The American Association of Diabetes Educators (AADE) is the professional association representing diabetes educators and the field of diabetes education. AADE's vision is to be the leading authority in diabetes self-management training and in lifestyle management for the prevention of diabetes.

To advance this vision, AADE has invested over seven years of resources to develop a framework of standards for behavioral measurement in diabetes self-management training (DSMT). This framework more accurately reflects the best practice of DSMT by measuring behavioral outcomes rather than solely focusing on completion of required content areas as specified in the National Standards for DSMT (See Figure 1 to the left).

The primary goal of diabetes education is to provide knowledge and skill training, as well as help individuals identify barriers, facilitate problem-solving and develop coping skills to achieve effective self-care management and behavior change. It is the position of AADE that all educators should measure both individual and aggregate AADE 7 Self-Care Behaviors™ at a minimum of pre- and post- intervention. Additional follow-up measurements are ideal, and should be applied as appropriate to the practice setting.

Through adoption of the AADE 7 Self-Care Behaviors™, (listed in Figure 2 on the right) educators are able to determine their effectiveness with individuals and populations, compare their performance with established benchmarks and measure and quantify the unique contribution that DSMT plays in the overall context of diabetes care. (Mulcahy, K., et al., 2003.)

AADE Outcomes Measurement Standards

In the September/October issue of The Diabetes Educator (TDE 29[5]) AADE published its Position Statement on Standards for Outcomes Measurement of Diabetes Self-Management Education. The Standards elaborate the five areas shown in Figure 1 above and listed below:

1. Behavior change is the unique outcome measurement for diabetes self-management education.
2. Seven diabetes self-care behavior measures determine the effectiveness of diabetes self-management education at individual, participant, and population levels (see Figure 2).
3. Diabetes self-care behaviors should be evaluated at baseline and then at regular intervals after the education program.
4. The continuum of outcomes, including learning, behavioral, clinical, and health status, should be assessed to demonstrate the interrelationship between DSME and behavior change in the care of individuals with diabetes.
5. Individual patient outcomes are used to guide the intervention and improve care for that patient. Aggregate population outcomes are used to guide programmatic services and for continuous quality improvement activities for the DSME and the population it serves.

The continuum of outcomes referred to in Standard 4 (above) is important because it acknowledges the full impact of diabetes education in the care of the person with diabetes, illustrated here in Figure 3, shown on the right.

The final standard refers to the necessity to gather data and measure outcomes for both the individual with diabetes and for an aggregate population. Aggregate data guide program development and quality improvement efforts at the diabetes program. The AADE 7™ framework supports this by describing a full-spectrum approach. This includes the AADE 7™ measurement methodology; tools and a data model that can be applied at a program and/or integrated into existing data platforms and EMR management systems; and the eventual development of a diabetes data repository that is expected to include a diabetes educator and program registry. This approach is pictured immediately below in Figure 4.

In this day of evidence-based medicine, diabetes educators must gather the evidence to support their practices and modify their approaches in response to the evidence. Applying the AADE standards for outcomes measurement of DSMT will provide the educator with the tools to understand what is working and what is not. As the profession of diabetes education matures, we must establish our own core of knowledge about our practice. The 5 DSMT Outcomes Standards complement the foundation of the National Standards for DSMT to create a full circle of quality in the delivery of education and care to people with diabetes. It is only with the clear understanding and adoption of standards and core measures for DSMT outcomes measurement that the profession will progress to a level of maturity that establishes DSMT as an essential therapeutic intervention in the care of people with diabetes.

AADE gratefully acknowledges and thanks our many volunteers who have worked on this framework, the 80 diabetes programs that have prototyped these methods, the 1,500 diabetes patients that participated in the prototype tests, the AADE leadership and staff, and our IT vendor partners, for developing these standards, methods and tools to improve diabetes education, and to improve the lives of the millions of people with diabetes in the United States and around the world. We also acknowledge with much gratitude that the outcomes development work for the AADE 7™ has benefitted from the generous support of seven major corporations in the diabetes field, whose logos are pictured below.