INcreasing Veteran EngagemeNT to Prevent Diabetes (INVENT)

There is tremendous national enthusiasm for translating and disseminating efficacious
strategies to prevent type 2 diabetes mellitus (T2DM). Yet, little attention has been devoted
to how the investigators can better leverage the processes through which patients receive
information about prevention of T2DM to better engage them in such prevention. Further,
despite efforts to disseminate structured programs, many patients at high risk for developing
T2DM may still be unable or unwilling to access them. In these cases, increasing patient
engagement in individually directed lifestyle change or pharmacotherapy is critical.
Strategies developed in the fields of behavioral economics and health psychology hold
significant promise for improving Veteran engagement in each of these approaches. To date,
however, these strategies have rarely been translated into real-world settings where they
could benefit Veterans. This novel work will address this critical gap and could transform
communication with Veterans about prevention in ways that will improve their health outcomes.

The following 5 strategies will be implemented in the weekly messages that study participants
will receive: (1) tailoring to aspirations in life; (2) implementation intentions; (3)
preference checklists; (4) urgency framing; (5) social norms. The investigators will
implement these strategies alone and in combination in a 16-arm factorial design experiment.

Inclusion Criteria:

1. HbA1c test within the past 6 months that meets the ADA/CDC requirements for
prediabetes.

2. Currently registered in the VA's MyHealtheVet Secure Messaging System

3. Receiving care within the Ann Arbor VA Healthcare System

Exclusion Criteria:

1. Completed more than 4 VA MOVE! classes in the last year (or other evidence of another
recent weight loss program)

2. Are trying to lose weight and are very physically active

3. Are >75 years of age

4. Are pregnant or plan to be

5. Are taking Metformin

6. Have participated in the FINDIT study (this study's predecessor under the same grant
funding)

7. Have been hospitalized or received rehab for stroke or myocardial infarction within
past 6 months

8. Have received chemotherapy for cancer in the past 6 months

9. Self-report or have any International Classification of Diseases (ICD-9/10) codes for:

- Diabetes

- Dementia

- Major functional limitations

- Cirrhosis

- Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 4 chronic
obstructive pulmonary disease (COPD)

- End stage renal disease (ESRD)

- New York Heart Association (NYHA) class III or IV congestive heart failure (CHF)