGIN) Trial in Primary Care

> **NIH NIH R18** · NORTHWESTERN UNIVERSITY · 2020 · $680,418

## Abstract

Project Summary
 Large randomized trials have found that intensive lifestyle interventions (ILI) and metformin are safe and
effective treatment options for promoting modest weight loss and preventing type 2 diabetes (T2D) among adults
with prediabetes. However, these treatments are rarely used in practice, and little existing research has focused
on patient-centered approaches for promoting their use. One potential approach, behavioral nudges, involves
manipulating health messages and treatment options to make behavior change more likely and easier to enact.
While a large body of evidence suggests that behavioral nudges are effective, they have not been definitively
studied for T2D prevention. We will address this critical knowledge gap by conducting the Behavioral Nudges for
Diabetes Prevention (BEGIN) Trial. The proposed study will take place in primary care clinics, whose
unprecedented reach and regular interaction with prediabetic adults make this an ideal setting for translational
T2D prevention research. This definitive study will test two low-touch interventions: 1) In-person intervention
consisting of a prediabetes decision aid designed to nudge uptake of evidence-based treatments and delivered
by health educators; and 2) Automated intervention consisting of motivational letters and text messages that
deliver similar information and use the same behavioral nudges. The proposed R18 study will accomplish the
following specific aims to determine the most effective low-touch intervention that promotes maximal treatment
adoption and weight loss. In Aim 1, we will engage national stakeholders in T2D prevention to finalize and
integrate the automated intervention components for maximal sustainability and scalability. Aim 2 is a pragmatic
clinic-level cluster RCT examining the weight loss effectiveness of the in-person and automated interventions.
Our full factorial design allows us to test each intervention, both individually and combined, vs. usual care. The
proposed pragmatic trial of 984 primary care patients with prediabetes and overweight/obesity will estimate the
effects of these low-touch interventions on the following 12-month outcomes: change in weight (primary) and
adoption of ILI and/or metformin (secondary). Change in weight and hemoglobin A1c from baseline to 24 months
are examined as exploratory outcomes. Aim 3 uses mixed methods to examine the proposed interventions'
reach, adoption, implementation, maintenance, and cost. This study will be conducted in a large community
health center, in which 95% of patients with prediabetes are racial/ethnic minorities and 83% live in poverty. Our
proposal is responsive to PAR-18-925 by: 1) recruiting a vulnerable study population that shoulders a
disproportionate burden of T2D and is underrepresented in clinical research; 2) studying low-touch interventions
that are truly pragmatic, that have great potential for sustainability and scalability, and that our partner clinic
system has already use...

## Key facts

- **NIH application ID:** 10049535
- **Project number:** 1R18DK123375-01A1
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Matthew James O'Brien
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $680,418
- **Award type:** 1
- **Project period:** 2020-09-15 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10049535

## Citation

> US National Institutes of Health, RePORTER application 10049535, Behavioral Nudges for Diabetes Prevention (BEGIN) Trial in Primary Care (1R18DK123375-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10049535. Licensed CC0.

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