Ehrmann Dominic, Hermanns Norbert, Reimer André, Weißmann Jörg, Haak Thomas, Kulzer Bernhard
1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany .
2 Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg , Germany .
Diabetes Technol Ther. 2016 Mar;18(3):194-9. doi: 10.1089/dia.2015.0292. Epub 2016 Feb 23.
Carbohydrate estimation and bolus calculation are two important skills for handling intensive insulin therapy and effectively using bolus calculators. Structured assessment of both skills is lacking. A new tool for the assessment of skills in carbohydrate estimation and bolus calculation was developed and evaluated.
A new assessment tool (SMART) was developed that included 10 items for bolus calculation and 12 items for carbohydrate estimation. In total, 411 patients on intensive insulin treatment were recruited. Different parameters of glycemic control were used as validity criteria.
The SMART tool achieved good reliability for the assessment of bolus calculation (Cronbach's α = 0.78) and sufficient reliability for the assessment of carbohydrate estimation (Cronbach's α = 0.67). A good bolus calculation skill was significantly associated with lower glycated hemoglobin values (r = -0.27), lower mean blood glucose levels (r = -0.29), and higher fluctuation of blood glucose control (r = -0.43). A good carbohydrate estimation skill was significantly associated with a lower frequency of severe hyperglycemia (r = -0.27) and a higher frequency of euglycemia (r = 0.26).
SMART is a reliable and valid tool for the assessment of both skills. Bolus calculation as well as carbohydrate estimation was associated with glycemic control. With the help of SMART, important skills for the management of intensive insulin therapy can be assessed separately. Thus, in clinical practice patients in need of assistance from a bolus calculator can be identified.
碳水化合物估算和大剂量胰岛素计算是强化胰岛素治疗及有效使用大剂量胰岛素计算器的两项重要技能。目前缺乏对这两项技能的结构化评估。为此开发并评估了一种用于评估碳水化合物估算和大剂量胰岛素计算技能的新工具。
开发了一种新的评估工具（SMART），其中包括10项大剂量胰岛素计算项目和12项碳水化合物估算项目。共招募了411名接受强化胰岛素治疗的患者。将不同的血糖控制参数用作效度标准。
SMART工具在评估大剂量胰岛素计算方面具有良好的信度（克朗巴哈系数α = 0.78），在评估碳水化合物估算方面具有足够的信度（克朗巴哈系数α = 0.67）。良好的大剂量胰岛素计算技能与较低的糖化血红蛋白值（r = -0.27）、较低的平均血糖水平（r = -0.29）以及较高的血糖控制波动（r = -0.43）显著相关。良好的碳水化合物估算技能与较低的严重高血糖发生率（r = -0.
