Increase in the pharmacological management of Type 2 diabetes with pay-for-performance in primary care in the UK

Diabet Med. 2015 Jan;32(1):62-8. doi: 10.1111/dme.12575. Epub 2014 Oct 16.


Aims: To determine whether the financial incentives for tight glycaemic control, introduced in the UK as part of a pay-for-performance scheme in 2004, increased the rate at which people with newly diagnosed Type 2 diabetes were started on anti-diabetic medication.

Methods: A secondary analysis of data from the General Practice Research Database for the years 1999-2008 was performed using an interrupted time series analysis of the treatment patterns for people newly diagnosed with Type 2 diabetes (n = 21 197).

Results: Overall, the proportion of people with newly diagnosed diabetes managed without medication 12 months after diagnosis was 47% and after 24 months it was 40%. The annual rate of initiation of pharmacological treatment within 12 months of diagnosis was decreasing before the introduction of the pay-for-performance scheme by 1.2% per year (95% CI -2.0, -0.5%) and increased after the introduction of the scheme by 1.9% per year (95% CI 1.1, 2.7%). The equivalent figures for treatment within 24 months of diagnosis were -1.4% (95% CI -2.1, -0.8%) before the scheme was introduced and 1.6% (95% CI 0.8, 2.3%) after the scheme was introduced.

Conclusion: The present study suggests that the introduction of financial incentives in 2004 has effected a change in the management of people newly diagnosed with diabetes. We conclude that a greater proportion of people with newly diagnosed diabetes are being initiated on medication within 1 and 2 years of diagnosis as a result of the introduction of financial incentives for tight glycaemic control.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / epidemiology
  • Female
  • General Practice* / economics
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemic Agents / economics
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Physician Incentive Plans / economics*
  • Practice Patterns, Physicians' / economics*
  • Primary Health Care* / economics
  • Quality Improvement*
  • Quality of Health Care
  • Reimbursement, Incentive
  • United Kingdom / epidemiology


  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human