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MSN,RN,CDE
Licenses for diabetes educators?!
Section:  General Diabetes

Kentucky Governor Steve Beshear signed a bill on 03/16/2011 that requires a license to practice diabetes education, a move that the American Association of Diabetes Educators (AADE) says will enhance consumer protection and increase professional recognition. AADE is advocating for licensure in all 50 states  . The licensure is intended for diabetes educators only, not health care professionals who may perform some diabetes-related functions as part of, or in the course of other routine occupational duties. The Association believes that state licenses deliver and communicate a standard of care, and ensure that people have an appropriate comfort level and respect for the discipline.

The following is a list of Diabetes Educator Levels as defined by AADE Guidelines:

Level1 - A community health worker;

Level2 - The health care professional who occasionally educates a person with diabetes as she/he provides medical support;

Level3 - The health care professional who meets the AADE definition of diabetes educator, but who is not credentialed and whose competencies have not been tested in a measurable way;

Level4 -  The certified diabetes educator (CDE);

Level5 - The diabetes educator who has advanced skills and experience developing and managing diabetes education programs. Credentialing is a necessary prerequisite for this level. The educator may be CDE or BC-ADM(board certified in Advanced Diabetes Management) and function either with protocols or have prescriptive author.

It sounds like professionals who belong to levels 3 ,4 and 5 will be required (eventually) to get  licensed to practice diabetes education. Is this correct? Also, what does this quote:"There are many others who identify themselves as diabetes educators and work in the field, but are not eligible or choose not to pursue a credential.  We must find a way to recognize these individuals and ensure that others who are delivering diabetes education are properly prepared and qualified. State licensure is the way to do this" taken directly from the AADE's official site mean? What would it entail to maintain the new licensure? Will there be a requirement of additional CE? How often does this licensure need to be renewed? Also, RDs and NPs are currently able to bill and get reimbursed for providing diabetes education. Will licensed diabetes educators who are non-RDs or NPs  be able (in time) to do the same? This would be rewarding for many. What are your thoughts on this and the passed bill in general? Looking forward to a great discussion. Thank you very much in advance for your pearls of wisdom.  Isabella, RN/CDE

SOURCE:http://www.endocrinetoday.com/view.aspx?rid=81799

MEMBER COMMENTS
Re: Licenses for diabetes educators?!

Hi Isabella,

 

Thank you for bringing up this timely conversation. I've just been made aware of it and would like more information.

 

I will reach out to some educators I know that may be more familiar with this and can add some more insight to what you so clearly wrote.

 

EnJOY!

Joy

 

Re: Licenses for diabetes educators?!


 Good morning!
 I did some research re :licensure for diabetes educators and came across A&Q session @AADE site. The content is interesting and addresses some of the questions I raised in my post . Please read and share your thoughts. Thank you very much. Isabella ,RN/CDE

Here is the link:   http://www.diabeteseducator.org/PolicyAdvocacy/State_Licensure_FAQs.html

Re: Licenses for diabetes educators?!

All -

I'll respond to this wearing my hat as an AADE member of the Board of Directors (2011-2014). Yes, AADE has initiated a licensure effort and Kentucky has become the first state to have their Governor sign this bill into law. AADE has posted valuable information and descriptions on their website - www.diabeteseducator.org. This is accessible by anyone.

 

From AADE's website: http://www.diabeteseducator.org/PolicyAdvocacy/State_Legislative_Initiative.html

In an effort to gain recognition for the qualified diabetes educator, AADE has embarked on a state licensure initiative.

As management of diabetes becomes increasingly complex, it is imperative that diabetes health care professionals be well educated and appropriately credentialed. Licensure of the diabetes educator will provide for consumer safety and provide minimum standards for recognition of the professional.

 

Without this “legal” definition, diabetes educators will continue to be self-defined. While payors may reimburse for the diabetes education service (DSMT), they may not recognize (reimburse) the provider of these services – the qualified diabetes educator.

 

Diabetes educator licensure is intended for the healthcare professional that has a defined role as a diabetes educator, not for those who may perform some diabetes-related functions as part of, or in the course of, other routine occupational duties.

 

There's links to more indepth info at this link: http://www.diabeteseducator.org/PolicyAdvocacy/State_Legislative_Initiative.html -- an FAQ, a podcast and more.

 

Thought this effort may seem arduous at the moment, I believe we have at AADE staff and leadership who are forward thinking and are looking at the healthcare landscape realizing that securing licensure for the work we diabetes educators do is extremely important.

 

Thanks,

Hope Warshaw, MMSc, RD, CDE

Nutrition Section editor, PRESENTdiabetes.com

Re: Licenses for diabetes educators?!

Hope, thank you for your response and the links. It sounds like the initiative will accomplish good things for the DEs and will not undermine the role of the CDEs . Isabella, RN/CDE

Re: Licenses for diabetes educators?!

Once again, thank you Isabella for bringing this up. And thank you Hope for making it so clear.

 

The more I learn about this, the more sense it makes to move forward to licensure.

 

EnJOY!

Joy

Re: Licenses for diabetes educators?!

You are welcome Joy!
 I read your most recent article re:anemia and found it interesting. Isabella, RN/CDE

Re: Licenses for diabetes educators?!

I think this is a great concept.  In this day and age anyone with a web page and a voice can put a shingle outside their office or home that says they can educate you in "whatever".  What are they really teaching, who are they really teaching, is any of their teaching based in any type of clinical evidence-based practice??  Working in wound care for so long I have seen my fair share of charlatans promise people a cure, take their last dollar and the person still winds up in the same place they were before the "educator" came into the picture. I think, in order to protect the public, there should be some type of licensure for any person that provides health education to people.  Just my two cents...

Re: Licenses for diabetes educators?!

Judy-Oh so true! When you say that about wound care, it makes me think of salespeople who want everybody who has been diagnosed with diabetes to buy their shoes. They tell the people it doesn't cost them a thing. WRONG! It's costing all of us. I could go on and on about how not everyone who has diabetes needs "diabetic shoes" and if they do, the appropriate way and places to purchase them.

 

Isabella-sorry I'm so late to thank you for your kind words about my anemia article in Diabetes Self Management. I get lots of questions about anemia. Main points...what's the cause and what kind of anemia. Knowing those two things are the beginning...

 

EnJOY!

Joy

Re: Licenses for diabetes educators?!

I have to tell you, in the patient communities where I hang out these moves to restrict diabetes education are not necessarily seen very positively.   There are only 17,000 CDEs.  With the estimated number of diabetics reaching into the 50M range, that is 3000 patients per CDE.  Every CDE should have their calendar booked out 'till 2012.

While there are certainly lots of charlatans out there like Gabriel Cousens suggesting you can "cure" T1 with a raw diet, or that acai berry fixes everything.  There are also vast resources of educational material of high quality that don't have to be delivered through an accredited provider.  It adds cost to force that approach to delivery and can severely limit the availability of information.

In my view of the world, diabetics should have the option to utilize CDEs for their education, and if insurers wish to limit reimbursed education to certified educators, that is fine.  But creating laws to restrict access to education seems counterproductive.  And one must realize that many diabetics do not agree with certain core education principles like the high carb diet.

From a patients point of view these moves appear to be efforts to restrict access to education, force diabetics to use CDEs even when other sources of education exist and to enforce the teaching of what some consider flawed educational material.

Re: Licenses for diabetes educators?!

This is a very interesting and important discussion. Thank you, Isabella, for introducing it.

 I think that with all the discussion in the media and in health payer groups about the crisis in health care due to the burden of taking care of so many people with diabetes, it is interesting that there is not usually mention of the value of individualized Siabetes Self Management Education by Certified Diabetes Educators. Perhaps If there was more of an emphasis regarding the need for patients to take responsibility for their own health, the need for the highest quality of Diabetes Self-Management Education would be emphasized by the media legislative bodies as well as the health care payers.

  All of us who are Certified Diabetes Educators know that our personal individualized interactions with a person diagnosed with diabetes can be life changing for the patient as well as their family or significant other. Becoming empowered by learning how to obtain glycemic control in a manner that allows the optimal qulaity of life for the individual patient can make all the difference in terms of positive outcomes for patients with diabetes.  If there was a clear path to adequate reimbursement for Certified Diabetes Educators in a Private Practice, two very positive things would happen:  motivated patients would have greater access to high quality Diabetes Self Management Education, and there would be more health professionals wanting to become credentialed as Certified Diabetes Educators. 

Re: Licenses for diabetes educators?!

Joy and Patricia, you are welcome! 

  I find Judy Lajoie's comment relevant to the issue at stake  .  However, I have a question and wondering if the colleagues here can address it . We all know  what we had to do, the knowledge-base (both theoretical and clinicaI)we had to master and the amount of time we had to dedicate in order  to become  CDEs.  I guess what I don't understand is how can the knowledge-base of diabetes educators pertaining to levels 1 ,2 and 3  possibly compare  to those of levels 4 and 5? If you were the one wanting an evidence based  /well-rounded DM education -wouldn't  you want for your diabetes educator to  be a leader in his/her area of expertise? Thoughts? Thank you very much. Isabella, RN/CDE

Re: Licenses for diabetes educators?!

Brian, I was very interested in your comments about licensure restricting access to DSME.  I didn't take that conclusion from anything I've read.  Can you point me to something that you've read or give me an example of how that could happen.  What brought you to this conclusion?  I want to look at all aspects of this movement.  I appreciate your perspective.  Thanks  Sonia

Re: Licenses for diabetes educators?!

Hi Isabella
I completely agree with you. Levels one, two and three should not be promoted as equal in any way to levels four  and five. If there was a license available for levels four and five only, then it would be and incentive for people in Levels one, two and three to study and prepare to fulfill the requirements needed to become a level four and five provider. 

I recall my own personal experience as an expert RN, BSN. My initial education in nursing was with a bachelors degree. I had many excellent experiences as a nurse and really was an expert nurse. When I applied for a position in a major teaching hospital 30 years after graduation, I was told that I must matriculate in a Masters degree in Nursing program in order to be appointed to the position as a Diabetes Clinical Specialist. My experience and expertise was outstanding, but the additional degree was a requirement for the position. As I progressed in my studies toward obtaining a Masters degree in Nursing (which I now have) it was obvious to me  that I was learning so many additional ways to use my knowledge to communicate with patients, other health professionals, etc...plus I grew in knowledge in so many areas of nursing as well.  The Master of Science in Nursing degree identified me as an expert because I fulfilled the requirements needed for that level of expertise to be recognized. I can relate this experience to encouraging people in levels one, two and three to work hard to get the credentials needed for levels four and five if they want a license as a diabetes educator.

I earnestly hope that our American Association of Diabetes Educators does not dumb down the requirements for licensure. In my opinion, It would be a big step backward in terms of promoting quality in Diabetes Self Management  Education.

Re: Re: Licenses for diabetes educators?!
Quote:

Brian, I was very interested in your comments about licensure restricting access to DSME.  I didn't take that conclusion from anything I've read.  Can you point me to something that you've read or give me an example of how that could happen.  What brought you to this conclusion?  I want to look at all aspects of this movement.  I appreciate your perspective.  Thanks  Sonia


Here is an example.  The Diabetes Prevention Program is aimed at providing "diabetes education" and altering the diet and lifestyle of people with pre-diabetes or at risk of diabetes.  It is not taught by CDEs, in fact the current DPP/YMCA program is taught by instructors certified by the YMCA as having been trained with the DPP materials.  Under this new law, one would expect that the DPP/YMCA program would be not be able to operate under the current model in KY.  I don't think that is anyone's intent.

Re: Licenses for diabetes educators?!

Hi Isabella and Patricia. I totally agree with the items you both have brought to the table. Pat, I wholeheartedly agree that we hope they do not "dumb down" the requirement, just to facilitate getting more people through the program.  I agree that  CDE's are in short supply when you look at the educator:patient ratio BUT that does not mean we should arbitrarily push more educators through to bring the suspected ratio down.  Quantity does not mean quality just like certified does not always mean qualified. I think this is an issue that needs to be examined and thought about very carefully for both the safety of the patient and the sanctity of the certification.

Re: Licenses for diabetes educators?!

Ditto Patricia and Judy!

Brian, there is quite a difference between trained lifestyle coaches who provide the DPP/YMCA program  and diabetes educators. I don't believe that what we are discussing in this thread has any bearing on the provision of the DPP/YMCA program . Please read the following document :below and see for yourself. Thank you. Isabella RN/CDE

http://www.gken.org/Synopses/CI_10007.pdf

Re: Re: Licenses for diabetes educators?!
Quote:

Ditto Patricia and Judy!

Brian, there is quite a difference between trained lifestyle coaches who provide the DPP/YMCA program  and diabetes educators. I don't believe that what we are discussing in this thread has any bearing on the provision of the DPP/YMCA program . Please read the following document: below   and see for yourself. Thank you. Isabella RN/CDE

http://www.gken.org/Synopses/CI_10007.pdf


I think is it a stretch to suggest that the DPP is not diabetes education.

And I believe your pointer was a description of the original pilot research program.  If you go read up on the current implementation, the educators are YMCA staff educated with the DPP materials.  See http://www.ymcade.org/pdfs/diabetes/DEPLOY_AmJPrevMedOct08.pdf

 and then http://www.ymcade.org/pdfs/diabetes/DIABETES%20EDUCATOR%20-%20Adapting%20the%20DPP%20YMCA%20Model.pdf . These are YMCA instructors, not in any way certified educators.

The program would require significant modification to be compliant with the suggested KY law

Re: Licenses for diabetes educators?!

Brian, thanks for the links. I read the content of the first link ,however, not able to access the content of the second.
In any case, I do believe that the DPP/YMCA   program will continue to exist ....since lifestyle coaches(instructors) have their own rules/regs and certification guidelines to follow. Thank you. Isabella RN/CDE.

Re: Licenses for diabetes educators?!

Brian, lifestyle coaching and teaching healthy diet and exercise habits are a far cry from teaching patients to make decisions about frequency of SMBG, identifying causes for BG patterns and self titration of insulin, managing an insulin pump and CGM. I would prefer to have a CDE for the more advanced DSME.  Licensure will not eliminate the need for prevention coaching and teaching healthy eating and exercise to manage BG.  It will not close down those kinds of beneficial programs.  I also couldn't open up your second link and   I still haven't seen any wording that says that kind of education can only be provided by a licensed CDE.  But I do think that providing a way to help providers and patients identify the appropriate level of care is important.