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PURPOSE In this paper, we examine the nature of vision and the role it plays in helping educators identify and use theories productively. We also discuss the role of theory in diabetes education and provide criteria for selecting appropriate theories. METHODS The vision of diabetes education developed at the Michigan Diabetes Research and Training Center was used to illustrate how our vision has influenced our use of educational and behavioral theories. RESULTS Both our vision and our theoretical assumptions should be articulated, discussed, debated, and studied. CONCLUSIONS Diabetes patient education research can systematically contribute to the development of a sound, coherent, and progressive body of knowledge that will truly serve diabetes patient education.

Certain questions often arise regarding carbohydrate counting, such as: Why use carbohydrate counting ? Where does one start? How much carbolrydrate is prescribed? How does one balance the diet? How is carbohydrate counting taught to patients? Which patients are the best candidates for carbohydrate counting? This article provides possible answers to these questions based on clinical experience at the Vanderbilt University Medical Center Diabetes Research and Training Center, and the Diabetes Control and Complications Trial.

The use of a team approach to the management of patients using intensive insulin therapy (IIT) has been supported by policy/position statements of both the American Association of Diabetes Educators and the American Diabetes Association. A course designed and taught by a health care team within the Washington University Diabetes Research and Training Center was offered to 18 multidisciplinary health care teams desiring information about initiating IIT programs. Course outcomes demonstrated positive responses to the team approach to team education but raised questions about the actual compo sition and functioning of the health care "team." While a well- defined team with IIT knowledge and skills is essential for the development of a comprehensive and safe approach to IIT programs, it is not clear who should be offering these programs.

An educational needs assessment instrument for individuals with diabetes has been developed at the Michigan Diabetes Research and Training Center. Responses to the 110-item questionnaire provide subscores on con structs labeled "Control Problems, " "Psychosocial Impact," "Barriers to Compliance, " "Benefits of Regimen, " "Regimen Complexity," and "Risk of Complications." Com bined with demographic and clinical information, these scores form a com prehensive summary of the patient's attitudes, beliefs, behaviors, and knowledge in relation to diabetes. This summary is in the form of an individ ualized graphic profile that highlights possible prob lem areas to be consid ered when developing patient education and management plans.

The task of reviewing and critiquing the hundreds of audiovisual programs available for diabetes education is an exceedingly time consuming and tedious activity. To assist the many users of educational audiovisual materials the Outreach Core of the Michigan Diabetes Research and Training Center undertook the review and critique of these programs. Based on specified selection and review cri teria, 35 programs have been chosen for inclusion in a booklet entitled "Recommended Audiovisual Re sources for Diabetes Education. " This booklet is available to any diabetes educator upon request.

Over a three-year period, 202 nurses and dietitians attended professional edu cation courses conducted at the Diabetes Research and Training Center. The courses were designed to develop trainee knowledge and skill for diabetes management and to guide the expansion of patient education programs. Trainees' satisfaction with the course components was high and knowledge changes were significant. Sixty-one percent of the trainees returned a follow- up survey indicating im provements in counseling and teaching skills. Trainees' reports indicated greatest progress in areas over which they had most direct control. Professional education may have positive effects on trainee knowledge, teaching preparation and counseling skills, and patient education programs.