A randomised controlled trial in diabetes demonstrating the positive impact of a patient activation strategy on diabetes processes and HbA1c: The WICKED project.

Syed M R Gillani, Alan M Nevill, Baldev M Singh


Background: Patient activation is a demonstration of people participating effectively in their own care as measurable in objective outcomes. Techniques of activating patients are various.

Aims: We developed a structured information booklet to promote patient activation and report the 1-year outcomes of a randomised controlled trial assessing its impact on diabetes care processes and on glycaemic control.

Design and setting: It is an open label cluster randomised trial involving all people with diabetes aged more than 18 years within Wolverhampton Clinical Commissioning Group.

Methods: All people with diabetes were cluster randomised into a group who were multiply mailed (MM) at 0, 3 and 6 months whilst a control group was mailed once at 3 months. Comparison of a Failed Process Score (FPS) between active and control groups was performed at 0, 3 and 12 months and of HbA1c at baseline and 12 months.

Results: FPS improved significantly with multiple mailing (p=0.013), with particular impact on those with poor baseline FPS (≥2) (achieved FPS ≤1 at 12 months 49.2% vs. 46.0%, χ2=6.09, p<0.05). Overall HbA1c% across the year (adjusted) was significantly better with MM (p=0.021), with specific impact in those with a baseline HbA1c ≤7.5 (MM HbA1c% 6.7±0.07 (mean±SEM) vs. 7.0±0.09; mean±SEM difference 0.3±0.1, F=11.1, p=0.009).

Conclusion: The direct provision of structured information to people with diabetes activates them to engage in their care delivery as reflected in care process and glycaemic control outcomes.


diabetes, care delivery, patient activation, patient engagement, key care processes

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DOI: http://dx.doi.org/10.15277/bjd.2017.134


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