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.