Psychosocial Aspects


Donkers E, Dekker P, Winterdijk P, Mul D, Sas T, de Vries M, Veeze HJ, Aanstoot HJ, Nefs G, Eilander M.

The Qualimeter: Improving care for children and adults with type 1 diabetes by measuring and discussing Quality of Life. ICHOM 2019 conference.

Although type 1 diabetes care has seen many improvements over the years, still only 30% of people with type 1 diabetes reach guideline-defined glycemic treatment goals. Thus, improving self-care could greatly improve clinical outcomes and quality of life (QoL) while simultaneously decreasing the burden on the healthcare system.


Diabeter has negotiated contracts with healthcare insurers based on outcomes as opposed to volume or budget. This requires a transparent measurement system including patient-reported outcome measures (PROMs) in addition to clinical parameters. The International Consortium for Health Outcomes Measurement (ICHOM) suggests multi-item PROMs only for adults in their data collection reference guide.


Diabeter aimed to develop an easy to use one-item questionnaire which can be used during consultation visits. The Qualimeter is a one-item moodscale to measure QoL in people with type 1 diabetes, consisting of the first item of the My-Q QoL questionnaire. In a pilot study at one of Diabeter’s locations, people with type 1 diabetes aged 5 ≥ years were asked to rate their life on a likert scale of 0–10 (low–high). Children aged 5–9 years old (5–6 year old children helped by their parents) rated their life on an adapted version of the Visual Analogue Mood Scale, with 5 smileys. Prior to implementation of the Qualimeter, the Session Rating Scale (SRS) was used to assess ratings of the consultation visitof both people with type 1 diabetes and HCPs. This tool measures the tendency to build alliances (maximum possible score of 40: a score of <36 may be a reason to discuss the results with participants).


Key findings:

  • HCPs in the pilot study found the Qualimeter to be a user friendly and accessible instrument.
  • During 98% of consultations, HCPs discussed the results in the treatment room.
  • Both people with diabetes and HCPs mentioned that the quality of the conversations improved.
  • A total of 158 people with diabetes filled out the Qualimeter with a mean (SD) score of 7.6 (1.3) and median (IRQ) of 8.0 (1.5).
  • SRS baseline scores showed that only 4% of HCPs had SRS ≥36, compared with 50% of people with diabetes, suggesting issues needing follow-up in order to improve the care experience for HCPs and people with diabetes.


These preliminary results suggests the Qualimeter is a suitable PROM and facilitates discussion of QoL in regular care due to its ease of use, simplicity, and quality improvement of the conversation. Use of the Qualimeter will be a first step to measure QoL in a structured way. This piltot study is currently being followed up by a Diabeter-wide implementation and assessment of the imact of the Qualimeter after 4 months of use.


Click here for the poster presented at the 2019 ICHOM Conference in Rotterdam.

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