Practice Options

Three practice options, which may overlap, are available to health-care professionals who choose to specialize in diabetes care:

1. Diabetes educator

2. Certified diabetes educator (CDE)

3. Board certified in advanced diabetes management (BC-ADM)

These classifications are differentiated by educational preparation, formal creden-tialing, professional practice regulations, and the clinical practice environment. It is the position of the AADE that all diabetes educators work toward formal certification. The diabetes educator and CDE are chiefly concerned with and actively engaged in the process of DSMT. The BC-ADM incorporates skills and strategies of DSMT into the more comprehensive clinical management of people with diabetes. Differences in the preparation, scope, and practice of diabetes educators (certified or not) and the BC-ADM may make dual credentialing desirable for some. For example, a diabetes educator or CDE may also have the BC-ADM credential, provided he or she meets the academic and practice requirements for BC-ADM certification. Conversely, the BC-ADM may not necessarily be a diabetes educator as defined here. A more comprehensive description of each classification is given below (2).

Diabetes educators are health-care professionals who have achieved a core body of knowledge and skills in the biological and social sciences, communication, counseling, and education and who have experience in the care of people with diabetes. Mastery of the knowledge and skills required to become a diabetes educator are obtained through formal and continuing education, individual study, and mentorship. The role of the diabetes educator can be assumed by professionals from a variety of health disciplines, including, but not limited to, registered nurses, registered dietitians, pharmacists, physicians, mental health professionals, podiatrists, optometrists, and exercise physiologists. The diabetes educator is an integral partner in the diabetes care team.

The diabetes educator understands the impact of acute or chronic problems on a person's health behaviors and lifestyle, and on the teaching/learning process. Such appreciation is essential for the development of a comprehensive plan for continuing education and cost-effective, self-care management.

Members of the various health disciplines who practice diabetes education bring their particular focus to the educational process. This widens or narrows the scope of practice for individual educators as is appropriate within the boundaries of each health profession, which may be regulated by national or state agencies or accrediting bodies. Regardless of discipline, the diabetes educator must be prepared to provide clients with the knowledge and skills to effectively manage his or her diabetes. Diabetes educators must possess a body of knowledge that spans across disciplines in order to provide comprehensive DSMT. For example, dietitians who are diabetes educators provide instruction for insulin injection, insulin dosing, and medication side effects as well as providing nutrition counseling. Exercise physiologists in the diabetes educator role may help clients develop a meal plan, and pharmacists may provide counseling and instruction about foot care.

Diabetes educators may assume responsibilities beyond providing DSMT to individuals. Program management; case management; clinical management; health-care consultancy with other providers, organizations, and industry; public and professional education; public health and wellness promotion; and research in diabetes management and education are all important roles assumed by diabetes educators.

CDEs, in addition to fulfilling the requirements of a diabetes educator, meet the academic, professional, and experiential requirements set forth by the National Certification Board for Diabetes Educators (NCBDE) (27). The NCBDE defines the criteria for certification as a diabetes educator. As part of the application process, a diabetes educator must document that he or she meets all the criteria for certification. An accepted applicant must demonstrate competency in the required body of knowledge and skills by means of a written examination. Certification is valid for a period of 5 years, and is maintained either through repeat examination or through documented participation in relevant continuing education activities every 5 years.

BC-ADM is a credential available since 2001. The BC-ADM credential is the first advanced-practice certification offered to members of more than one discipline. Nurse Practitioners, Clinical Nurse Specialists, dietitians, and registered pharmacists may apply. Recognizing that nonnursing health-care professionals participate in diabetes care, the task force acknowledged the need for an advanced diabetes manager credential that includes nutrition and pharmacy as well as nursing.

Four discipline-specific examinations are offered for the BC-ADM credential, reflecting the practice of comprehensive clinical management of individuals with diabetes. Candidates must document at least 500 hours of recent advanced-practice diabetes care. They must demonstrate skill in performing complete and/or focused assessments, recognizing and prioritizing complex data, and providing therapeutic problem-solving, counseling, and regimen adjustments for people with diabetes.

The educational preparation required to take the exams is as follows: a master's degree in nursing is required for clinical nurse specialists and nurse practitioners, dietitians must have a relevant clinical master's degree, and registered pharmacists must have a doctorate of pharmacy degree. Upon verification of eligibility, candidates sit for a discipline-specific written examination administered by the American Nurses Credentialing Center (ANCC). Certification is valid for 5 years. Recertification is by reexamination or through qualified continuing education activities as defined by the ANCC. Additional information about certification and recertification can be obtained directly from the ANCC (28).

The BC-ADM practice is characterized by autonomous assessment, problem identification, planning, implementation, and evaluation of diabetes care, within the guidelines for BC-ADM practice set by the individual discipline. The process of using assessment data to independently derive a diagnosis or problem list is a key distinguishing aspect of BC-ADM practice. A diabetes care professional with a BC-ADM credential may or may not be a CDE. As diabetes education is an integral part of diabetes care and management, the professional with the BC-ADM credential necessarily incorporates aspects of DSMT into his or her practice, either directly or through referral to another qualified diabetes educator.

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