A national consensus on outcomes and indicators for diabetes patient education.

AIM: To develop a national evidence and consensus position on the desired goals, outcomes and indicators of diabetes patient education (DPE). METHODS: A mixture of qualitative and quantitative methods were used including: (i) literature reviews to identify existing definitions, issues and work in the area; (ii) interviews with key opinion leaders; (iii) focus groups with people with diabetes; (iv) a national survey of diabetes education service providers; (v) a systematic consultation process culminating in a national stakeholder forum. RESULTS: Three overarching goals were identified as the main purpose of diabetes patient education: (i) optimal adjustment to living with diabetes, (ii) optimal health outcomes and (iii) optimal cost-effectiveness (for the individual and for society). Given the difficulty in attributing cause and effect between education and clinical or cost outcomes and that mechanisms already exist for collecting data on clinical endpoints and surrogate indicators, the development of education indicators concentrated on the goal of optimal adjustment to living with diabetes. Four key outcomes for this goal were listed in order as either directly attributable to DPE or in which DPE plays a discernable role: knowledge and understanding, self-determination, self-management and psychological adjustment. CONCLUSIONS: The consensus position represents a sound evidence-informed platform on which diabetes education policy, programmes, data collection and research can be based. However, further work was required to test and make recommendations about applying potentially relevant psychometric tools to measure changes in the identified indicators.

Are current psychometric tools suitable for measuring outcomes of diabetes education?

AIMS: To critically appraise the suitability, validity, reliability, feasibility and sensitivity to change of available psychometric tools for measuring the education outcomes identified in the (Australian) National Consensus on Outcomes and Indicators for Diabetes Patient Education. METHODS: Potentially suitable psychometric measurement tools were identified through a two-step process. Step 1: a structured semi-systematic literature review and consultation with experts; step 2: development of inclusion criteria and a formal, purpose-designed, systematically derived Appraisal Checklist-from the literature and with expert psychometric advice-to critically appraise the identified tools for relevance, validity, reliability, responsiveness to change, burden, feasibility and acceptability. RESULTS: Searching medline, PubMed, PsycINFO and cinhal yielded 37 diabetes-specific and generic measurement tools. Eleven of these did not address the research questions, leaving 26 tools. Of these, 11 assessed indicators of psychological adjustment; seven assessed various domains of self-determination; five measured self-management behaviours, for example, foot care, blood glucose testing and lifestyle domains; and three measured diabetes knowledge und understanding, respectively. When the Appraisal Checklist was applied, only three tools met all criteria, namely the Problem Areas in Diabetes (PAID) scale, the Summary of Diabetes Self-Care Activities (SDSCA) scale and the Appraisal of Diabetes Scale (ADS). However, a number of other suitable tools [i.e. the Diabetes Integration Scale (ATT19), the Diabetes Health Profile (DHP-1/18), the Self-Care Inventory-Revised (SCI-R), the Diabetes Management Self Efficacy Scale Australian/English version (DMSES-A/E), the Diabetes Empowerment Scale-Short Form (DES-SF)] met all except one criteria, that is, either no formal test-retest or no responsiveness to change data. CONCLUSIONS: Although numerous tools were identified, few met rigorous psychometric appraisal criteria. Issues of suitability, adequate psychometric testing for the intended purpose, burden and feasibility need to be considered before adopting tools for measuring diabetes education outcomes.

Effect of ambient temperature and humidity on performance of blood glucose meters.

The accuracy of four blood glucose meters (Accutrend, ExacTech Companion, Medisense Companion 2, and Glucometer III) was tested at temperatures ranging from 4 to 44 degrees C (control solutions) and 8 degrees C, 24 degrees C, and 36 degrees C (venous blood) and at humidities of 60% and 80%. Low and high temperatures resulted in a number of statistically significant changes in glucose readings with all meters. However, Accutrend, Medisense Companion 2, and Glucometer III were 100% clinically accurate at all temperatures. With the ExacTech Companion, only 70.8% of control solution and 55.6% of venous blood results were clinically accurate. The main errors were: (1) cold temperatures lowered the result so that euglycaemic levels erroneously read in the hypoglycaemic range and hyperglycaemic levels gave a better than actual result and (2) hot temperatures increased the result whereby hypoglycaemic levels falsely gave a euglycaemic result. Weather conditions at which blood glucose meters may be operated can affect results and potentially lead to errors in clinical decisions.