Incentive-based approaches developed to improve daily adherence to a single behavioral process, such as blood glucose monitoring in adolescents, may not be as effective as multicomponent interventions that address emotional, social, and family processes of diabetes self-management, according to data published in JAMA Pediatrics.1

Shelagh Mulvaney, PhD, of the School of Nursing, Vanderbilt University, Nashville, Tennessee, and Joyce M. Lee, MD, MPH, of the division of pediatric endocrinology, University of Michigan, Ann Arbor, reviewed a study by Wong, et al2 that used an investigator-blinded randomized clinical trial of using financial incentives to improve daily adherence to blood glucose monitoring in patients between 14 and 20 years of age with type 1 diabetes.

The study investigators used the concept of loss aversion as an incentive. Participants in the intervention group were given $60 monthly in a virtual account during a 3-month period. They were required to perform a minimum of 4 daily blood glucose checks with at least 1 blood glucose level in range (70 to 180 mg/dL). Failure to reach these goals resulted in a $2 loss from their account. After the 3-month intervention period, participants were monitored for a second 3-month period with no incentives.

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The results showed that the change in hemoglobin A1c (HbA1c) levels at 3 months was not statistically significant in the 2 groups. The intervention group demonstrated greater improvement for the secondary outcome of adherence to blood glucose monitoring goals compared with the control group (50.0% vs 18.9%). The study researchers found no significant difference for either outcome in the follow-up period.

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Other studies that provided incentives for blood glucose monitoring have also failed to find benefit for the intervention. Drs Mulvaney and Lee concluded that the Wong, et al study provides some evidence for the short-term potential of monetary motivation in health behavior interventions. However, they noted that to achieve sustainable effects, such interventions will need to be integrated with other intervention components that address multiple aspects of behavior.


  1. Mulvaney S, Lee JM. Motivating health behaviors in adolescents through behavioral economics [published online October 23, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.3464
  2. Wong CA, Miller VA, Murphy K, et al. Effect of financial incentives on glucose monitoring adherence and glycemic control among adolescents and young adults with type 1 diabetes: a randomized clinical trial [published online October 23, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.3233