OBJECTIVES: Successfully managing type 2 diabetes (T2DM) depends upon patients’ willingness to self-monitor and regulate their health behaviors (e.g., diet, exercise). “Activated” patients exhibit greater health management and better health outcomes, but it is unclear whether these effects depend on patients' access to support systems. We examined whether social support moderated the influence of patient activation on preventive steps to self-manage diabetes and diabetes-related complications.

METHODS: European adults reporting a diagnosis of T2DM on the 2021 National Health and Wellness Survey were stratified by health-management capability using the Patient Activation Measure (PAM Levels 1-4). Social support was evaluated using the Medical Outcomes Study Social Support Survey (median total score >30 indicated high social support). Nested generalized linear models were compared using the Likelihood Ratio Test (LRT X²) to evaluate whether the covariate-adjusted contributions of patient activation, social support, and their interaction significantly improved the prediction of diabetes-related outcomes.

RESULTS: 3,994 adults with T2DM were evaluated. Most respondents were actively managing their health (73%, PAM Level 3-4) at the time of survey. PAM was positively associated with the number of preventive steps used to self-manage diabetes (p<0.001), irrespective of social support (p=0.10) or the PAM*Social Support interaction (p=0.39). However, for diabetes-related complications, the effect of PAM depended on social support (X² for interaction: 9.34(3); p=0.03): PAM was unrelated to diabetes complications when social support was low (p values ≥ 0.11), but adults with PAM ≥ Level 2 reported significantly fewer diabetes complications than adults with PAM Level 1 (p values ≤ 0.02) when social support was high. Highly activated patients (Level 4) appeared to selectively benefit from increased social support (p<0.01).

CONCLUSIONS: Patient activation can empower patients to engage in the lifestyle changes necessary for successful diabetes management, but clinical benefits may be best realized among those with greater social support.