title: Development of a New Tool to Assess Bolus Calculation and Carbohydrate Estimation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany .|2 Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg , Germany .
authors.forename: Dominic
authors.initials: D
authors.lastname: Ehrmann
authors.affiliation: 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany .|2 Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg , Germany .|3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany .
authors.forename: Norbert
authors.initials: N
authors.lastname: Hermanns
authors.affiliation: 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany .|3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany .
authors.forename: André
authors.initials: A
authors.lastname: Reimer
authors.affiliation: 4 Roche Diabetes Care , Roche Diagnostics Germany, Mannheim, Germany .
authors.forename: Jörg
authors.initials: J
authors.lastname: Weißmann
authors.affiliation: 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany .|3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany .
authors.forename: Thomas
authors.initials: T
authors.lastname: Haak
authors.affiliation: 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany .|2 Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg , Germany .|3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany .
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kulzer
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy*; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000009:adverse effects; D054796:Drug Dosage Calculations; D005260:Female; D017144:Focus Groups; D005858:Germany; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human