Role of delay discounting in predicting change in HBA1c for individuals with prediabetes

  • Leonard H. EpsteinEmail author
  • Rocco A. Paluch
  • Jeff S. Stein
  • Alexandra M. Mellis
  • Teresa Quattrin
  • Lucy D. Mastrandrea
  • Kyle A. Bree
  • Mark H. Greenawald
  • Warren K. Bickel


The majority of people with prediabetes transition to type 2 diabetes. Weight gain is a known predictor of increasing the risk of diabetes, but another reason may be a focus on immediate rewards and discounting of the future. Delay discounting (DD: devaluation of future consequences) is related to obesity and poor glycemic control in persons with type 2 diabetes. This study was designed to assess whether changes in DD are associated with HbA1c change beyond BMI change in individuals with prediabetes. Hierarchical regression showed changes in BMI (p = 0.008) and the $1000 DD task (p = 0.04) were associated with HbA1c change beyond demographic characteristics, with the full model accounting for 25.8% of the variance. Those with greater BMI increases and greater increases in discounting of the future showed the greatest increases in HbA1c. DD represents a novel target to prevent progression from prediabetes to type 2 diabetes.


Delay discounting Prediabetes Glycemic control 



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.

Compliance with ethical standards

Conflict of interest

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 authors Paluch, Stein, Mellis, Quattrin, Mastrandrea, Bree and Greenawald 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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Leonard H. Epstein
    • 1
    Email author
  • Rocco A. Paluch
    • 1
  • Jeff S. Stein
    • 2
  • Alexandra M. Mellis
    • 2
  • Teresa Quattrin
    • 1
  • Lucy D. Mastrandrea
    • 1
  • Kyle A. Bree
    • 1
  • Mark H. Greenawald
    • 2
  • Warren K. Bickel
    • 2
  1. 1.Department of Pediatrics, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloUSA
  2. 2.Virginia Tech Carilion Research InstituteRoanokeUSA

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