The Effect of Financial Incentives on Improvement of Glycemic Control in Diabetic Patients From Low Socioeconomic Background

The study will be performed in primary care clinics in a big Health Funds in Jerusalem and the area (Clalit Health Services). Guidance will be given to the professional staff in the clinics and the pharmacists in the pharmacies of the Health Care Fund. Candidates will be identified from lists of diabetic patients and will be invited to the clinic or will be contacted upon arrival to the clinic. Candidates that will agree to participate in the study will sign an informed consent and answer a small survey.

Candidates that do not have a recent HbA1c result (from the last month) will be referred to perform a blood test. Only patients with an updated result of 8.5% or higher, will be included in the study. The participants will receive explanations from the research staff or the medical professionals at the clinic. General recommendations for diabetes care will be provided orally, and a written summary will be given. Contact details with the research staff will be provided as well.

All participants will be contacted by phone to inform them of their group membership within three days of the recruitment, or 3 days after receiving the result of the blood test. The information will be delivered by a member of the research team that will not know the participants. The result will be sent by mail as well.

The incentives group participants will be told they will receive a bonus to buy their medications at the designated pharmacies. After three months, if they reduce their HBA1c by 0.7% compared to the previous test, or if their HbA1c level is reduced to 7.5% or below, they will get a bonus of up to 100 ILS (30$) every month, for the next three months depending on the total amount of their purchased medicine that month. Six months after entering the trial they will be entitled to a bonus for one additional month if they have reduced their HbA1c level by 0.3% compared to the last test. The bonus can be used to pay for chronic prescription drugs for diabetes, hypertension (HTN) or hyperlipidemia those who are included in the Israeli "health basket," or not included.

The standard treatment group will buy medications as usual. All participants will be encouraged to get their treatment and prescriptions from their physician, and to take their medication regularly. They will receive recommendations for a healthy lifestyle with low-sugar diet and physical activity, be encouraged to perform routine blood and urine tests and have an eye examination once a year. They will receive by mail a tracking page for documentation of hypoglycemia events. They will be asked to document events of symptomatic low blood sugar (55mg/dl or less) and to indicate whether they needed help to recover from hypoglycemia. They will be told a research assistant will contact them during the follow- up period.