The Benefits of Becoming A CDE By Ruth Toiba, PhD, RD, CDE Dr. Ruth Diabetes Watchers, Inc.

Diabetes 29.1 million people or 9.3% of the total U.S. population have diabetes. Diagnosed 21.0 million people Undiagnosed 8.1 million people (27.8% of people with diabetes are undiagnosed)

Prediabetes 86 million of total US population have prediabetes (about 30%). 9 out of 10 do NOT know they have prediabetes. Without weight loss and physical activity, 15%-30% of those will develop Type 2 Diabetes within 5 years.

Caring for Diabetes Diabetes can be controlled by: Healthy eating Regular physical activity Medications Routine screening for complications People with diabetes or prediabetes are encouraged to Self Manage their condition under the supervision of the healthcare professional

DSME DSME is defined as the ongoing process of facilitating the knowledge, skill, and ability necessary for self-care. DSME includes An individual assessment and education plan Educational interventions to help individuals achieve self-management goals. Periodic evaluations Follow up Documentation

Regulation and Certification DSME services need be regulated to ensure the provision of safe, effective and appropriate patient care. The regulating board for certification of diabetes educators is NCBDE, www.ncbde.org There is a great demand – only 19,000 CDEs in the US

Why Should an RD Become a CDE? Certification is not required by law for employment in the field, but many healthcare agencies are using board certification as a basis for employment, job promotions, salary increases and other considerations. RDs are one of 13! professions that may be eligible to become CDEs, even though we are among the few that TREAT our patients by providing MNT. So if you ask me….most and foremost – its to protect my profession…. But more specifically….

Benefits for RDs Protect your profession, by establishing your role as THE nutrition expert of the diabetes healthcare team Being more marketable, by acquiring additional skills such as insulin administration and management, blood glucose monitoring, etc…. Increased employment opportunities: hospitals, doctor offices, federal and state agencies, accredited DMCs and more… Higher wages The average salary for CDE RD jobs is $68,929 The average salary for Clinical Dietitians jobs is $57,001

Employees with a Certified Diabetes Educator (CDE) Certification Median Salary by Job National Salary Data  Certified Diabetes Educator (CDE)169 salaries $64,022   Registered Dietitian57 salaries $56,312 Dietitian24 salaries $55,819 Registered Nurse (RN)8 salaries $72,293 Clinical Dietitian8 salaries $55,980 Family Nurse Practitioner (NP)8 salaries $93,015 United States | Currency: USD | Updated: 24 Jun 2017 | Individuals Reporting: 36

Employees with a Certified Diabetes Educator (CDE) Certification Median Salary by State or Province Salary Data  New York38 salaries $66,805   California34 salaries $77,218 Texas28 salaries $64,013 Florida21 salaries $78,377 Pennsylvania16 salaries $73,878 Arizona13 salaries $74,514 Massachusetts13 salaries $64,415 Country: United States | Currency: USD | Updated: 24 Jun 2017 | Individuals Reporting: 363 http://www.payscale.com/research/US/Certification=Certified_Diabetes_Educator_(CDE)

Benefits for Patients Having advanced certification, rather than an entry level one, assures a high quality of care for the patient. The ability to integrate between food, medications and blood-sugar levels, is best achieved by an RD CDE, to the patient’s advantage. In most cases, the RD CDE can serve as the “one stop shop” for the patient, with no need to see a nurse or a pharmacist. The patient can get all their instructions and follow-ups from the RD.

Benefits for Employer Maintaining a policy to employ certified health professionals that possess distinct and specialized knowledge, is promoting quality care for persons with diabetes. Maintaining a good reputation and staying competitive among other facilities. Reimbursement – some private insurances require DSME to be provided by a CDE.

Medicare …. Certified Providers for DSME – RDs – Physicians (MDs and DOs) – Advanced Practitioners (i.e. Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Clinical Social Worker, Clinical Psychologist) • Legislation is under way to recognize CDEs as providers Can Patients Receive both DSMT and MNT? • Yes, a beneficiary can receive the full 10 hours of initial DSMT and the full three hours of MNT • But DSMT and MNT cannot be billed on the same date of service • In subsequent years the beneficiary can receive two hours of DSMT (with a referral) and two hours of MNT (with a referral)

Scope of Practice According to AND: The Scope of Practice describes a range of roles, functions, responsibilities, and activities that dietetic professionals are educated on, and authorized to perform when working with people with diabetes. Three Levels of Practice • Competent - An entry level RD or RD new to diabetes practice • Proficient - An RD that has developed a deeper understanding of diabetes care and has the ability to modify practice to various situations • Expert - An RD who has developed a more intuitive understanding of diabetes care and whose practice reflects a broad range of skills and judgments acquired through a combination of experiences and education

Scope of Practice (cont…) RD's scope of practice is determined by state statute, organization’s or employer’s standards, and based on the RD’s education, training, credentialing, and demonstrated and documented competence in practice.  Specifically: In addition to nutrition education, Proficient and Expert RD’s are competent to instruct blood-sugar monitoring and insulin administration. CDE’s are able to recommend initiation or adjustment of medications, by integrating patients’ blood sugar levels with nutrition and physical activity.

Professional eligibility Who is Eligible to Become a CDE? Professional eligibility clinical psychologist registered nurse occupational therapist Optometrist Pharmacist Physical Therapist Physician Podiatrist RD or RDN Physician Assistant Certified or Registered Clinical Exercise Physiologist Master Certified Health Education Specialist Master Certified Social Worker www.ncbde.org

Practice Experience: Minimum of 2 years experience of working or volunteering in the specific health discipline, AND… Minimum of 1000 hours of documented DSME experience, while 400 hours performed within the most recent year before applying for the exam. Minimum of 15 hours of continuing education activities applicable to diabetes within the two years prior to applying for certification. Fees: Initial Certification: $350.00 Renewal of Certification: $250.00 Expired Certification: $350.00

Referring to CDEs, AADE states: “All diabetes educators, no matter their discipline, provide all aspects of DSME/T. It is recognized that members of the various healthcare disciplines who practice diabetes education bring their particular focus to the educational process. This widens or narrows the scope of practice for individual educators as is appropriate within the boundaries of each health profession, which may be regulated by national or state agencies or accrediting bodies. Regardless of discipline, the diabetes educator must be prepared to provide clients with the knowledge and skills to effectively manage their diabetes. Diabetes educators must possess a body of knowledge that spans across disciplines to provide comprehensive DSME/T.”

As an RD CDE You Posses These Abilities…. Don’t Be Left Out! Thank You….