Patient activation in individuals with type 2 diabetes mellitus: associated factors and the role of insulin

Figures & data

Table 1 Characteristics of the study population showing differences between those on insulin therapy and those not on insulin therapy

	All	Insulin use	No insulin use	P-value
	N=1,189	n=310 (26.1%)	n=879 (73.9%)
Age (years), mean ± SD	66±10	66±10	66±10	0.856
Sex: female, n (%)	490 (41.2)	145 (46.8)	345 (39.2)	0.021
Educational level: n (%)				0.150
Low	399 (33.6)	111 (35.8)	289 (32.9)
Middle	535 (45.0)	145 (46.8)	390 (44.4)
High	255 (18.9)	54 (17.4)	200 (22.8)
Smoking: yes, n (%)	172 (14.5)	58 (18.7)	114 (13.0)	0.016
Alcohol: yes, n (%)	560 (47.1)	117 (37.7)	443 (50.4)	<0.001
Diabetes duration (years), median (IQR)	10 (11)	16 (12)	7 (9)	<0.001
Treatment in primary care, n (%)	1,043 (87.7)	174 (56.1)	869 (98.9)	<0.001
Microvascular complications, n (%)	430 (36.2)	153 (49.4)	277 (31.5)	<0.001
Macrovascular complications, n (%)	298 (25.1)	97 (31.3)	201 (22.9)	0.004
BMI (kg/m^2), median (IQR)	29 (7)	30 (7)	29 (7)	<0.001
SBP (mmHg), mean ± SD	137±17	139±19	136±16	0.009
HbA1c (%), mean ± SD	7.0±1.0	7.7±1.1	6.8±0.7	<0.001
HbA1c (mmol/mol), mean ± SD	53±11	61±12	50±8
LDL cholesterol (mmol/L), mean ± SD	2.4±0.9	2.4±0.9	2.4±0.9	0.760
PAM-13 score, mean ± SD	59±12	58±12	59±12	0.258
PAM level, n (%)				0.639
1	175 (14.7)	51 (16.5)	124 (14.1)
2	266 (22.4)	73 (23.5)	193 (22.0)
3	561 (47.2)	139 (44.8)	422 (48.0)
4	187 (15.7)	47 (15.2)	140 (15.9)
EQ-5D, median (IQR)	0.84 (0.23)	0.81 (0.28)	0.84 (0.23)	<0.001
BIPQ, mean ± SD
1. Consequence	4.2±2.7	5.6±2.4	3.7±2.6	<0.001
2. Timeline	8.5±2.6	9.5±1.4	8.1±2.8	<0.001
3. Personal control	6.8±2.1	7.1±1.7	6.6±2.3	<0.001
4. Treatment control	7.4±2.2	7.9±1.8	7.3±2.3	<0.001
5. Identity	3.6±2.6	5.0±2.5	3.1±2.5	<0.001
6. Illness concern	4.8±2.9	5.8±2.7	4.4±2.9	<0.001
7. Coherence	6.9±2.2	7.4±1.7	6.8±2.4	<0.001
8. Emotional representation	3.1±2.9	4.6±3.0	2.6±2.6	<0.001
ADDQoL, median (IQR)	−0.40 (1.17)	−1.06 (1.64)	−0.25 (0.84)	<0.001
Social support, n (%)				0.579
Very good	285 (24.0)	74 (23.9)	211 (24.0)
Good	814 (68.5)	213 (68.4)	601 (68.4)
Poor	69 (5.8)	20 (6.5)	49 (5.6)
Very poor	21 (1.8)	3 (1.0)	18 (2.0)
PAID-5, median (IQR)	4 (6)	6 (7)	3 (5)	<0.001

Abbreviations: ADDQoL, Audit of Diabetes-Dependent Quality of Life; BIPQ, Brief Illness Perception Questionnaire; BMI, body mass index; EQ-5D, EuroQol 5D; LDL, low-density lipoprotein; PAID, Problem Areas In Diabetes; PAM, Patient Activation Measure.

Table 2 Multivariate analyses of factors associated with patient activation

	β	95% CI	P-value
Insulin use	0.22	−1.53 to 1.97	0.809
Age (every year increase)	−0.04	−0.12 to 0.03	0.274
Educational level
Low	−3.33	−5.13 to −1.54	<0.001
Middle	−1.18	−2.86 to 0.40	0.166
High	Ref.	Ref.
Smoking	−0.35	−2.20 to 1.50	0.708
Alcohol	−0.40	−1.69 to 0.89	0.542
Diabetes duration (every year increase)	0.05	−0.03 to 0.14	0.208
Macrovascular complications	−0.94	−2.40 to 0.52	0.206
BMI (every kg/m^2 increase)	−0.05	−0.18 to 0.07	0.401
SBP (every mmHg increase)	−0.03	−0.07 to 0.02	0.232
HbA1c (every % increase)	−0.22	−0.97 to 0.54	0.572
HbA1c (every mmol/mol increase)	−0.02	−0.09 to 0.05
LDL (every mmol/L increase)	0.04	−0.75 to 0.83	0.919
EQ-5D (one unit increase)	4.37	0.90 to 7.85	0.014
BIPQ (one unit increase)
1. Consequence	0.02	−0.35 to 0.39	0.916
2. Timeline	−0.71	−1.00 to −0.42	<0.001
3. Personal control	0.38	0.03 to 0.73	0.033
4. Treatment control	0.26	−0.09 to 0.60	0.144
5. Identity	−0.02	−0.41 to 0.37	0.917
6. Illness concern	−0.04	−0.36 to 0.27	0.794
7. Coherence	1.27	0.92 to 1.62	<0.001
8. Emotional representation	−0.16	−0.50 to 0.18	0.362
ADDQoL (every unit increase)	0.22	−0.58 to 1.02	0.586
Social support
Very good	4.64	3.12 to 6.16	<0.001
Good	Ref.	Ref.
Poor	−1.00	−3.85 to 1.84	0.488
Very poor	5.23	0.46 to 10.00	0.032
PAID (every unit increase)	−0.13	−0.37 to 0.11	0.299

Notes: Reference categories: macrovascular complications absent; alcohol: no; smoking: no; and insulin: no. Ref, reference category; β, regression coefficient.

Abbreviations: ADDQoL, Audit of Diabetes-Dependent Quality of Life; BIPQ, brief illness perception questionnaire; BMI, body mass index; EQ-5D, EuroQol 5D; LDL, low-density lipoprotein; PAID, Problem Areas In Diabetes; PAM, Patient Activation Measure; LDL, low-density lipoprotein; Ref, reference.