Joint influence of patient-assessed chronic illness care and patient activation on glycaemic control in type 2 diabetes

Abstract

To examine the association of the Patient Assessment of Chronic Illness Care (PACIC) with glycaemic control and the modulating effect of patient activation on this association. A population-based prospective cohort study of people with type 2 diabetes in Queensland, Australia, using data from self-report questionnaires, collected annually from 2008 (N = 3761) to 2010 (N = 3040). Predictors were the 20-item PACIC (dichotomized at the score of 3), and the 13-item Patient Activation Measure (PAM), dichotomized into activation levels 1 and 2 versus levels 3 and 4. Analyses were restricted to participants whose PACIC and PAM categories did not change over 2 years of follow-up. Outcome variable was self-reported HbA1c of ≤ 7% (53 mmol/mol) versus >7%. An inverse probability-weighted Poisson regression with a log-link function and a binary response outcome variable (HbA1c) was used to obtain risk ratios (RRs), and the interaction between PACIC and PAM was statistically modelled, taking into consideration patient characteristics and baseline glycaemic status. The effect of the PACIC was not seen in the activated participants (adjusted RR: 1.1; 95% CI: 0.96-1.2; P = 0.20) but was strongly observed in participants with low activation (adjusted RR: 2.3; 95% CI: 1.6-3.1; P < 0.001). Similarly, there was a positive association between patient activation and glycaemic control when the PACIC was low (adjusted RR: 1.6; 95% CI: 1.3-2.0; P < 0.001). Better patient-assessed chronic care received consistently over time facilitates achievement of better glycaemic control in patients with low activation.