REDEEM trial: The effect of individual and mixed REwards in DiabEtEs Management, a randomised controlled trial
Lead Research Organisation:
Cayetano Heredia University
Department Name: Research
Abstract
Studies in developed countries have demonstrated benefits to preventive care (diet modifications, exercise) among patients with diabetes. Despite this knowledge, patients often don't manage their diabetes properly. In a study that we conducted in Lima, 71% of subjects with diabetes were aware of their disease, 40% were receiving treatment, and only 7% had achieved therapeutic goals. In Latin America, diabetes has a great impact on the health system due to high costs of disease control (US$10.7 billion) and indirect costs (US$54.5 billion) related to loss of productivity, disability, and premature death.
Payment for achieving therapeutic goals, or "rewards," have been tested as a way to improve health. Several studies have shown the promise of this approach in encouraging and maintaining weight loss, which is an important way to control diabetes. One study found that paying people to lose weight led to significantly greater weight loss. In another study in which the payments were linked to the success of multiple members of a group achieving their weight loss goals, the participants not only lost more weight, but also maintained the weight loss. These results are intriguing, and suggest that the study of rewards in self-management of diabetes requires further research.
The approach of paying people to achieve health-related goals has also worked in developing countries. For example, Juntos is a program in Peru that pays pregnant women and mothers to utilize certain health services. On study found that Juntos increased the probability that children in households met their weight-height goals. In addition, families that were part of Juntos were more likely to seek professional health assistance in case of any disease, and the pregnant women were more likely to have their delivery attended by a skilled professional. This type of program takes advantage of the strong family structures in Latin America, and brings an element of group responsibility to the improvement of health. The individual responsible for fulfilling the requirements is not only encouraged to be responsible because of an individual reward, but to improve the situation of the family. This highlights the potential to use responsibility to others to design more effective policies.
In this project, our goal is to determine the effectiveness of two different economic reward programs in promoting preventive behaviors and improving the health of individuals with Type II diabetes in Peru. In addition to rewarding patients for their improved health outcomes, we will go one step further and evaluate a cash incentive for a family or friend supporter, an approach we believe has great potential and may be more effective. In our study, we will enroll diabetes patients and randomly assign them to one of three groups. In one group, patients will receive cash rewards if they achieve certain goals related to management of their diabetes. In a second group, patients and a family or friend supporter will both receive a cash reward if the patient achieves their diabetes management goals. This will allow us to test whether or not the element of responsibility to others improves the ability of the patient to achieve their goals. Finally, a third group will not receive any cash reward. This is the "control" group to which the other groups will be compared to measure success of our approaches.
We expect that after nine months of rewards, patients will effectively improve the preventive behaviors. Six months later, we will also assess if these improvements have been maintained without the cash reward. If our study is successful, it could be a way to encourage people with diabetes to better manage their disease. While there are costs associated with this approach, it could save money in the long run by reducing the complications of diabetes that occur when people don't manage their disease.
Payment for achieving therapeutic goals, or "rewards," have been tested as a way to improve health. Several studies have shown the promise of this approach in encouraging and maintaining weight loss, which is an important way to control diabetes. One study found that paying people to lose weight led to significantly greater weight loss. In another study in which the payments were linked to the success of multiple members of a group achieving their weight loss goals, the participants not only lost more weight, but also maintained the weight loss. These results are intriguing, and suggest that the study of rewards in self-management of diabetes requires further research.
The approach of paying people to achieve health-related goals has also worked in developing countries. For example, Juntos is a program in Peru that pays pregnant women and mothers to utilize certain health services. On study found that Juntos increased the probability that children in households met their weight-height goals. In addition, families that were part of Juntos were more likely to seek professional health assistance in case of any disease, and the pregnant women were more likely to have their delivery attended by a skilled professional. This type of program takes advantage of the strong family structures in Latin America, and brings an element of group responsibility to the improvement of health. The individual responsible for fulfilling the requirements is not only encouraged to be responsible because of an individual reward, but to improve the situation of the family. This highlights the potential to use responsibility to others to design more effective policies.
In this project, our goal is to determine the effectiveness of two different economic reward programs in promoting preventive behaviors and improving the health of individuals with Type II diabetes in Peru. In addition to rewarding patients for their improved health outcomes, we will go one step further and evaluate a cash incentive for a family or friend supporter, an approach we believe has great potential and may be more effective. In our study, we will enroll diabetes patients and randomly assign them to one of three groups. In one group, patients will receive cash rewards if they achieve certain goals related to management of their diabetes. In a second group, patients and a family or friend supporter will both receive a cash reward if the patient achieves their diabetes management goals. This will allow us to test whether or not the element of responsibility to others improves the ability of the patient to achieve their goals. Finally, a third group will not receive any cash reward. This is the "control" group to which the other groups will be compared to measure success of our approaches.
We expect that after nine months of rewards, patients will effectively improve the preventive behaviors. Six months later, we will also assess if these improvements have been maintained without the cash reward. If our study is successful, it could be a way to encourage people with diabetes to better manage their disease. While there are costs associated with this approach, it could save money in the long run by reducing the complications of diabetes that occur when people don't manage their disease.
Technical Summary
There is strong evidence of benefits of preventive care among patients with diabetes, but adherence to guidelines worldwide is quite low and this constitutes a major problem across healthcare systems. Cash rewards have been tested in adherence to treatment for substance abusers, and to promote weight loss and smoking cessation. Less is known about the effect on behaviour of pairing individual cash with group cash rewards or cash rewards to a family member or friend who provides support in the process.
This study will explore the ability of rewards to change the behaviour of individuals with type II diabetes in a randomised controlled trial. Two different nine-month reward strategies will be tested against usual care (control group). One arm will receive individual-only cash rewards. A separate arm will receive mixed rewards, which consist of individual cash reward plus a cash reward to a supportive individual chosen by the study participant. The primary outcome will be metabolic control rates as per HbA1c criteria.
Research Question 1 will compare the effect of each of the intervention arms against the control group on the primary study outcomes at nine months.
Research Question 2 will allow a comparison between the two reward interventions in terms of behavioural-related goals.
Research Question 3 will explore, within each of the intervention groups, if the intrinsic motivation sustains six months after the removal of the reward.
Fourth, throughout the study qualitative data will be collected. If the trial is successful, e.g. if Research Questions 1 and 2 do show an effect, we will be well positioned to gain an understanding about the pathways on which the intervention operates to achieve the observed differences. In addition, we will complete a cost-effectiveness analysis to demonstrate the feasibility of the proposed approach, if our intervention shows a benefit.
This study will explore the ability of rewards to change the behaviour of individuals with type II diabetes in a randomised controlled trial. Two different nine-month reward strategies will be tested against usual care (control group). One arm will receive individual-only cash rewards. A separate arm will receive mixed rewards, which consist of individual cash reward plus a cash reward to a supportive individual chosen by the study participant. The primary outcome will be metabolic control rates as per HbA1c criteria.
Research Question 1 will compare the effect of each of the intervention arms against the control group on the primary study outcomes at nine months.
Research Question 2 will allow a comparison between the two reward interventions in terms of behavioural-related goals.
Research Question 3 will explore, within each of the intervention groups, if the intrinsic motivation sustains six months after the removal of the reward.
Fourth, throughout the study qualitative data will be collected. If the trial is successful, e.g. if Research Questions 1 and 2 do show an effect, we will be well positioned to gain an understanding about the pathways on which the intervention operates to achieve the observed differences. In addition, we will complete a cost-effectiveness analysis to demonstrate the feasibility of the proposed approach, if our intervention shows a benefit.
Planned Impact
One of the main beneficiaries of this research are diabetes patients, as our intervention could greatly improve their health outcomes. Clinical trials in developed countries and population-based studies have indicated that there are major benefits to be achieved by preventive care among patients with diabetes. However, despite the medical consensus on the effectiveness of preventive measures, achievement of control targets by patients worldwide is quite low. In this application, we aim to explore the role of rewards to change the preventive behaviour of individuals with Type II diabetes in a randomised controlled trial in Peru. If we are successful and our intervention is implemented, it could have a significant impact on the health outcomes of patients with diabetes. This will benefit them personally, and will also benefit their families by extension, both emotionally and financially.
In addition, policymakers can benefit from this research, as it can help them to design improved interventions for the management of diabetes patients. For example, Peru's Ministry of Inclusion and Social Development (MIDIS) already recognizes the value of economic rewards and have implemented them in other health-related areas. They will be very interested in the results of our study, and could support and benefit from its implementation. Our intervention could also benefit the financial state of the health care system by reducing the costs of morbidity and mortality associated with diabetes. For example, ESSALUD, the social health insurance in Peru, could benefit from our intervention, as it could lead to reduced morbidity and mortality in patients with diabetes, leading to a reduction in health care costs. We have included letters of support from both MIDIS and ESSALUD, demonstrating their interest and potential involvement in the future of our intervention.
Finally, academic researchers will also benefit from our research. Mixed rewards have not been explored in a health care context. These types of rewards may improve performance when the agent has low knowledge about their ability and cost of their action, which is of particular relevance in the case of diabetes management. Peer pressure may elicit higher individual effort than pure cash rewards, and sentiments of trust and group belonging may create additional pressure for individuals to perform better in mixed reward than in pure cash rewards. If our results are promising, they could lead to studies of this type of intervention in other areas of health care.
In addition, policymakers can benefit from this research, as it can help them to design improved interventions for the management of diabetes patients. For example, Peru's Ministry of Inclusion and Social Development (MIDIS) already recognizes the value of economic rewards and have implemented them in other health-related areas. They will be very interested in the results of our study, and could support and benefit from its implementation. Our intervention could also benefit the financial state of the health care system by reducing the costs of morbidity and mortality associated with diabetes. For example, ESSALUD, the social health insurance in Peru, could benefit from our intervention, as it could lead to reduced morbidity and mortality in patients with diabetes, leading to a reduction in health care costs. We have included letters of support from both MIDIS and ESSALUD, demonstrating their interest and potential involvement in the future of our intervention.
Finally, academic researchers will also benefit from our research. Mixed rewards have not been explored in a health care context. These types of rewards may improve performance when the agent has low knowledge about their ability and cost of their action, which is of particular relevance in the case of diabetes management. Peer pressure may elicit higher individual effort than pure cash rewards, and sentiments of trust and group belonging may create additional pressure for individuals to perform better in mixed reward than in pure cash rewards. If our results are promising, they could lead to studies of this type of intervention in other areas of health care.
Organisations
- Cayetano Heredia University (Lead Research Organisation)
- Hospital Nacional Arzobispo Loayza (Collaboration)
- George Institute for Global Health (Collaboration)
- Johns Hopkins University (Collaboration)
- London School of Hygiene and Tropical Medicine (LSHTM) (Collaboration)
- Geneva University Hospitals (Collaboration)
- Medical Research Council (MRC) (Collaboration)
- Research Triangle Institute International (Collaboration)
Publications
Lazo-Porras M
(2016)
Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants: PERU MIGRANT cohort study.
in Atherosclerosis
Najera H
(2019)
Within-country migration and obesity dynamics: analysis of 94,783 women from the Peruvian demographic and health surveys.
in BMC public health
Mendoza W
(2017)
Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology.
in Cardiology clinics
Kwan GF
(2016)
Endemic Cardiovascular Diseases of the Poorest Billion.
in Circulation
Gianella GE
(2019)
What is a COPD-Like Spirometry Test Result in Resource Constrained Settings?
in COPD
Lazo-Porras M
(2020)
Intermediate hyperglycaemia and 10-year mortality in resource-constrained settings: the PERU MIGRANT Study
in Diabetic Medicine
Pesantes MA
(2017)
An exploration into caring for a stroke-survivor in Lima, Peru: Emotional impact, stress factors, coping mechanisms and unmet needs of informal caregivers.
in eNeurologicalSci
Lazo-Porras M
(2016)
Evaluation of cognitive impairment in elderly population with hypertension from a low-resource setting: Agreement and bias between screening tools.
in eNeurologicalSci
Carrasco-Escobar G
(2020)
Travel Time to Health Facilities as a Marker of Geographical Accessibility Across Heterogeneous Land Coverage in Peru.
in Frontiers in public health
Description | This study was designed to evaluate the feasibility of implementing individual and mixed cash rewards on HbA1c and weight loss among patients with type 2 diabetes mellitus. After completion of the 3-month intervention, notable reductions were observed in HbA1c, weight and BMI, and also in some of the intermediate and self-reported outcomes. Subgroup analysis confirm reductions in weight and BMI among those who complete a higher number of appointments and more clearly among those who achieve early success, i.e. those who were eligible to receive a cash reward during their first two appointments. Contrasting with the effect of oral antidiabetic drugs, which lowers HbA1c in the order of 0.5%-1.25%, our results, derived from a complex intervention relying on diabetes education with tailored goal-setting with or without group (partner) support, showed reductions in HbA1c of similar magnitude to those achieved with pharmacological treatment. |
Exploitation Route | This study was intended to generate hypotheses, and the rationale for using the term feasibility in this work was informed by a combination of issues related to the fieldwork, to packaging and deploying the intervention, and the experience of the support partner. In terms of fieldwork, we document the ability to approach, identify eligible individuals, as well as to recruit, enroll, and follow-up sufficient number of patients and partners. Key aspects of the intervention include the capacity to deliver the intervention, an intense intervention with tailoring features, and to have a separate team to measure outcomes, expressed in the results reported. Acceptability of the intervention and challenges of the implementation were also captured in the post-study interviews reporting the experience of the partner support. The accomplishment of recruitment and conduction of this study, together with the uptake of the intervention by the study participants as well as the lessons from the experience of the partner support, demonstrate the feasibility of conducting larger effectiveness studies using individual incentives and mixed incentives involving carers for supporting diabetes management. |
Sectors | Agriculture Food and Drink Communities and Social Services/Policy Creative Economy Education Electronics Environment Financial Services and Management Consultancy Healthcare Leisure Activities including Sports Recreation and Tourism Government Democracy and Justice Pharmaceuticals and Medical Biotechnology Transport |
Description | - with the clinical teams that manage diabetes, who are more aware of complex interventions and the challenges, at the individual level, of ensuring compliance with the treatment for diabetes. - with policymakers, including former Ministers of Health and former Minister of Social Inclusion, who were invited to be part of an advisory board as part of a proposal for a larger study. The proposal was not funded, but it was well received by the advisory board who supported the idea. |
First Year Of Impact | 2018 |
Sector | Agriculture, Food and Drink,Communities and Social Services/Policy,Digital/Communication/Information Technologies (including Software),Education,Financial Services, and Management Consultancy,Healthcare,Leisure Activities, including Sports, Recreation and Tourism,Pharmaceuticals and Medical Biotechnology,Transport |
Impact Types | Societal Economic Policy & public services |
Description | "Los países que más han funcionado (en pandemia) son los que tienen apoyo científico". [Podcast] Mentes Peruanas, Aug 2, 2021. |
Geographic Reach | South America |
Policy Influence Type | Influenced training of practitioners or researchers |
URL | https://elcomercio.pe/podcast/mentes-peruanas/podcast-mentes-peruanas-ciencia-medicina-jaime-miranda... |
Description | Diabetes Education Manual for patients |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Influenced training of practitioners or researchers |
Description | Jaime. [Podcast] Global Health Lives, Jan 9, 2022. |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Influenced training of practitioners or researchers |
URL | https://anchor.fm/globalhealthlives/episodes/Jaime-e195sb1/a-a6oj49o |
Description | Miranda - AHPSR STAC Member |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Participation in a guidance/advisory committee |
URL | https://ahpsr.who.int/about-us/governance/scientific-and-technical-advisory-committee-stac |
Description | Miranda - WHO TAG NCD R&I |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Participation in a guidance/advisory committee |
URL | https://www.who.int/groups/who-technical-advisory-group-of-experts-on-ncd-research-and-innovation |
Description | Scientific meeting "From the Epidemiology of Non-communicable Diseases to Interventions to Tackle Them - Lessons from Latin America" |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Contribution to new or Improved professional practice |
Description | Seminar : "Can Dementia researchers capitalize from population health research partners? From the Epidemiology of Non-communicable Diseases to Interventions to Tackle Them - Lessons for Latin America" |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Contribution to new or Improved professional practice |
Description | UN independent group of scientists to draft Global Sustainable Development Report |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Membership of a guideline committee |
URL | https://sdgs.un.org/news/un-secretary-general-appoints-15-independent-scientists-draft-second-quadre... |
Description | "Multi-Morbidity and Infectious Diseases: strengthening links between the UK and Peru." |
Amount | £44,352 (GBP) |
Funding ID | 413495350 |
Organisation | British Council |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 02/2019 |
End | 02/2020 |
Description | "Understanding and modelling the distribution of the double burden of malnutrition in Peru" |
Amount | £41,458 (GBP) |
Funding ID | 413843191 |
Organisation | British Council |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 02/2019 |
End | 02/2020 |
Description | APPLICATION OF NOVEL BIOMARKERS TO MEASURE HEALTH IMPACTS OF ANTHROPOGENIC CHANGE IN THE AMAZON |
Amount | $145,858 (USD) |
Funding ID | K01TW011478 |
Organisation | National Institutes of Health (NIH) |
Department | Fogarty International Centre |
Sector | Public |
Country | United States |
Start | 08/2020 |
End | 05/2024 |
Description | Addressing the double burden of disease: improving health system for Noncommunicable and Neglected Tropical Diseases |
Amount | SFr. 3,350,000 (CHF) |
Funding ID | 40P740-160366 |
Organisation | Swiss National Science Foundation |
Sector | Public |
Country | Switzerland |
Start | 02/2016 |
End | 02/2022 |
Description | Addressing the double burden of malnutrition in Peru: using a community-based system dynamics approach to improve food systems |
Amount | £689,810 (GBP) |
Funding ID | BB/T009004/1 |
Organisation | Biotechnology and Biological Sciences Research Council (BBSRC) |
Sector | Public |
Country | United Kingdom |
Start | 02/2020 |
End | 02/2023 |
Description | BUILDING SUSTAINABLE AND INNOVATIVE RESEARCH IN CANCER AND CARDIOVASCULAR DISEASE: PLANNING THE DESIGN AND DEVELOPMENT OF THE SOUTH AMERICAN CENTER OF RESEARCH EXCELLENCE TO COUNTER NCDS (SACREN) |
Amount | $497,499 (USD) |
Funding ID | P20CA217231 |
Organisation | National Institutes of Health (NIH) |
Department | National Cancer Institute (NCI) |
Sector | Public |
Country | United States |
Start | 08/2017 |
End | 08/2019 |
Description | Chronic Kidney Disease of unknown cause (CKDu) in disadvantaged communities in low-and-middle income countries (LMICs) |
Amount | £0 (GBP) |
Funding ID | MR/P02386X/1 |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 04/2017 |
End | 05/2019 |
Description | Does household food biodiversity protect adults against malnutrition and favour the resilience of Shawi Indigenous households to climate change related events? |
Amount | $307,624 (USD) |
Funding ID | 218743/Z/19/Z |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 01/2020 |
End | 01/2023 |
Description | GCRF_NF228 The COVID Observatories: Monitoring the interaction of pandemics, climate risks, & food systems among the most disadvantaged communities |
Amount | £510,562 (GBP) |
Funding ID | EP/V043102/1 |
Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
Sector | Public |
Country | United Kingdom |
Start | 09/2020 |
End | 03/2022 |
Description | Household air pollution and health: A multi-country LPG intervention trial |
Amount | $6,176,184 (USD) |
Funding ID | 1UM1HL134590 |
Organisation | National Institutes of Health (NIH) |
Sector | Public |
Country | United States |
Start | 08/2016 |
End | 09/2021 |
Description | Implementation of COPD Case Finding and Self-Management Action Plans in Low and Middle Income Countries |
Amount | £1,122,116 (GBP) |
Funding ID | MR/P008984/1 |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 01/2017 |
End | 12/2019 |
Description | PLANNING TO ESTABLISH A REGIONAL CENTER OF NCD RESEARCH TRAINING IN PERU |
Amount | $49,680 (USD) |
Funding ID | D71TW010877 |
Organisation | National Institutes of Health (NIH) |
Department | Fogarty International Centre |
Sector | Public |
Country | United States |
Start | 08/2017 |
End | 09/2019 |
Description | Risk-based Prevention of Heart Disease and Stroke in Latin America and the Caribbean: A Pooled Analysis of Prospective Cohorts and Population-Based Surveys |
Amount | £265,036 (GBP) |
Funding ID | 214185/Z/18/Z |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 02/2019 |
End | 05/2022 |
Description | Scaling-up and evaluating salt/sodium reduction policies and programs in Latin American countries |
Amount | $1,200,000 (CAD) |
Funding ID | 108167 |
Organisation | International Development Research Centre |
Sector | Public |
Country | Canada |
Start | 08/2016 |
End | 09/2019 |
Description | UNC Chapel Hill Practicum |
Amount | $5,000 (USD) |
Organisation | UNC Gillings School of Global Public Health |
Sector | Academic/University |
Country | United States |
Start | 04/2016 |
End | 07/2016 |
Description | USING BURDEN OF TREATMENT AS A CLINICAL INDICATOR OF BARRIERS TO MULTIMORBIDITY MANAGEMENT IN PERU: A MIXED METHODS APPROACH |
Amount | $150,825 (USD) |
Funding ID | R21TW011740 |
Organisation | National Institutes of Health (NIH) |
Department | Fogarty International Centre |
Sector | Public |
Country | United States |
Start | 08/2020 |
End | 06/2022 |
Description | What makes cities healthy, equitable, and environmentally sustainable? Lessons from Latin America |
Amount | £9,391,398 (GBP) |
Funding ID | 205177/Z/16/Z |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 03/2017 |
End | 03/2023 |
Title | Economic incentive determination |
Description | The rationale behind the amount of economic incentives in behavioral interventions is rarely described. We propose a set of inputs to determine the amount of the economic incentive we gave participants: miinimum wage, amount given in cash transfer programs, the amount people are willing to pay for loosing weight and the amount of money peoplw are willing to accept as payment for loosing weight. |
Type Of Material | Improvements to research infrastructure |
Provided To Others? | No |
Impact | This method enabled us to determine an appropriate amount to promote behavioral change in the study participants. |
Title | Database REDEEM trial |
Description | The database of REDEEM trial includes all the variables collected during the study. We have information from 54 participants at baseline and their respectives companions. Baseline data of participants is related sociodemographic characteristics, diabetes care and lifestyle. Also we have information of the follow up visits that include information of weight, lifestyle and support of the companion. |
Type Of Material | Database/Collection of data |
Year Produced | 2019 |
Provided To Others? | Yes |
Impact | The database was used by researchers to analyse and publish the results of the REDEEM trials. |
URL | https://figshare.com/articles/REDEEM_Study_Feasibility_pilot_study/7180802 |
Description | COHESION Project |
Organisation | Geneva University Hospitals |
Country | Switzerland |
Sector | Hospitals |
PI Contribution | COHESION is a new project, recently awarded by the Swiss National Foundation, aiming at pursuing a clear understanding of barriers and enablers for diagnosis, management and care of Non-Communicable Diseases and Neglected Tropical Diseases in Nepal, Mozambique, and Peru. We have participated since the design of the proposal and built upon a previous relationship with Dr David Beran to expand our common interests in NCDs in LMIC. |
Collaborator Contribution | Peru was one of the study sites for this collaboration. |
Impact | Funding awarded. |
Start Year | 2015 |
Description | Collaboration with Hospital Arzobispo Loayza Endocrinology Service |
Organisation | Hospital Nacional Arzobispo Loayza |
Country | Peru |
Sector | Hospitals |
PI Contribution | We have established a good working relationship with de endocrinology service at the public hospital Arzobispo Loayza. Through our meetings with the doctors we have been able to improve our research protocol, have access to patients and build a partnership for future research. |
Collaborator Contribution | - Input to the protocol regarding inclusion criteria and the educational material we designed for the project participants. |
Impact | We are preparing at least two manuscripts based on the study results where two doctors of the endocrinology service will be contributing with. |
Start Year | 2016 |
Description | JHU |
Organisation | Johns Hopkins University |
Country | United States |
Sector | Academic/University |
PI Contribution | We have established the CRONICAS Centre of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia |
Collaborator Contribution | Joint faculty from JHU and UPCH got together to produce a strong application that secured one of the NHLBI's Centre of Excellence awards. |
Impact | - Multiple papers - Ancillary studies - Capacity building - Further grants secured |
Start Year | 2008 |
Description | LSHTM NCDs |
Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
Department | Faculty of Epidemiology and Population Health |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | I completed my Masters and PhD in Epidemiology and LSHTM, funded by Wellcome Trust. Ever since I have maintained the links and collaborations with this institution and various colleagues. |
Collaborator Contribution | - Funding opportunities - Capacity Building, training |
Impact | Various grants and papers. My main collaborator at LSHTM is Prof Smeeth, and together we have, to date 28 joint publications. http://www.ncbi.nlm.nih.gov/pubmed/?term=Miranda+JJ%5BAuthor%5D+AND+Smeeth%5BAuthor%5D |
Description | MRC Review Panel |
Organisation | Medical Research Council (MRC) |
Country | United Kingdom |
Sector | Public |
PI Contribution | I have served in the Review Panels of the MRC Adolescents Health 2016 |
Collaborator Contribution | Invitation to a selected group of people to review grant applications at a very highly competitive level. |
Impact | Learnt about Grant funding and Panel decisions. |
Start Year | 2016 |
Description | RTI NCD group |
Organisation | Research Triangle Institute International |
Country | United States |
Sector | Charity/Non Profit |
PI Contribution | Generating ideas for mutual work alongside diabetes prevention programs in LMICs. |
Collaborator Contribution | They bring the angle of case studies for making the case of economic investments, e.g. childhood obesity. |
Impact | Preparatory meetings to submit a grant for the GACD round 7 (2022). |
Start Year | 2021 |
Description | The George Institute for Global Health |
Organisation | George Institute for Global Health |
Country | Australia |
Sector | Academic/University |
PI Contribution | Our feasibility REDEEM trial has enabled us to engage on conversations about process evaluation, and our study was a case study. |
Collaborator Contribution | The George Institute has a stream of work on the topic of process evaluation, so there is uptake about our work. |
Impact | Presentations in group meetings in Australia. |
Start Year | 2018 |
Title | Economic Incentives to Improve the Management of Type 2 Diabetes Mellitus |
Description | This pilot study aims to compare the implementation process of three different interventions that use economic incentives to promote lifestyle behavioral changes in patients with Type 2 diabetes mellitus (T2DM), and to identify barriers and facilitators linked to the process of implementing each of the interventions. The interventions are based on economic incentives directed to the patient (individual incentives) or a team comprised by the patient and a partner (mixed incentives). Design: Three-month randomized control pilot study to test the feasibility of implementing three types of intervention with economic incentives. Setting: Diabetes outpatient clinics from a public hospital in Peru. Population: Subjects are eligible if they (1) have a diagnosis of type 2 diabetes mellitus, (2) are between 18 - 70 years of age, (3) have a body mass index between 25 - 39.9 kg/m2, (4) do not have blindness or amputations or foot ulcers or are on dialysis, and (6) have the ability to provide informed consent. To be eligible as a "partner" for the participant with diabetes, the partner has to (1) be between 18 and 70 years of age, (2) not have a physical or mental impairment that does not allow him to help the participant to lose weight, (4) be available and committed to supporting the participant in achieving their weight loss goals, and (5) be able to provide informed consent. Outcomes: Feasibility of conducting a three-arm incentives-based pilot study. Secondary outcomes: Weight loss, and change in glycated hemoglobin after 3 month. We have completed the delivery of the intervention, we are analysing the data and doing a follow-up after 7 months of completion, |
Type | Management of Diseases and Conditions |
Current Stage Of Development | Small-scale adoption |
Year Development Stage Completed | 2017 |
Development Status | Closed |
Clinical Trial? | Yes |
Impact | A total of 54 eligible subjects were randomized, 18 in each study arm. Mean age was 54.5 (SD: 8.9) years and 66% were females. We did not find differences between study groups in the clinical, sociodemographic, anthropometric measurements (weight), and glycated hemoglobin measurements. A total of 10 (18.5%) individuals were lost to follow-up. The individual incentive reduced weight significantly compared to the mixed incentives arms. In addition, a greater effect on A1c reduction was seen in the individual incentive and mixed incentives 2 (i.e. the arm in which the incentive was split between patient and partner). A clinical trial with patient-important outcomes is needed to implement and scale up this intervention. |
URL | https://clinicaltrials.gov/show/NCT02891382 |
Description | "From the Epidemiology of Non-communicable Diseases to Interventions to Tackle Them - Lessons from Latin America" |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Department of Medicine/Hudson Seminar |
Year(s) Of Engagement Activity | 2021 |
Description | Monthly visits to Endocrinology Service, Hospital Nacional Arzobispo Loayza |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | Monthly visits with 4-6 staff from the endocrinology service, plus their physicians in training (residents), nurses and technicians to optimize collaborations. This has provided support to existing projects plus initiation of new projects of common interests. Before they used to collect data for clinical trials (pharma-funded), now they are engaged in pursuing their own research questions. |
Year(s) Of Engagement Activity | 2016,2017 |
Description | Seminar: Can Dementia researchers capitalize from population health research partners? From the Epidemiology of Non-communicable Diseases to Interventions to Tackle Them - Lessons for Latin America |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation to the Global Brain Health Initiative, hosted by Agustín Ibáñez, PhD, Atlantic Fellow for Equity in Brain Health; Director, Latin American Brain Health Institute; Director, Cognitive Neuroscience Center (UdeSA) & Lea Grinberg, MD, PhD, Executive Committee Member, GBHI; John Douglas French Alzheimer's Foundation Endowed Professor Department of Neurology and Pathology, UCSF |
Year(s) Of Engagement Activity | 2021 |