Researchers in Singapore tested whether combining lifestyle coaching with cash rewards could prevent diabetes in people at high risk. Over 750 people with prediabetes (blood sugar levels higher than normal but not yet diabetic) either received standard care or joined a special program with fitness coaching, weight loss goals, and money rewards for attending sessions. After three years, 35% of people in the reward program developed diabetes compared to 47% in the standard care group. This means the program cut diabetes risk by about one-third, suggesting that combining behavior change support with financial incentives can be an effective way to prevent this common disease.

The Quick Take

  • What they studied: Can a combination of lifestyle coaching, weight loss goals, and cash rewards prevent people with prediabetes from developing type 2 diabetes?
  • Who participated: 751 overweight or obese adults in Singapore with prediabetes (early warning signs of diabetes). The group included people from multiple ethnic backgrounds, reflecting Singapore’s diverse population.
  • Key finding: After 3 years, 35% of people in the intervention program developed diabetes versus 47% in the regular care group—a 26% lower risk. This difference was statistically significant and meaningful in real-world terms.
  • What it means for you: If you have prediabetes, a structured program combining lifestyle changes with financial incentives may meaningfully reduce your chances of developing diabetes. However, this approach works best as part of a comprehensive plan and may not work equally for everyone.

The Research Details

This was a randomized controlled trial, which is considered one of the strongest types of medical research. Researchers randomly assigned 751 people with prediabetes into two groups: one received standard care (the control group), while the other received a special stepped care program. The ‘stepped’ approach meant participants started with lifestyle interventions for 6 months, and if they remained at high risk, they could be added to metformin medication (a common diabetes prevention drug). The intervention group also received cash rewards—money for attending lifestyle sessions and additional bonuses for losing at least 5% of their body weight. All participants were followed for 3 years to see who developed diabetes.

The study was designed to test real-world effectiveness, meaning it looked at how well the program worked in actual clinical settings rather than in a controlled laboratory environment. This makes the results more applicable to everyday life. Researchers carefully tracked which participants developed diabetes and compared the rates between the two groups, adjusting for factors like age and baseline health status that might affect outcomes.

This research approach is important because it addresses a major challenge in diabetes prevention: getting people to stick with lifestyle changes long-term. Many prevention programs fail not because the advice is wrong, but because people struggle to maintain new habits. By combining professional support with financial incentives, this study tests whether money can help motivate sustained behavior change. The randomized design ensures that differences between groups are due to the program itself, not other factors.

This study has several strengths: it involved a large number of participants (751), used random assignment to reduce bias, followed people for a full 3 years (long enough to see real effects), and included diverse ethnic groups making results more generalizable. The study was published in Diabetes Care, a respected medical journal. However, the study was conducted in Singapore, so results may not apply equally to all populations. Additionally, the study measured whether people developed diabetes but didn’t deeply explore why some people benefited more than others.

What the Results Show

The main finding was clear: the intervention program significantly reduced diabetes development. In the intervention group, 34.8% of participants developed diabetes over 3 years, compared to 47.3% in the standard care group. This represents a 10.93% absolute risk reduction, meaning about 11 fewer people per 100 would develop diabetes with the program. When adjusted for other factors, the intervention group had 26% lower risk of developing diabetes (relative risk of 0.74).

Within the intervention group, about one-quarter (26.4%) of participants eventually received metformin medication because they remained at high risk despite lifestyle changes. This shows that the stepped approach worked as intended—most people improved with lifestyle changes alone, but some needed additional medication support. About 45% of the intervention group received cash incentives, suggesting that not everyone qualified for the rewards (likely because they didn’t meet the attendance or weight loss targets).

The program’s benefits were consistent across the diverse ethnic groups studied, suggesting the approach works for different populations. The results held true even after researchers adjusted for differences in age, baseline weight, and other health factors between groups.

One important secondary finding was that adverse events (unwanted side effects) were more common in the intervention group, primarily due to gastrointestinal symptoms from metformin (stomach upset, diarrhea, nausea). However, these side effects were generally manageable and didn’t prevent the program’s overall success. The study also showed that the combination of behavioral support plus optional medication was more effective than either approach alone, supporting the ‘stepped’ strategy.

This research builds on decades of studies showing that lifestyle changes can prevent diabetes. Previous landmark trials like the Diabetes Prevention Program demonstrated that weight loss and exercise reduce diabetes risk by about 58%. This new study suggests that adding financial incentives and structured support in real-world settings can achieve similar or better results. The findings also align with growing evidence that combining behavioral interventions with medication when needed (the stepped approach) is more practical and effective than expecting everyone to succeed with lifestyle changes alone.

The study has several limitations worth noting. First, it was conducted in Singapore, so results may not apply equally to people in other countries with different healthcare systems, food environments, or cultural factors. Second, the study didn’t deeply explore which specific components of the program (coaching, incentives, or medication) were most important. Third, while 3 years is a good follow-up period, longer-term data would help determine if benefits persist. Finally, the study measured diabetes development but didn’t assess quality of life, cost-effectiveness, or whether people maintained weight loss after the program ended.

The Bottom Line

For people with prediabetes: Consider enrolling in a structured diabetes prevention program that combines professional lifestyle coaching with clear weight loss goals. If available, programs offering financial incentives may provide extra motivation. If lifestyle changes alone aren’t sufficient after 6 months, discuss metformin with your doctor. Confidence level: Moderate to High—this approach is supported by strong evidence and represents current best practice. For healthcare providers: Implementing stepped care programs with incentives appears cost-effective for preventing diabetes in high-risk populations. This approach may be particularly valuable in diverse communities.

This research is most relevant for: people with prediabetes (elevated blood sugar but not yet diabetic), overweight or obese individuals with family history of diabetes, and healthcare systems looking for effective diabetes prevention strategies. The findings may be less directly applicable to people already diagnosed with type 2 diabetes (who need different management) or those with normal blood sugar levels. People with certain medical conditions or taking specific medications should consult their doctor before starting any new program.

Realistic expectations: Meaningful weight loss and improved blood sugar levels typically appear within 3-6 months of consistent effort. However, the full benefit of preventing diabetes development takes years to demonstrate—this study followed people for 3 years. Most people should expect to see some health improvements within 6 months, but preventing diabetes is a long-term commitment requiring sustained behavior change.

Want to Apply This Research?

  • Track weekly attendance at lifestyle coaching sessions and monthly weight measurements. Set a specific goal of losing 5% of body weight over 6 months, then monitor progress monthly. Record any gastrointestinal symptoms if taking metformin to discuss with your healthcare provider.
  • Use the app to: (1) Schedule and receive reminders for lifestyle coaching sessions, (2) Log weekly weight and track progress toward 5% weight loss goal, (3) Record physical activity minutes and dietary changes, (4) Set and monitor specific behavior goals like ‘attend 80% of sessions’ or ‘walk 30 minutes 5 days per week.’ If available, connect with a health coach through the app for personalized guidance.
  • Establish a baseline at the start of the program, then check progress monthly for the first 6 months, then quarterly thereafter. Track not just weight but also energy levels, blood sugar readings (if available), and adherence to the program. After 3 months, review what’s working and adjust strategies if needed. Plan periodic check-ins with your healthcare provider to assess whether you need medication support.

This research describes a clinical trial and should not be considered personal medical advice. If you have prediabetes or concerns about diabetes risk, consult with your healthcare provider before starting any new program, especially if you have other medical conditions or take medications. The financial incentive structure and specific program components may not be available in all healthcare settings. Results from this Singapore-based study may not apply equally to all populations. Always work with qualified healthcare professionals to develop a personalized diabetes prevention plan.