Remotely Monitored Gamification and Social Incentives to Improve Glycemic Control Among Adults With Uncontrolled Type 2 Diabetes (iDiabetes): Protocol for a Randomized Controlled Trial

Michael Fortunato, Joseph Harrison, Ai Leen Oon, Dylan Small, Victoria Hilbert, Charles Rareshide, Mitesh Patel, Michael Fortunato, Joseph Harrison, Ai Leen Oon, Dylan Small, Victoria Hilbert, Charles Rareshide, Mitesh Patel

Abstract

Background: Type 2 diabetes is a significant cause of morbidity and mortality in the United States. Lifestyle modifications including increasing physical activity and losing weight have been demonstrated to improve glycemic control. However, most patients struggle to make these changes. Many stakeholders are interested in using gamification and social incentives to increase engagement in healthy behaviors. However, these approaches often do not appropriately leverage insights from behavioral economics that could be used to address predictable barriers to behavior change.

Objective: This study aimed to describe the protocol for the Influencing DIabetics to Adapt Behaviors related to Exercise and weighT by Enhancing Social incentives (iDiabetes) trial, which aimed to evaluate the effectiveness of gamification interventions that leverage insights from behavioral economics to enhance supportive, competitive, or collaborative social incentives to improve glycemic control, promote weight loss, and increase physical activity among overweight and obese adults with type 2 diabetes.

Methods: We are conducting a one-year four-arm randomized controlled trial of 361 overweight and obese patients with type 2 diabetes and a glycated hemoglobin (HbA1c) level ≥8.0. Wireless weight scales and wearable devices are provided to remotely monitor weight and physical activity and transmit data to the study team. Patients are recruited by email, following which they establish a baseline measure of weight, daily step count, HbA1c level, and low-density lipoprotein cholesterol level and then repeat these measures at 6 and 12 months. The control arm receives no other interventions. Patients randomized to one of the three intervention arms are entered into a game designed using insights from behavioral economics to enhance supportive, competitive, or collaborative social incentives. To examine predictors of strong or poor performance, participants completed validated questionnaires on a range of areas including their personality, risk preferences, and social network.

Results: Enrollment of 361 patients was completed in January 2019. Results are expected in 2020.

Conclusions: The iDiabetes trial represents a scalable model to remotely monitor the daily health behaviors of adults with type 2 diabetes. Results from this trial will help provide insights into how to improve management of patients with type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT02961192; https://ichgcp.net/clinical-trials-registry/NCT02961192.

International registered report identifier (irrid): DERR1-10.2196/14180.

Keywords: behavioral economics; diabetes; gamification; glycemic control weight; physical activity; remote monitoring; social incentives; wearable devices.

Conflict of interest statement

Conflicts of Interest: MP is supported by career development awards from the Department of Veterans Affairs HSR&D and the Doris Duke Charitable Foundation. MP is the founder of Catalyst Health, a technology and behavior change consulting firm. MP also has received research funding from Deloitte, which is not related to the work described in this paper. No other disclosures were reported.

©Michael Fortunato, Joseph Harrison, Ai Leen Oon, Dylan Small, Victoria Hilbert, Charles Rareshide, Mitesh Patel. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 20.11.2019.

Figures

Figure 1
Figure 1
Depiction of the wireless devices used by participants.
Figure 2
Figure 2
Example of a physician letter.
Figure 3
Figure 3
Example of support partner messages.
Figure 4
Figure 4
Study flow diagram of participants randomized into the Influencing DIabetics to Adapt Behaviors related to Exercise and weighT by Enhancing Social incentives trial. BMI: body mass index; HbA1c: glycated hemoglobin; LDL-C: low-density lipoprotein cholesterol.

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