Eric Andrew Finkelstein, Daphne Su-Lyn Gardner, Kwang Wei Tham, Mihir Gandhi, Yin Bun Cheung, Joann Bairavi, Chun Fan Lee, Ngiap Chuan Tan, Ester Yeoh, Phong Ching Lee, Emily Tse Lin Ho, Thofique Adamjee, Yong Mong Bee, Su-Yen Goh
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Adults with Type 2 Diabetes (diabetes), HbA<sub>1c</sub> of 7.5%-11.0% (inclusive) and taking at least one oral diabetes medication were eligible. In total, 269 participants were randomised across three arms [Usual care (UC): 117, diabetes management programme (DMP) (intervention without rewards): 36, DMP+ (intervention with rewards): 116]. Data were analysed using intention-to-treat analysis with change in HbA<sub>1c</sub> at month 12 between DMP+ and UC as the primary outcome. Cost-effectiveness of DMP+ relative to UC was also calculated.</p><p><strong>Results: </strong>Mean HbA<sub>1c</sub> improved by 0.1% in UC and by 0.5% in DMP+ at 12 months, revealing a mean difference of 0.4% (95% confidence interval (CI): -0.70, -0.08, p = 0.015). The odds ratio of HbA<sub>1c</sub> improvements of >0.5% was 2.12 (95% CI: 1.17, 3.85, p = 0.013) for DMP+ relative to UC. The incremental cost-effectiveness ratio of DMP+ relative to UC was SGD8,516 (USD6,531) per quality-adjusted life year gained if effectiveness could be maintained with a single year of intervention.</p><p><strong>Conclusions: </strong>A comprehensive app-based diabetes self-management programme with rewards for healthy behaviours and health outcomes (DMP+) cost-effectively improved glycaemic control in Type 2 diabetes patients. 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引用次数: 0
摘要
目的：数字健康干预和经济激励在促进糖尿病自我管理方面显示出希望，尽管证据有限。因此，本研究旨在评估基于应用程序的综合糖尿病自我管理计划的有效性和成本效益，并对健康行为和健康结果进行奖励。材料和方法：减缓糖尿病进展的试验（TRIPOD）研究是在新加坡杜克大学-新加坡国立大学医学院进行的一项开放标签、平行组、随机对照试验。成人2型糖尿病（糖尿病），HbA1c为7.5%-11.0%（含），并服用至少一种口服糖尿病药物。总共有269名参与者被随机分为三个组[常规护理（UC）： 117人，糖尿病管理计划（DMP）（无奖励干预）：36人，DMP+（有奖励干预）：116人]。数据分析采用意向治疗分析，第12个月时DMP+和UC之间的HbA1c变化作为主要结局。还计算了DMP+相对于UC的成本效益。结果：12个月时，UC患者平均HbA1c改善0.1%，DMP+患者平均HbA1c改善0.5%，平均差异为0.4%（95%置信区间（CI）： -0.70, -0.08, p = 0.015）。与UC相比，DMP+组HbA1c改善>.5 %的优势比为2.12 （95% CI: 1.17, 3.85, p = 0.013）。如果通过一年的干预可以保持有效性，DMP+相对于UC的增量成本-效果比为每个质量调整生命年获得8,516新元（6,531美元）。结论：基于应用程序的综合糖尿病自我管理程序，对健康行为和健康结果（DMP+）进行奖励，可经济有效地改善2型糖尿病患者的血糖控制。注重以价值为基础的医疗保健的组织应考虑资助类似的干预措施。
Effectiveness and cost-effectiveness of an app and rewards-based intervention in type 2 diabetes: A randomised controlled trial.
Aim: Digital health interventions and economic incentives have shown promise in facilitating diabetes self-management, though evidence is limited. Therefore, this study aimed to evaluate the effectiveness and cost-effectiveness of a comprehensive app-based diabetes self-management programme with rewards for healthy behaviours and health outcomes.
Materials and methods: The TRIal to slow the Progression Of Diabetes (TRIPOD) study was an open-label, parallel-group, randomised controlled trial conducted at Duke-NUS Medical School, Singapore. Adults with Type 2 Diabetes (diabetes), HbA1c of 7.5%-11.0% (inclusive) and taking at least one oral diabetes medication were eligible. In total, 269 participants were randomised across three arms [Usual care (UC): 117, diabetes management programme (DMP) (intervention without rewards): 36, DMP+ (intervention with rewards): 116]. Data were analysed using intention-to-treat analysis with change in HbA1c at month 12 between DMP+ and UC as the primary outcome. Cost-effectiveness of DMP+ relative to UC was also calculated.
Results: Mean HbA1c improved by 0.1% in UC and by 0.5% in DMP+ at 12 months, revealing a mean difference of 0.4% (95% confidence interval (CI): -0.70, -0.08, p = 0.015). The odds ratio of HbA1c improvements of >0.5% was 2.12 (95% CI: 1.17, 3.85, p = 0.013) for DMP+ relative to UC. The incremental cost-effectiveness ratio of DMP+ relative to UC was SGD8,516 (USD6,531) per quality-adjusted life year gained if effectiveness could be maintained with a single year of intervention.
Conclusions: A comprehensive app-based diabetes self-management programme with rewards for healthy behaviours and health outcomes (DMP+) cost-effectively improved glycaemic control in Type 2 diabetes patients. Organizations focusing on value-based healthcare should consider subsidising similar interventions.
期刊介绍：
Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.
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