Does patient activation predict the course of type 2 diabetes? A longitudinal study.

OBJECTIVE

To examine whether patient activation is predictive of the course of diabetes over a three year period among patients with and without diabetes.

METHODS

Longitudinal analyses utilized electronic health record data from 2011 to 2014. We examined how the patient activation measure (PAM) was predictive of 2014 diabetes-related outcomes among patients with diabetes (n=10,071); pre-diabetes (n=1804); and neither diabetes nor pre-diabetes (n=46,402). Outcomes were clinical indicators (blood pressure, cholesterol, and trigylcerides), costly utilization, and progression from no diabetes to pre-diabetes or diabetes.

RESULTS

Higher PAM level predicted better clinical indicator control in patients with diabetes. In patients with pre-diabetes, PAM level predicted better clinical indicator control, and those in the highest level of PAM in 2011 had lower odds of having a hospitalization compared to those in the lowest level. In patients without diabetes or pre-diabetes in 2011, higher PAM level was associated with lower odds of developing pre-diabetes.

CONCLUSIONS

More activated patients with diabetes and pre-diabetes had better outcomes than less activated patients. More activated patients without diabetes or pre-diabetes were less likely to develop pre-diabetes over a three year period.

PRACTICE IMPLICATIONS

Strategies to improve patient activation may be useful to help curb the diabetes epidemic.