Opportunity

Black Americans have a greater incidence of diabetes, decreased control, and higher rates of microvascular complications. Diabetes is challenging to manage, especially for socially isolated patients, because of the need to continually choose healthy behaviors. Clinic-based interventions can help, but they are expensive. Effective interventions to remotely manage patients with persistently poor diabetes control are needed. 

Intervention 

A team of researchers from the University of Pennsylvania leveraged Way to Health to explore if financial incentives and social support could enhance adherence to healthy behaviors and improve glycosylated hemoglobin (HbA1c) levels in Black veterans ages 50 - 70 with persistently poor diabetes control.  

Participants were assigned to one of three study arms:  

1. Peer mentorship: Patients were matched by race, sex, and age to a trained peer mentor who spoke with the participant at least once a week. Mentors were Black patients who previously had poor control of their diabetes but had good control at the time of the study.   
2. Financial incentives: Patients earned $100 if their HbA1c levels improved by one point or $200 if their levels dropped either by two points or to 6.5 percent after six months.  
3. Control: Patients in the control group received usual care and were notified of their HbA1c levels and the recommended goals. 

Impact 

Although there was a slight drop in HbA1c in the financial incentive arm, it was not deemed statistically significant. Peer mentorship, however, had a statistically significant impact on improving diabetes control, with participants in that arm dropping their HbA1c level by close to one point.  

A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes.