Delay Discounting, Glycemic Regulation and Health Behaviors in Adults with Prediabetes

Abstract

The majority of people with prediabetes transition to type 2 diabetes. Research has suggested that persons with type 2 diabetes are likely to discount the future and focus on immediate rewards. This study was designed to assess whether this process of delay discounting (DD) is associated with glycemic regulation, medication adherence and eating and exercise behaviors in adults with prediabetes. Participants included 81 adults with prediabetes who were also prescribed hypertension or dyslipidemia drugs, which is common for people with prediabetes. Participants completed adjusting amount DD $100 and $1000 tasks, as well assessments of glycemic control (Hemoglobin (Hb) A1c), medication adherence, diet quality, and objectively measured physical activity. Relationships between DD and these variables were assessed. Results showed higher rates of DD were related to higher HbA1c; as well as poorer medication adherence, lower diet quality and lower physical activity. Hierarchical regression showed that the association between minority status, a known risk factor for type 2 diabetes, was moderated by DD, as minorities with higher DD had greater HbA1c values. Delay discounting may represent a novel target to prevent progression from prediabetes to type 2 diabetes.

Keywords:

• delay discounting
• diet quality
• glycemic control
• medication adherence
• physical activity
• prediabetes

Disclosure statement

Dr. Epstein was a consultant and had equity in Daltri when the study was implemented. Dr. Bickel is a consultant or has equity in HealthSim LLC, NotifiUs LLC, Sober Grid Inc., DxRx, Prophase LLC, Teva Branded Pharmaceuticals, General Genetic Corporation. The other authors do not declare any conflict of interest with respect to the authorship or publication of this article.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendment of comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

Additional information

Funding

This research was funded in part by the National Institutes of Health (NIH) Science of Behavior Change Common Fund Program through an award administered by the National Institute of Diabetes and Digestive and Kidney Diseases (1UH2DK109543), awarded to Drs. Epstein and Bickel.