Background: This article describes the results of qualitative work aiming to highlight and understand the experiences of older adults who have lived with type 2 diabetes (T2DM) for approximately 20 years. Methods: Twenty-eight participants (mean age, 70 years) were interviewed using a triangulated research design of in-depth, semistructured interviews, two quantitative questionnaires and the main findings from theoretical frameworks on chronic illness literature. One of the questions that the study sought to address was the advice that participants would give to a person newly diagnosed with T2DM, thereby determining self-reported priorities in the illness trajectory. The research analysis was grounded within an interpretative paradigm with emphasis on a life course approach. Results: Several themes emerged; denial and acceptance were inherent in these older adults' experiences of being diagnosed with diabetes, as was the need to fight the illness rather than let it take control of their lives. The need to prepare people for the degenerative nature of diabetes and therefore the need to commence insulin was also apparent within the sample. Conclusion: These findings indicate the diabetes journey that individuals may experience from diagnosis, acceptance and changes to self-identity. Currently, older adults with T2DM and their experiences of the illness trajectory are a little-used resource. Their 'pearls of wisdom' -sometimes recognised too late to assist themselves -may inform others with T2DM and perhaps alleviate the psychological disturbance that many feel at diagnosis and later on at the commencement of insulin.

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The success and effectiveness of diabetic screening programmes are dependent on the availability of appropriately trained image graders. This study was designed to evaluate graders enrolled on a locally devised, formal training course by means of a performance-based measure. The course consisted of four days of classroom-based tuition followed by three months of practice-based learning in the workplace. The aim was to establish whether trainees showed an improvement in their ability to grade images, and secondly whether test sets of images are useful in measuring training outcome. Thirteen trainees were required to grade a test set of 24 single images both before and after training. A significant improvement in sensitivity (from 35% before training to 45% after training) was observed as a result of training but at a cost of a decline in specificity. Trainees' confidence ratings measured on a five-point scale increased from an average of 2.4 to 4.1 (p<0.01). We concluded that the course needs to focus more on trainees' ability to discriminate between normal and abnormal images as well as improving grading accuracy in line with increased grading confidence. Test-based course evaluation can be seen to be a valuable instrument in establishing a quality standard for stated learning outcomes. In this research it has clearly indicated weaknesses of the training programme in its current form. Copyright © 2005 FEND.Eur Diabetes Nursing 2005; 2(2): 58-62.