The impact of monetary incentives and gamification on glucose levels: real-world assessment in people with diabetes

Karaz is a mobile health solution designed to leverage real-time monitoring, monetary incentives, and gamification to improve health outcomes in people with diabetes (PWD). Data generated by wearables are all displayed on a unified interface for users and healthcare professionals. Karaz app rewards users for engaging in health-promoting behaviors by offering points redeemable for monetary value. To evaluate the changes in continuous glucose monitoring (CGM) metrics, level of physical activity, and sleep duration over three months among PWD who used Karaz app for ≥ 3 months. Data from 384 Karaz app users who had diabetes, were wearing CGM, and used Karaz app for ≥ 3 months were retrospectively analyzed. Logistic regression analysis was performed to identify potential predictors of improvement in time in range (TIR) after using Karaz app. The average age of the study participants was 24 years, 57% women, and 78% had type 2 diabetes. In PWD who had baseline TIR ≤ 60%, CGM metrics improved from baseline to month 3: TIR (43.1 to 45.89%, p < 0.01), time above range (TAR) > 250 mg/dL (24.66 to 22.5%, p < 0.01), TAR > 180 mg/dL (51.83 to 48.79%, p < 0.01), glycemia risk index (GRI) (87 to 84%, p < 0.01), and time in tight range (TITR) 70-140 mg/dL (25.54 to 27.84%, p < 0.01). Whereas, in PWD with baseline TIR > 60%, glucose levels changed from baseline to month 3 as follows: TIR (74.88 to 73.53%, p < 0.01), TAR > 250 (4.03 to 4.81%, p = 0.03), TAR > 180 (20.19 to 21.24%, p = 0.07), TITR (52.63 to 52.04%, p = 0.29). Compared to PWD with baseline TIR > 70%, those with baseline TIR 40-70% and TIR < 40% were 10 and 8 times, respectively, as likely to experience a significant improvement in TIR, by > 5%, after adjusting for age, gender, baseline TBR, and daily steps. Use of Karaz app, with monetary incentives and gamification, was associated with significant improvements in CGM metrics in PWD who had suboptimal glucose control at baseline. This highlights the promising role of innovative digital solutions and management approaches in improving health outcomes in PWD.