A Trial of Incentives and Peer Mentors to Improve Diabetic Outcomes
A Trial of Incentives and Peer Mentors to Improve Diabetic Outcomes
In recent years, social networks have garnered attention in both academic journals and the
 lay press because of strong associations demonstrated in retrospective studies between social
 networks and incidence of major health problems such as obesity and smoking. Financial
 incentives have also been demonstrated to improve health behaviors in obesity, smoking, and
 medication adherence. We propose to conduct a randomized controlled trial among a
 predominantly African American population with persistently poor diabetes mellitus (DM)
 control to examine whether two novel interventions, lottery based financial incentives and
 telephone based one-on-one peer mentoring (the 'buddy system'), can significantly ameliorate
 disparities in poor DM control.

 The intervention is based on epidemiologic evidence, randomized controlled trials, and pilot
 studies demonstrating: 1) Lottery based financial incentives are a powerful motivator of
 behavior change; 2) One-on-one peer mentoring is a flexible, cost-efficient means of
 increasing DM specific social support and may be particularly salient in minority
 communities; and 3) Matching patients with poorly controlled DM with a similar individual
 from their community who has gained control of their DM draws on existing community assets in
 creating an inherently culturally competent intervention. DM patients with poor DM control
 will be randomized to 1 of 4 arms: usual care; telephone based one-on-one peer mentoring;
 lottery based financial incentives; and peer mentoring plus financial incentives.

 The Specific Aims are to test: 1) The effectiveness of telephone based one-on-one peer
 mentoring in improving glycemic control relative to usual care; 2) The effectiveness of
 lottery based financial incentives in improving glycemic control relative to usual care; 3)
 The effectiveness of combining peer mentoring and financial incentives relative to control;
 and 4) The relative cost effectiveness of all four approaches. In exploratory analyses, we
 will examine whether African American patients enrolled in intervention arms have greater
 improvement in glycemic control than white patients, whether intervention group patients
 experience greater improvements in blood pressure (BP) and lipid control, and whether peer
 mentors experience improvements in their own health. We will pair mentors with mentees based
 on race, gender, age, and disease severity. The active intervention will be run for a 6-month
 time period, with participants followed for an additional 6 months to determine if effects
 persist post intervention.

 The proposed interventions address multiple barriers to effective disease management common
 among patients with DM. If effective, these interventions could provide important models for
 improving glycemic control in general and, in particular, for addressing racial disparities
 in DM outcomes.
Inclusion Criteria:

 -  diagnosed with diabetes mellitus

 -  30 to 70 years old

 -  persistently poor glucose control, defined as having the last two HbA1c values > 8%,
 with at least one measure within 3 months of enrollment

 -  receiving treatment for diabetes mellitus at one of five University of Pennsylvania
 outpatient clinics

 Exclusion Criteria:

 -  does not speak English

 -  unable to provide informed consent