We get a lot of questions about Certified Diabetes Educators (CDEs) – what they can offer patients, how to find one, and even how to become a diabetes educator yourself if interested.
We’ve queried some top diabetes education experts in the country to compile this at-a-glance guide.
Read on for practical information about the world of CDEs, along with lists of the Top Tips for Patients to Make the Most of Their CDE Appointments, and Top Things You Should Know About Becoming a CDE.
A huge thank you to the following expert contributors:
Jane K. Dickinson, RN, PhD, CDE, Coordinator of the Columbia University Master’s in Diabetes Education and Management program, and person with type 1 diabetes herself
Diabetes Educator Basics
What is a Certified Diabetes Educator (CDE)?
CDEs are healthcare professionals trained specifically to coach patients with diabetes through their own self-care. This means coaching on glucose testing, medication dosing, insulin delivery, results logging and more. Some CDEs even have specialized training as insulin pump educators, focusing on helping patients get set up on those advanced devices.
What Does a Certified Diabetes Educator (CDE) Do?
CDEs work with patients and their families to teach diabetes self-management skills, and help with everyday challenges that doctors often don’t have time to address. They work in hospitals, clinics and small practices, and spend time with patients reviewing their glucose records, discussing life challenges, and suggesting actions for improving your diabetes management regimen.
How Can a CDE Help You as a Patient?
A CDE can help you adjust your diabetes routine in terms of food, exercise, glucose monitoring and medication dosing to gradually achieve your goals. If you are honest with them about your behaviors, they can help you craft a realistic plan for improvement that takes into consideration all the demands of real life: your daily routine, work and family obligations, financial considerations, etc.
How Do You Find a Certified Diabetes Educator (CDE)?
These educators work at clinics and practices across the country – although there are sadly not enough of them in the United States to see all the patients who could benefit. Still, it is wise to look for a doctor’s office that includes a CDE.
Use this link to find a CDE in your area:
Does Insurance Cover Seeing a Diabetes Educator?
This is not required in every state, and note that most insurance carriers won’t accept “self-referral” to a CDE. This means that in order to get coverage, you’ll need a formal referral from your doctor before you see any educator.
If you don’t have insurance – look for diabetes education sessions in your local community centers, churches, and hospitals, often run by professional CDEs.
Also be aware that walk-in “retail clinics” now located in many shopping malls around the country provide on-site diabetes care, including affordable A1C testing if needed.
Certified Diabetes Educator (CDE) Requirements: How Can You Become One?
Note that being a CDE is not a stand-alone profession: it is a certification that one gets on top of already being established as registered nurse, dietitian, doctor, pharmacist, or other licensed health professional.
You generally need to already be a licensed medical professional – most are nurses – and you need to accumulate several years’ worth of professional practice working with diabetic patients (1,000 hours total). When these requirements are met, you can then sit for a comprehensive exam overseen by the National Certification Board for Diabetes Educators (NCBDE).
After passing the exam, every CDE needs to take ongoing courses to earn “continuing medical education” (CME) credits each year in order to maintain their certification.
What About (non-certified) Community Diabetes Educators?
There is growing attention to these community educators, mentor / coaches, and so-called promotoras (in the Hispanic/Latino community) who can provide very valuable support to patients.
The American Association of Diabetes Educators (AADE), the big professional group for CDEs, recently began a “Career Path Certificate” program to offer some level of training and accreditation without full certification. One can either become a “Diabetes Educator Associate” or a “Diabetes Educator” at two different levels depending on your professional background and experience.
See also, these related articles from our team:
“My Life as a Diabetes Educator and Person with Diabetes” - DiabetesMine guest post by Aimee Jose
“New Academy for Certified Diabetes Educators Butts Up Against AADE” - DiabetesMine news report
“The Crisis in Diabetes Education, and What We Can Do to Fix It” - article by ‘Mine editor Amy Tenderich
Making the Most of Your Diabetes Educator Visit: Top 6 Tips
We asked our expert Certified Diabetes Educators: What are the priority things you wish your patients would do to prepare for a fruitful session with you? Here is a compilation of what they told us:
1. Ask questions! Write down a list of questions in advance and share them with the educator at the beginning of your appointment, to be sure they get covered. Be persistent, and don't leave until you have answers. (As one educator noted, “The only stupid question is the one you don't ask.”)
2. Work with the right person. Make sure your CDE is a good fit for you -- that you feel comfortable with them and can communicate openly with them. Make visiting your CDE something you look forward to, not dread!
3. Bring your stuff! Make sure you have your glucose and/or insulin delivery devices with you, along with your blood glucose records either in a log book, a software printout form, or by sharing data via an online or mobile application*. Ideally your records should capture “structured glucose data” before and after meals to help identify how the food you eat and your physical activity impact your blood glucose. Also, know your most recent A1C test result. Only armed with this information can a CDE help you problem solve to identify changes you may want to make to improve glucose values.
(*consider trying the highly recommended MySugr Companion Pro app -- a great way to log everything on your smartphone. It sends a PDF report with all the data and info via email to your clinician of choice.)
4. Be honest. An educator can only help you if you’re honest. Don't be afraid to talk about feelings because even if you don't realize it, they do dictate the way you care for yourself. Also, do some basic self-analysis of your glucose records BEFORE your visit: circle the too-high and too-low readings, and give some thought to what happened there. This will give direction to where your clinician may focus attention.
5. Focus on goals. What one or two things would you like to accomplish or improve on in the next months? Most diabetes educators focus on behavior change using the AADE7 Self-Care Behaviors™ model: healthy eating, being active, monitoring, taking medications, problem solving, healthy coping and reducing risks. Think about behavior change goals you might need help with in any of these categories.
6. Demand patient-centered care. If you are uncomfortable with something, tell your CDE. Patient-centered care means considering YOUR needs and preferences. It's not about being told what to do. If the educator recommends a change you don't agree with, it's important to explain why and what you think might be better. Often you can come to a happy compromise.
Bonus tip: one expert also recommended bringing someone with you to the appointment. If you’re comfortable doing that, two sets of ears can be better than one. Having a friend or loved one with you can help you remember what was discussed. It can also be a great way for the other person to get their questions answered so they can best support you.
Considering Becoming a CDE? 6 Things You Should Know
We also asked the experts what they thought newbies to the profession should know – it could be something as simple as, "I wish someone had told me… on my journey to becoming a CDE.” Here’s what they said:
1. Know who's eligible. Generally, to become a CDE you need to have a health-related degree (doctor, nurse, pharmacist, dietitian, etc.), log 1,000 hours of experience treating people with diabetes, and then pass a comprehensive exam administered by the NCBDE (National Certification Board for Diabetes Educators). If you don't already have a clinical background, check out the eligibility list for taking the CDE exam at www.ncbde.org before deciding which route you will take to becoming a diabetes educator.
2. Volunteer with patients. There are now many opportunities to get the needed hours to become a CDE. In the past, those hours needed to be paid, but now volunteer hours count. So volunteering at a diabetes camp or in a free clinic providing diabetes self-management education is now acceptable. Also, spending time with people young and old with diabetes can help you learn about what daily life is like with this disease, so you can have more insight and impact.
3. Don’t judge. People with diabetes are not "non-compliant." Be prepared to strike that word (and others like it) from your vocabulary and focus on helping people feel empowered to make healthy choices.
4. Walk the walk. Related to the last tip, if you're asking people to be healthy, be healthy yourself. Better yet, spend a day or two living the life of someone with diabetes -- check your blood sugar 4 times daily, wear a pump or continuous glucose monitor if you can, count your carbs, exercise after meals and carry glucose with you everywhere you go. Empathy is a tool you will need to really make a difference.
5. Build trust. Remember that communication is key. If someone is "lying about their numbers" it's most likely because they don't trust their healthcare providers. It's up to the educator to create a trusting relationship where people feel comfortable sharing openly and honestly. This also applies to giving people credit for the changes THEY make, and never trying to take credit yourself -- they did the work! (At the same time, it's not your fault if they don't change -- don't beat yourself up.)
6. Keep on learning. A CDE's education never stops. There’s something new to learn about diabetes every day. Read, discuss, attend conferences, check out online communities, get involved in local advocacy groups like JDRF, ADA, local camps, YMCA, health fairs, etc. And of course joining the American Association of Diabetes Educators (AADE) can be incredibly helpful as it allows you to learn from CDEs in your area and across the country. Consider subscribing to the group’s Communities of Interest to learn about areas of specialization.