If you have diabetes, you’ve probably thought to yourself, “It sure would be nice to have someone really work with me on my blood sugar control.” Your doctors don’t have time to do that—but there is someone who does. A certified diabetes educator (CDE) will learn about your specific case of diabetes and your preferences for managing it…help you make the most important day-to-day lifestyle and treatment decisions…and guide you to more effective actions that you might never have thought of. Before hiring a CDE, ask these questions to make sure this is the right person to guide your diabetes management…
When were you last certified? To properly use the designation “CDE,” a health-care provider must have met the eligibility requirements of the specialty’s governing board—the National Certification Board for Diabetes Educators—and passed an exam covering all aspects of managing diabetes. A CDE must then renew the credential every five years. This requires accruing a minimum of 1,000 hours of practice as a diabetes educator as well as keeping up-to-date on the latest research and treatments for diabetes care. If a candidate’s certification is more than five years old, it suggests that he/she may not be as experienced or as knowledgeable as you would want.
What is your background? CDEs usually have been trained in at least one other type of health care. Many have already been registered nurses (RNs), registered dietitians (RDs) or exercise physiologists (BS or MS in exercise physiology and certified by the American College of Sports Medicine), to name just a few. Knowing the background of the CDEs you’re considering will help you find the best match for your unique needs, and whoever you hire should also be able to tell you how his background will specifically benefit you. For instance, if planning meals, counting carbs and losing weight are key issues for you, a CDE who is also a registered dietitian should outline nutrition changes he will likely suggest.
What will diabetes counseling sessions with you be like? Some diabetes educators work one-on-one with patients. Others provide group counseling and/or classes at hospitals, diabetes centers or doctor offices. To help you decide on the best format for you, ask for an overview of how a candidate operates and what he will cover. Ask his opinion of the benefits of private versus group classes and which you are most likely to benefit from and why. The answers should be specific. Topics should include diet, exercise and glucose monitoring, all of which should be geared to your immediate needs. If you choose to work with a CDE one-on-one, find out whether he is available at a time and place that is convenient for you and can be flexible if your schedule changes.
How will you work with my doctor? You want a CDE who will share your progress with your doctor and work with that doctor if the CDE sees that adjustments to your treatment plan are needed. Ask how well the CDE knows your diabetes doctor and how he/she will communicate with all your health-care professionals. It’s OK if a CDE doesn’t already know your doctor at all if the answers to these questions make you think that the CDE will be a team player.
How will you involve my family in my care? Managing diabetes is easier with support at home. A good CDE recognizes this and will have ideas for you to increase the amount of support you get from those who live with you or who you see very often. He should also welcome close family members at your sessions or classes.
What will I learn beyond the basics? Ask your CDE what he can do for you beyond getting you set up with everyday diabetes management tools such as a blood glucose meter. A CDE should be able to tell you how he plans to help you reduce your risk for setbacks and cope with challenging situations, such as attending holiday dinners and birthday parties. The suggestions should seem practical to you even if they might sound a bit challenging at first.
How will you keep me motivated? An important part of the CDE’s job is to keep clients actively on track with a diabetes management plan. The CDE you choose should be able to articulate the seven self-care behaviors developed by the American Association of Diabetes Educators, which range from healthy eating to healthy coping, and outline a plan to help you adopt them. How often you should meet depends on your needs, but generally after the initial meeting, you should meet at least once a year plus whenever there is a change in your treatment, living conditions (such as moving to assisted living or a teen going away to college) or if any health complications arise.
How will we know I’m making progress? A good CDE will outline how he will assess your progress, including reviewing your blood glucose monitoring readings and explaining the results of tests such as the A1C to you in a way you can understand. A CDE should say that he will work with you on achieving goals, such as avoiding wide blood glucose fluctuations, but never promise a quick-fix because diabetes management takes time and every patient is unique.
Do you take my insurance? Most CDE sessions are covered by Medicare or private insurance (you may need a referral from your doctor). If you don’t want to end up paying out of pocket, ask up-front whether the CDE you’re considering is covered by your plan.