CDE Certification – Does It Have Value?

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This is a valid question for everyoneand should include diabetes patients as well. The other question inthis article is perhaps the question educators are asking is, “what’sin it for me?” What is the value and what's in it for me are twoquestions that make a patient stop and think, do I really need theseservices if that is the attitude fostered by people that are supposedto be professionals.
Sure, I admit that I have taken onecompletely out of context, but the question does need clarity anddefinition, which really begs for another question. If a member ofthe National Certification Board forDiabetes Educators can state such a question, then maybe, just maybe,we have something to be concerned about and wonder if the test peopleneed to pass to be certified as a diabetes educator is really thecorrect test for certification? And, another question – are theyreally qualified and do they understand diabetes to be able to relateto the patients?
And what about the hours they need tohave working in their profession? Is really what is needed to makethese professionals caring and understanding about patients withdiabetes. It seems to me that this is lost on many patients when theattitude is one of mantras and you must follow the American DiabetesAssociation's guidelines or risk losing your certification.
This “one-size-fits-all” mantra isan indication that the CDEs are out of touch and unwilling to workwith the patient as an individual. This to me as a patient, says Imay not need the services of a CDE when I do not follow theguidelines of either the ADA or AADE. I have been fortunate to findwhat works for me and with fine-tuning it from time to time should beable to maintain reasonably good health. That is providing somethingbesides diabetes does not complicate the issues.
I do have several friends that areCDEs, mostly from the registered nurse (RN) profession. When I amtold that they are speaking as a RN or their primary training, I willlisten and I have received some excellent advice. They know fromexperience that if they are speaking as a CDE, my eyes will probablyglaze over and I have probably tuned them out. How do they knowthis? Because we have talked about the different topics encompassingthe CDE profession and they have learned that if they are advocatingthe ADA way, I will be contradicting in nature and quoting from someof the ADA areas that are newly published that they are not up todate on.
With the medical field changing daily,it is not easy for them to stay up-to-date and I do try to reeducatethem. I will send them URLs for the latest information and directthem to the latest information that disagrees with what they havelearned. Since they are friends, I try to be polite, butoccasionally they know that even they cannot follow some of it as theAADE has not approved the change.
None of my CDE friends are overly happythat several of us have an informal group (more along the lines of apeer-to-peer group) and work with each other at the level of theindividual. We follow the idea (mantra if you will) that as long assomething works for you, and if your A1c shows that it is working,don't change. As individuals, we seldom find something that worksidentically for each of us. A few of us have friends or relativesthat have the credentials as a CDE, but we do not invite them to ourget-togethers. Almost all of us refuse to have meetings with theCDEs that work with our doctors or endocrinologists.
We do need to be clear as patients whatthe definition for a CDE is and says. To quote from this article, “ACDE is a medical professional who possesses comprehensive knowledgeof and experience in diabetes management, prediabetes, and diabetesprevention. The CDE plays a unique and essential role for peopleaffected by diabetes.
The CDE is a recognized and highlyrespected credential in the industry. Diabetes self managementeducation from a CDE can lead to better control and can also decreaseshort and long-term complications that strain the healthcare systemand cause unnecessary pain and suffering to patients.
The reality of diabetes is that ittouches many different aspects of a patient’s life. Certifiededucators therefore come from a variety of backgrounds ranging fromnurses and dietitians to exercise physiologists and podiatrists. They are required to have knowledge across multiple disciplines.
“All diabetes educators need to beaware of new technology and therapies and how to incorporate theminto the unique management plan they design for patients.”
The above is quite a statement. I wishit was as comprehensive as it appears on the surface. Diabetesself-management education (DSME) is played up in articles such asthis and in reality is seldom taught. It has been replaced too oftenwith mantras of “do this and do that” without the education. There are some excellent education programs available, but notpromoted by or used by CDEs.
One such program is BGAT (blood glucoseawareness training). Most (there are a few exceptions) CDEs do noteven 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 progressiveendocrinology practices like the Joslin Diabetes Center, and theDiabetes Behavioral Institute.
Another area that CDEs want toignore is peer-to-peer groups. It is most unfortunate that a studyhas not been done comparing peer-to-peer groups with CDE trainedgroups. Most studies use usual care (meaning nurses and others) withpeer-to-peer groups always doing better in helpinglower A1c's – often by a significant amount. Read my blog hereabout some of the studies.