Cashing In on Better Health: Financial Incentives Make “Cents” for Diabetes Prevention

Singapore, 3 February 2026 – A Singapore General Hospital-led (SGH) study has shown that combining a diabetes prevention programme with financial incentives may significantly reduce the risk of an individual with prediabetes progressing to type 2 diabetes. 

The Pre-Diabetes Interventions and Continued Tracking to Ease Out Diabetes (Pre-DICTED) study involved 751 overweight or obese adults with prediabetes aged 18 to 64 years. They were randomly assigned to the intervention group or control group, and followed up for three years. Regardless of which group participants were assigned to, they had two goals: achieve five per cent or more weight loss and engage in 150 minutes or more of moderate-intensity activity per week. 

The researchers found that after three years, 293 participants developed diabetes: 121 (34.8 per cent) in the intervention group and 172 (47.3 per cent) in the control group. Intervention group participants outperformed those receiving standard care in terms of weight loss, with 30.1 per cent achieving target weight loss versus 15.7 per cent. 

Associate Professor Bee Yong Mong, Head and Senior Consultant, Department of Endocrinology, SGH, and principal investigator of the study said, “Community diabetes prevention programmes often struggle with participant adherence and sustained behaviour change. Although financial incentives can boost participant engagement and weight loss, their value in large-scale diabetes prevention remains unclear. Our Pre-DICTED study has suggested that financial incentives, when integrated with a structured stepped care approach, may actually make a difference in lowering diabetes incidence in high-risk individuals with prediabetes.” 

Participants in the intervention group received lifestyle interventions, such as nutrition workshops and exercise sessions. After six months, metformin was introduced for those who remained at high risk of developing diabetes. They also received financial incentives for attending the lifestyle sessions and for achieving five per cent or more weight loss. Participants in the control group received standard care. 

Overall, the intervention cost was around SGD540 per participant, which included financial incentives as well as the cost of running the nutrition workshops and lifestyle interventions. When the researchers compared the cost to the health benefits, they found that the programme cost was about SGD32,126 for each life year gained. This figure is well within the range that experts consider to be good value for money, meaning the programme delivered strong health benefits for its cost. 

Professor Eric Finkelstein from the Health Services Research & Population Health Signature Research Programme at Duke-NUS Medical School, and co-author of the study, said: “Our findings show that modest financial incentives can be a cost-effective way to encourage participants to lower their blood sugar levels, with benefits reflected in improved quality of life as they achieve better control of their diabetes. These results suggest that it may be good value for money for governments or insurers looking to integrate similar approaches into strategies promoting healthy lifestyles, offering novel tools in Singapore’s fight against diabetes.” 

Prediabetes is defined as having impaired fasting glucose or impaired glucose tolerance. This is when blood sugar levels are higher than normal after fasting and after consuming a glucose drink but not elevated enough to be classified as diabetes. Prediabetes increases the risk of progression to type 2 diabetes, but the condition can be reversed by having a healthy diet, staying physically active, and reaching a healthy body mass index (BMI). 

According to the recent National Population Health Survey 2024 Report^[1], diabetes affects about 9.1 per cent of the population. Global prevalence of diabetes is also increasing, with 853 million people projected to be living with diabetes by 2050, according to the International Diabetes Federation. Asians typically have greater risk of developing type 2 diabetes at younger ages and at lower BMI, highlighting an urgent need for targeted prevention strategies. 

Dr Mihir Gandhi, Head, Biostatistics at Singapore Clinical Research Institute (SCRI), and co-author of the study, said: “The Pre-DICTED trial demonstrates the power of rigorous, evidence-based research in tackling public health challenges like diabetes. SCRI is honoured to have contributed to the study by providing the statistical backbone for the study from robust design and randomisation infrastructure to the final analysis. This rigorous framework ensures that the findings are reliable and can confidently guide future healthcare policies.” 

The study was conducted between November 2017 and February 2021 and was funded by Singapore’s Ministry of Health. The results were published in peer-reviewed journal, Diabetes Care, in November 2025.

^{[1] National Population Health Survey (NHPS) 2024 Report: https://www.moh.gov.sg/others/resources-and-statistics/national-population-health-survey--nphs--2024-report/}