Nudging people with Type 2 diabetes towards better self-management through personalised risk communication: a pilot randomised controlled trial in primary care

Objectives To assess the feasibility in routine primary care consultation and investigate the effect on risk recall and self-management of a new type of risk communication intervention based on behavioural economics (‘nudge-based’) for people with Type 2 diabetes mellitus (T2DM). Methods Forty adults with poorly controlled T2DM (HbA1c>7.5%) were randomised to receive a personalised, nudge-based risk communication intervention (n=20) or standard care (n=20). Risk recall and self-management were evaluated at baseline and 12 weeks after the intervention. Results Both in terms of feasibility and acceptability, this new risk communication intervention was very satisfactory. Study retention rate after 12 weeks was very high (90%) and participants were highly satisfied with the intervention (4.4 out of 5 on the COMRADE scale). Although not powered to identify significant between-group effects, the intervention significantly improved risk recall after 12 weeks and intentions to make lifestyle changes (dietary behaviour) compared to standard care. Conclusions This pilot study provides the first evidence of the feasibility of implementing in primary care a nudge-based risk communication intervention for people with T2DM. Based on the promising results observed, an adequately powered trial to determine the effectiveness of the intervention on long-term self-management is judged feasible. As a result of this feasibility study, some minor adaptations to the intervention and study methods that would help to facilitate a definitive trial are also reported.