Financial Incentives Telephone Education and Skills Trial in African Americans With Diabetes (FITEST)

African Americans with T2DM have higher prevalence of diabetes, poorer metabolic control, and
greater risk for complications and death compared to White Americans. HbA1c is the primary
marker for glycemic control and is a strong independent predictor of development of
complications and increased mortality in T2DM. Key self-care behaviors that influence
glycemic control (and HbA1c) include diet, physical activity, self-monitoring of blood
glucose and medication adherence. Systematic review of multiple RCTs show that self-care
interventions that include diabetes education and skills training are effective in improving
metabolic control in diabetes. Recent findings indicate that patients with diabetes,
especially ethnic minority patients, prefer telephone-delivered diabetes education to group
visits or internet-based education. Multiple RCTs have documented the effectiveness of
telephone-delivered self-care interventions in T2DM.

The overarching aim of this proposal is test the efficacy of three financial incentive
structures in combination with technology intensified diabetes education and skills training
intervention on blood pressure and quality of life in AAs with T2DM. 60 AAs with T2DM will be
randomized to three groups with varying frequency of financial incentives: 1) High Frequency:
financial incentives for weekly uploads plus average glucose, incentives for weekly
attendance to educational sessions, and incentives at the end of the study for meeting HbA1c
goals 2) Moderate Frequency: financial incentives for weekly uploads plus average glucose,
and incentives at the end of the study for meeting HbA1c goals, and 3) Low Frequency:
financial incentives at the end of the study for meeting HbA1c goals.

Inclusion Criteria:

- Age ≥21 years

- Clinical diagnosis of T2DM and HbA1c ≥8% at the screening visit

- Self-identified as AA

- Subject must be willing to use the FORA monitoring system for 3 months

- Subjects must be able to communicate in English

- Subjects must have access to a telephone (landline for data uploads) for the study
period

Exclusion Criteria:

- Mental confusion on interview suggesting significant dementia

- Participation in other diabetes clinical trials

- Alcohol or drug abuse/dependency

- Active psychosis or acute mental disorder

- Life expectancy <12 months