Researchers in Singapore studied 751 people with prediabetes to see if a special program could help them avoid developing diabetes. The program included lifestyle coaching, medication when needed, and cash rewards for attending sessions and losing weight. After 3 years, people in the special program were much less likely to develop diabetes compared to those getting regular care. About 35% of people in the reward program got diabetes versus 47% in the regular care group. This shows that combining lifestyle changes, medication, and financial incentives can be a powerful way to prevent diabetes in at-risk people.
The Quick Take
- What they studied: Whether a step-by-step diabetes prevention program with cash rewards could help people with prediabetes avoid developing full diabetes
- Who participated: 751 overweight adults from different ethnic backgrounds in Singapore who had prediabetes (blood sugar higher than normal but not yet diabetes)
- Key finding: The reward program reduced diabetes risk by about 26% - only 35% developed diabetes compared to 47% in the regular care group
- What it means for you: If you have prediabetes, structured programs with lifestyle support and incentives may significantly lower your chances of developing diabetes, though you should discuss options with your doctor
The Research Details
This was a randomized controlled trial, which is considered the gold standard for medical research. Scientists randomly divided 751 people with prediabetes into two groups. One group got standard medical care that doctors normally provide. The other group got a special ‘stepped care’ program that started with 6 months of lifestyle coaching about diet and exercise. If people in the special program were still at high risk after 6 months, doctors added metformin medication to help prevent diabetes.
The stepped approach is important because it matches the intensity of treatment to each person’s needs. Not everyone needed medication - only those who remained at high risk got metformin. The financial incentives were designed to solve a real problem: many people start diabetes prevention programs but don’t stick with them long enough to see benefits.
This study was published in Diabetes Care, a top medical journal, and followed people for 3 full years. The large sample size of 751 people and the random assignment to groups makes the results more reliable. However, it was done in one country with specific ethnic groups, so results might vary in other populations.
What the Results Show
The results were quite impressive. After 3 years, 34.8% of people in the incentive program developed diabetes compared to 47.3% in the regular care group. This means the program prevented diabetes in about 1 out of every 8 people who participated. The researchers calculated that people in the special program had a 26% lower risk of developing diabetes overall. The cash incentives seemed to work - 45% of participants earned money for losing weight or attending sessions, and 26% needed to add metformin medication to their lifestyle changes.
The study found that not everyone needed medication - about 3 out of 4 people in the intervention group managed with lifestyle changes alone. The financial incentives were given for two main achievements: attending lifestyle education sessions and losing at least 5% of body weight. The combination of education, accountability, and rewards appeared to help people stick with healthy changes longer than usual.
Previous diabetes prevention studies have shown that lifestyle changes can prevent diabetes, but many struggle with people dropping out or not maintaining changes long-term. This study’s use of financial incentives and stepped care addresses those common problems. The results are similar to other major diabetes prevention trials but with potentially better long-term adherence due to the incentive structure.
The study was done only in Singapore with specific ethnic groups (Asian populations), so the results might not apply equally to other populations. Some people in the intervention group experienced side effects, mainly stomach problems from metformin. The study doesn’t tell us what happens after the 3-year program ends or whether the financial incentives need to continue indefinitely to maintain benefits.
The Bottom Line
If you have prediabetes, consider asking your doctor about structured prevention programs that combine lifestyle coaching with accountability measures. Focus on achieving at least 5% weight loss through diet and exercise changes. If lifestyle changes aren’t enough after 6 months, discuss whether metformin might be appropriate for you.
This research is most relevant for adults who are overweight and have been diagnosed with prediabetes. People who have struggled to stick with diet and exercise programs in the past might especially benefit from programs with built-in incentives and support. However, anyone considering medication should discuss risks and benefits with their healthcare provider.
The study followed people for 3 years, with lifestyle interventions starting immediately and medication added after 6 months if needed. Participants who earned incentives likely saw benefits within the first 6 months, but the full diabetes prevention benefits became clear over the full 3-year period.
Want to Apply This Research?
- Track your weight weekly and aim for a 5% reduction from your starting weight, as this was one of the key targets that earned participants cash rewards in the study
- Set up a reward system for yourself - track attendance at exercise sessions or healthy meal preparation, mimicking the incentive structure that proved effective in this research
- Monitor blood sugar levels as recommended by your doctor (typically every 3-6 months for prediabetes) and track lifestyle factors like weight, physical activity minutes, and healthy eating days to see your progress over time
This information is for educational purposes only and should not replace professional medical advice. If you have prediabetes or concerns about diabetes risk, consult with your healthcare provider to discuss appropriate prevention strategies and monitoring for your individual situation.