Impact of Integrated Medication Reminders, Gamification, and Financial Rewards Via Smart Phone Application on Treatment Adherence in Uncomplicated Type II Diabetes Patients: A Randomized, Open-Label Trial

Abstract

Background: Poor medication adherence in type 2 diabetes mellitus (T2DM) leads to poor glycemic control. Materials and Methods: This randomized, open-labeled, controlled study recruited consenting adult patients with uncomplicated T2DM who were on daily oral antidiabetics with documented poor medication adherence (missing ≥20% of their prescribed doses in the past 15 days). Patients in the 'incentive group' installed a digital therapeutics mobile app (KYT-Adhere) and received multiple daily medication reminders. Patients were asked to show the pill/(s) to the app before consuming the medication, after which the patients received 'KYT-Points'; these would be converted into financial incentives after 3 months, provided that they maintained ≥80% medication adherence. These patients received incentives for 3 months and medication reminders for 6 months. 'Control group' patients received standard care. Results: A total of 118/120 recruited patients completed the study; 59 each with similar baseline parameters were randomized to incentive and control groups. At baseline, medication adherence and HbA1c were comparable (adherence: 65.7±4.7% and 65.3±4.0%; HbA1c: 9.0±0.3% and 9.0±0.3% for incentive and control groups, respectively). Over the study duration, the incentive group showed a significant improvement in medication adherence (P < 0.001) and significant HbA1c reduction (P < 0.001). At study closure, the average medication adherence and HbA1c were significantly different between the two groups (adherence: 86.8±3.2% vs. 67.7±4.6%, P < 0.001; HbA1c: 7.3±0.2% vs. 8.2±0.3%, P < 0.001). Conclusion: Gamification through combining repeated medication reminders and rewards through a smartphone application brought about a behavioral change, which improved medication adherence and glycemic control among T2DM patients within 3 months and was sustained for 3 more months without rewards.