Diabetes Risk Communication Tool Evaluation


Type 2 Diabetes (T2D) has been a public health challenge in Singapore posing a major burden on the healthcare system. Prevention for T2D has been vast but with limited success. Existing literature suggests that while Singaporeans have high knowledge about T2D, its symptoms, and risk factors, they did not translate into healthy practices. Upon a qualitative investigation, it was found that the solution lies in communicating the risk of diabetes in a more salient, effective, and memorable way. Relative risk demonstrated via visual diagrams and analogies has shown to have a bigger emotional impact on people, which can promote the intention of behaviour change for a healthier lifestyle. The current diabetes risk assessment used by Health Hub (BEAT Diabetes) is geared for 18-39-year-olds. However, those aged 40 years and above are at a higher risk of diabetes compared to those younger than 40 years. Additionally, the BEAT Diabetes tool's result page provides a binary output: "Higher vs Lower" Risk of being diabetic. This aligns with the usual care practiced in clinics currently; patients are told if they are pre-diabetic or not. While BEAT Diabetes recommends and provides information on how to get a health screening, it does not provide any personalized or relevant tips on how to reduce risk. Hence, there was a demonstrated need to developed risk assessment tools that increase threat appraisal and communicate T2D risk in a more emotionally salient way to motivate immediate behaviour change. With this insight and multiple rounds of public and expert consultation, the investigators developed two tools: Relative Risk, and Metabolic Age. The Relative Risk prototype demonstrates the user's relative risk on a scale of 1 to 10, in comparison to someone of the same age and sex. The number 1-10 represents their position in the percentile distribution of their risk scores. The risk score is modeled based on Singapore Population Health Study (SPHS) cohorts and includes the following measurement: height, weight, hypertension, triglycerides, HbA1C, and presence of parental history of T2D. The Metabolic Age is identified by matching the risk score's percentile position in the cohort distribution to the same percentile of the cohort distribution by the incidence of T2D. The median age of the people in that percentile is reflected as the metabolic age. This additional information addresses the present bias of only communicating the risk of developing a disease in ten years. The metabolic age reflects the current status of the body. The objective of this study is to evaluate which of these risk presentations (Usual care, relative risk, or metabolic age) evoke emotional responses to motivate the intention of behaviour change. Participants who have been identified to have an elevated risk of T2D through a recent health screening will be randomised into one of these three exposures. The hypothesis is that those who are exposed to the Metabolic Age risk communication tool will have the highest intention of engaging in behaviour change, followed by those exposed to relative risk, and then standard of care.

Full Title of Study: “Evaluation of Diabetes Risk Communication Tool to Promote Behaviour Change for Prevention of Type 2 Diabetes”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: Single (Participant)
  • Study Primary Completion Date: December 15, 2022


  • Behavioral: T2D Risk Communication Tool: Relative Risk
    • Risk of T2D is presented in comparison to the rest of the Singapore population. This is to evoke an emotional response to increase the motivation for behaviour change so as to reduce the risk of T2D and prevent or delay future diagnosis.
  • Behavioral: T2D Risk Communication Tool: Metabolic Age
    • Risk of T2D is presented as an age, compared to their chronological age as a proxy for their current health status. This is to evoke an emotional response to increase the motivation for behaviour change so as to reduce the risk of T2D and prevent or delay future diagnosis.
  • Behavioral: T2D Risk Communication Tool: Traffic Light
    • Risk of T2D is presented as either High (Red) or Low (Green). This is the tool that is currently available for residents of Singapore to use to assess their risk of T2D.

Arms, Groups and Cohorts

  • Active Comparator: Usual Care
  • Experimental: Relative Risk
  • Experimental: Metabolic Age

Clinical Trial Outcome Measures

Primary Measures

  • Differences in reaction to risk communication between arms
    • Time Frame: 1 week
    • Participants’ cognitive and emotional responses to their risk result are assessed using 6 items like “I found the results worrying” and “I am reassured by these results”. 3 additional items are used to assess their reaction to the process and confidence towards the tool by asking about their understanding of the results and if they will encourage others to use the tool. Participants will answer these on a 5-point scale, ranging from ‘strongly disagree’ to ‘strongly agree.’
  • Differences in behaviour Intention between arms
    • Time Frame: 1 week
    • Assessed using 10 items to understand the intention to improve their health-promoting behaviours after they have gone through one of the risk assessment tools. Items ask questions like “After seeing my results, I intend to have fewer sugary drinks (soda, fruit juice, bubble tea) in a week” and “After seeing my results, I intend to do more moderate to vigorous exercise (ie brisk walking, jogging, weight lifting, etc) in a week” Responses are evaluated on a 5-point scale, from “Extremely Unlikely to Extremely Likely”.

Participating in This Clinical Trial

Inclusion Criteria

  • Aged 30-60 years; – Singapore citizen, or permanent resident – Able to read and understand English, – Have had a health screening with blood pressure, triglycerides, and HbA1C done within the last 3 months – At least one risk factor for Type 2 Diabetes (BMI ≥ 23 kg/m2, blood pressure ≥130/85 mmHg or receiving therapy for hypertension, triglycerides ≥1.7mmol/L or HbA1c ≥5.7%) Exclusion Criteria:

  • Diagnosis of any event of cardiovascular disease, kidney issues, or type 2 diabetes

Gender Eligibility: All

Minimum Age: 30 Years

Maximum Age: 60 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • National University, Singapore
  • Collaborator
    • National Medical Research Council (NMRC), Singapore
  • Provider of Information About this Clinical Study
    • Principal Investigator: Huso Yi, Assistant Professor – National University, Singapore
  • Overall Official(s)
    • Huso Yi, PhD, Principal Investigator, National University, Singapore
  • Overall Contact(s)
    • Huso Yi, PhD, 6516 4988, husoyi@nus.edu.sg

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