Diabetes Educators Unveil New Name: 'We Help Patients Troubleshoot'

Miriam E. Tucker

January 24, 2020

For many years, diabetes educators have performed far more tasks beyond simply teaching patients to count carbs, check their blood sugar, and take insulin injections.

Now, both the profession and its US professional society have adopted new names to reflect their broad scope of practice.

As of January 22, the profession's credential is changed from certified diabetes educator to certified diabetes care and education specialist (CDCES) and the former American Association of Diabetes Educators is now named the Association of Diabetes Care & Education Specialists (ADCES).

The profession comprises nurses, dietitians, physicians, pharmacists, and other health professionals who obtain additional credentialing in diabetes management, prediabetes, and diabetes prevention.

The credentialing requirements will not change with the transition from CDE to CDCES, as the title reflects what the professionals are already trained to do and have been doing, including clinical management and support, ADCES President Kellie Antinori-Lent, MSN, RN, told Medscape Medical News.

"There's been a lot of confusion with the 'diabetes educator' title. We felt that we needed to change the title to more closely reflect everything that we do," she noted.

"We don't just educate...We're technology experts. We help patients problem-solve and troubleshoot...We are truly care providers," said Antinori-Lent, who works with inpatients as a diabetes clinical nurse specialist at the University of Pittsburgh Medical Center – Shadyside Hospital, Pennsylvania.

Woeful Participation in Diabetes Self-Education Management Services

The professionals work in a variety of settings, including physician offices, hospitals, and public health clinics. Their services are covered by Medicare and most insurers, although reimbursement is often suboptimal and there are other barriers to access, such as lack of geographic proximity and lack of physician awareness.

In addition, since 2012 the profession has also been working with individuals with prediabetes to forestall the development of type 2 diabetes through the Diabetes Prevention Program of the Centers for Disease Control and Prevention (CDC).

Evidence supports the benefits of CDCES in managing glucose levels and other diabetes-related outcomes including reducing emergency room visits and the need for medications in people with diabetes, and improving mental health and well-being.

Yet, data cited by the CDC suggest that less than 5% of Medicare beneficiaries and less than 6.8% of privately insured people in the United States participate in "diabetes self-management education services" within the first year of diagnosis, despite coverage for the service.

"For me personally it's been very difficult to understand, with the epidemic of the disease and needs of this patient population — we know that the healthcare team is already burdened...It's confusing why these numbers are so small. For 40 years we haven't been able to break down the barriers that prevent it," Antinori-Lent said.

Of course, the name change isn't expected to accomplish everything.

The ADCES is actively lobbying for passage of the Expanded Access to Diabetes Self-Management Training (DSMT) Act in Congress, introduced by Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) in the Senate and Representatives Tom Reed (R-NY) and Diana DeGette (D-CO) in the House of Representatives.

The bill aims to increase CDCES access for Medicare beneficiaries by expanding the types of providers who can refer them to a CDCES to include physicians and qualified nonphysician healthcare providers who are not directly involved in managing the person's diabetes, such as podiatrists or emergency department physicians.

The bill also expands the number of hours for coverage of the services, removes the restriction for receiving both CDCES and medical nutrition therapy services on the same day, and allows the services to be delivered in a community-based location and via telehealth.

"We're not going to give up," Antinori-Lent said. "We can help anybody who needs additional training, support, or coaching. Keep in mind this is a chronic illness. There's an emotional as well as behavioral aspect to helping patients achieve success. It's not just a one and done. We're there any time the patient needs us."

Antinori-Lent is a clinical training specialist for Valeritas.

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