Effectiveness of an incentives-enhanced stepped care intervention program on diabetes prevention in a multi-ethnic Asian prediabetes cohort: results from the Pre-DICTED randomized controlled trial

<p dir="ltr">OBJECTIVE </p><p dir="ltr">Diabetes prevention in real-world settings faces challenges of intervention adherence and difficulties in sustaining behavior change. This study evaluated the effectiveness of a stepped care prevention program, enhanced with financial incentives, in reducing the risk of diabetes conversion in a multi-ethnic prediabetes cohort in Singapore.</p><p><br></p><p dir="ltr">RESEARCH DESIGN AND METHODS</p><p dir="ltr">The Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED) trial was a randomized controlled trial involving 751 overweight or obese individuals with impaired glucose tolerance, impaired fasting glucose, or both. Participants were assigned to standard care (control arm) or a stepped care intervention program, starting with lifestyle interventions for 6 months before adding metformin for participants who remained at high risk of diabetes conversion based on study visit assessments. Intervention arm participants also received financial incentives for attending lifestyle sessions and for achieving ≥5% weight loss. The primary endpoint was the proportion developing diabetes at three years in the modified intention-to-treat population. </p><p><br></p><p dir="ltr">RESULTS </p><p dir="ltr">After three years, diabetes developed in 34.8% of participants in the intervention arm compared to 47.3% in the control arm (adjusted risk difference: -10.93%, 95% CI -18.04 to -3.81; p = 0.003). The adjusted relative risk was 0.74 (95% CI 0.62 to 0.88; p < 0.001). Within the intervention arm, 26.4% of participants received metformin, and 45.1% received cash incentives. Adverse events were more common in the intervention arm, mainly due to metformin-related gastrointestinal symptoms.</p><p><br></p><p dir="ltr">CONCLUSIONS</p><p dir="ltr">A stepped care diabetes prevention program, enhanced with financial incentives, effectively reduced diabetes conversion in a multi-ethnic Asian prediabetes cohort. </p>