How time and risk preferences affect glucose control in type 2 diabetes patients

The attitude to self-care of individuals with type 2 diabetes (T2D) is commonly influenced by their time preferences (i.e., long-run discounting and time-consistency), and/or risk preference (i.e., risk tolerance). Tailored preference-based self-care management may improve clinical and cost-effectiveness. This study investigates associations between elicited time and risk preferences with diabetes-related outcomes, i.e., Hemoglobin A1c (HbA1c) and blood glucose level. Time and risk preferences of 396 T2D patients were measured by incentivized tasks. Clinical data was retrieved from hospital information systems for diabetes outcomes (HbA1c and blood glucose levels) and clinical factors. We assessed patient diabetes-associated self-care behaviors and other epidemiological factors by questionnaire. Multivariate linear regressions with stepwise model selection were used to evaluate potential associations with T2D outcomes. We found that participants who favored immediate gratification over greater long-term benefits (time-inconsistent towards present or present-biased) had significantly higher HbA1c levels than time-consistent participants, with a coefficient (95% CI) of 0.41 (0.02,0.80). Neither time nor risk preferences were significantly associated with blood glucose levels. These findings suggest the use of tailored diabetes interventions to help present-biased patients overcome self-control problems. This targeted approach may be more cost-effective but requires formal testing.