Diabetes and the Certified Diabetes Educator (CDE)
I am sitting at the desk of a hotel outside of Chicago's O'Hare Airport, just having completed an Examination Review Committee meeting. What most people with diabetes do not know is that despite being cared for by members of a multidisciplinary team, there is truly an educational overlap of training required. There is an acceptable "standard" fund of diabetes related knowledge that is required to adequately care for people with diabetes. Enter the National Certification Board for Diabetes Educators (NCBDE). In 1993, I became aware of the need to ensure that I was well versed in the knowledge that was necessary to not only diagnose and treat children with diabetes, but to educate and teach my patients how to establish measurable goals.
It is one thing for a diabetes team to know what to do, but quite another to get the person with diabetes to do it. The NCBDE is a board that develops and maintains the CDE credential. A health professional must pass a certifying examination (with a required number of professional practice hours providing diabetes self-management training) to become a CDE. A CDE may be one of many disciplines, including but not limited to nurses, dieticians, pharmacists, exercise physiologists, podiatrists, psychologists, social workers, and physicians. Currently, only a small fraction of CDEs are physicians. In 1994, I studied for the exam, learning such topics unfamiliar to me as a pediatrician: Type 2 Diabetes, gestational diabetes, diabetes program management, and Continuous Quality Improvement (CQI) to build and maintain a quality diabetes education program. I passed and became a CDE. Until recently, one had to take the exam every 5 years to maintain the CDE credential; now continuing education in diabetes related topics may be used instead of having to retake the comprehensive exam.
My training as a CDE enables me to practice medicine with a unique perspective, combining treatment, teaching, and emotional support, as well as goal setting for individual patients and families. Despite my own personal goals for each child or teen with diabetes, my training as a CDE directs me to enable the child or teen, along with his family, to choose goals (and the appropriate method to achieve them) pertinent to his wishes. These goals are not necessarily the same and often we must compromise.
In 2006, I was invited to serve on the NCBDE as a physician member. Since the NCBDE is a working board, we had many different committees and task forces to continue refining and growing the CDE credential. One major reason for my decision to join the Board was to become involved in writing, evaluating, and refining the CDE qualifying examination. After one year on the Board, I became a member of the Item Construction Committee (question writing) and subsequently, chair of the newly designed Examination Committee, where we write, review, review again, pretest, score, and determine statistics about each question. From this committee I have learned to write a "stem" (question) with the "key" (correct answer) and "distracters" (incorrect responses) that will be statistically scrutinized by a professional testing agency.
Much work goes into this process to grow future CDEs who are competent to care for you and others with diabetes. Why have I described the CDE exam and the item writing, review, and statistical evaluation process? I wanted to make sure our families know that when they are treated by a multidisciplinary team of CDEs, they are receiving care from health professionals who have taken the extra step to ensure that they have the knowledge to administer current evidenced-based diabetes care. And, more importantly, the team is trained to use educational methods and techniques to enhance learning and reinforcement of the learned behaviors.
It is now time for me to go back to Washington, DC, and Children's National. By the way, our team currently has four nurse CDEs, two additional nurses are in the process of obtaining the necessary practice hours and will soon be applying to take the exam, one psychologist CDE (with another psychologist who will be sitting for the exam within the year), one dietician CDE, and myself as a physician CDE.