A national consensus on outcomes and indicators for diabetes patient education

To develop a national evidence and consensus position on the desired goals, outcomes and indicators of diabetes patient education (DPE). 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. 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. 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.