April 26, 2012

CDE Certification – Does It Have Value?

This is a valid question for everyone and should include diabetes patients as well. The other question in this article is perhaps the question educators are asking is, “what’s in it for me?” What is the value and what's in it for me are two questions that make a patient stop and think, do I really need these services if that is the attitude fostered by people that are supposed to be professionals.

Sure, I admit that I have taken one completely out of context, but the question does need clarity and definition, which really begs for another question. If a member of the National Certification Board for Diabetes Educators can state such a question, then maybe, just maybe, we have something to be concerned about and wonder if the test people need to pass to be certified as a diabetes educator is really the correct test for certification? And, another question – are they really qualified and do they understand diabetes to be able to relate to the patients?

And what about the hours they need to have working in their profession? Is really what is needed to make these professionals caring and understanding about patients with diabetes. It seems to me that this is lost on many patients when the attitude is one of mantras and you must follow the American Diabetes Association's guidelines or risk losing your certification.

This “one-size-fits-all” mantra is an indication that the CDEs are out of touch and unwilling to work with the patient as an individual. This to me as a patient, says I may not need the services of a CDE when I do not follow the guidelines of either the ADA or AADE. I have been fortunate to find what works for me and with fine-tuning it from time to time should be able to maintain reasonably good health. That is providing something besides diabetes does not complicate the issues.

I do have several friends that are CDEs, mostly from the registered nurse (RN) profession. When I am told that they are speaking as a RN or their primary training, I will listen and I have received some excellent advice. They know from experience that if they are speaking as a CDE, my eyes will probably glaze over and I have probably tuned them out. How do they know this? Because we have talked about the different topics encompassing the CDE profession and they have learned that if they are advocating the ADA way, I will be contradicting in nature and quoting from some of the ADA areas that are newly published that they are not up to date on.

With the medical field changing daily, it is not easy for them to stay up-to-date and I do try to reeducate them. I will send them URLs for the latest information and direct them to the latest information that disagrees with what they have learned. Since they are friends, I try to be polite, but occasionally they know that even they cannot follow some of it as the AADE has not approved the change.

None of my CDE friends are overly happy that several of us have an informal group (more along the lines of a peer-to-peer group) and work with each other at the level of the individual. We follow the idea (mantra if you will) that as long as something works for you, and if your A1c shows that it is working, don't change. As individuals, we seldom find something that works identically for each of us. A few of us have friends or relatives that have the credentials as a CDE, but we do not invite them to our get-togethers. Almost all of us refuse to have meetings with the CDEs that work with our doctors or endocrinologists.

We do need to be clear as patients what the definition for a CDE is and says. To quote from this article, “A CDE is a medical professional who possesses comprehensive knowledge of and experience in diabetes management, prediabetes, and diabetes prevention. The CDE plays a unique and essential role for people affected by diabetes.

The CDE is a recognized and highly respected credential in the industry. Diabetes self management education from a CDE can lead to better control and can also decrease short and long-term complications that strain the healthcare system and cause unnecessary pain and suffering to patients.

The reality of diabetes is that it touches many different aspects of a patient’s life. Certified educators therefore come from a variety of backgrounds ranging from nurses and dietitians to exercise physiologists and podiatrists. They are required to have knowledge across multiple disciplines.

All diabetes educators need to be aware of new technology and therapies and how to incorporate them into the unique management plan they design for patients.”

The above is quite a statement. I wish it was as comprehensive as it appears on the surface. Diabetes self-management education (DSME) is played up in articles such as this and in reality is seldom taught. It has been replaced too often with mantras of “do this and do that” without the education. There are some excellent education programs available, but not promoted by or used by CDEs.

One such program is BGAT (blood glucose awareness training). Most (there are a few exceptions) CDEs do not even understand what this is and since the AADE does not support it, few will learn about it. The few that do use it are with progressive endocrinology practices like the Joslin Diabetes Center, and the Diabetes Behavioral Institute.

Another area that CDEs want to ignore is peer-to-peer groups. It is most unfortunate that a study has not been done comparing peer-to-peer groups with CDE trained groups. Most studies use usual care (meaning nurses and others) with peer-to-peer groups always doing better in helping lower A1c's – often by a significant amount. Read my blog here about some of the studies.

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