1. Professional Education - Current registration as a dietitian by the Commission on Dietetic Registration.
   
   
2. Professional Practice Experience - all (A through C - listed below) of the following requirements must be met:
   
   A. A minimum of two years (to the day) of professional practice experience in diabetes self-management education in health care settings within the United States or its territories.* Only experience occurring AFTER completing the education requirement may be counted toward this requirement.
   
   and
   
   B. A minimum of 1,000 hours of diabetes self-management education experience within the past five years.* Work experience is defined as employment in diabetes education for compensation.
   
   All experience must be in health care settings within the United States or its territories.
   
   and
   
   C. Current employment in a primary role as a diabetes educator a minimum of four hours per week, or its equivalent, at the time of application.

* Note: information taken from the NCBDE website information on Eligibility Requirements. Please refer to the website for more details on the credentialing process.

NCBDE Content Areas for CDE Exam:
Content Outline (This information current as of 10/1/03, check NCBDE website for recent updates at www.ncbde.org)

I. ASSESSMENT

A. Learning/Self-Care Behaviors

1. Assess patient (family/caregiver) learning needs
2. Assess patient (family/caregiver) learning readiness (e.g., attitudes, developmental level, perceived learning needs)
3. Assess learning style
4. Assess barriers to teaching patient (e.g., literacy level, cultural values, religious beliefs, health beliefs, psycho-socioeconomic)
5. Assess physical capabilities/limitations (e.g., visual acuity, hearing, functional ability)

B. Medical/Health/Psycho-Socioeconomic Status

1. Collect diabetes-specific health history (e.g., duration, symptoms, complications, treatment)
2. Collect general health history (e.g., allergies, medical history, nutrition history)
3. Assess previous and current medication regimen (e.g., prescription and non-prescription drugs, alternative remedies, adverse reactions)
4. Assess treatment fears (e.g., hypoglycemia, hyperglycemia, needles, weight gain)
5. Assess family/caregiver dynamics and social supports
6. Assess substance abuse (e.g., alcohol, tobacco, caffeine)
7. Assess psychosocial/developmental/mental health status (e.g., adjustment to diagnosis)
8. Identify specific barriers to diabetes self-care regimen (e.g., cognitive ability, psychosocial, physical, economic)
9. Conduct diabetes-specific physical examination (e.g., lower extremities, injection sites, blood pressure, height and weight)
10. Assess laboratory results and trends (e.g., blood glucose, A1C, lipid profile, renal/liver function)
    

C. Current Knowledge and Practices Related to Diabetes Care

1. Assess diabetes education, knowledge, and self-management skills
2. Assess nutritional habits (e.g., food choices, portion sizes, timing of meals and snacks)
3. Assess exercise/physical activity history and/or level
4. Assess monitoring techniques and equipment (e.g., blood glucose and ketones)
5. Assess record keeping activities (e.g., blood glucose, food and activity records)
6. Assess medication administration (e.g., insulin administration technique, timing and dosage of diabetes medication)
7. Assess use of health care resources (e.g., primary care physician and other health care providers, insurance)
8. Assess use of community resources (e.g., schools, support groups, diabetes organizations)
   

II. INTERVENTION

A. Collaborate with Patient/Family/Caregiver to Develop:

1. Individualized learning objectives
2. Individualized diabetes education plan based on assessment (e.g., sequence of information, selection of content)
3. Measurable behavioral goals
4. An ongoing plan for achieving and evaluating goals
5. Instructional methods (e.g., discussion, demonstration, role playing, simulation)
   

B. Teaching

1. Discuss general issues related to diabetes with patient (family/caregiver):
   a. Classifications and diagnosis (current American Diabetes Association Guidelines)
   b. Normal vs. abnormal fuel metabolism
   c. Pathophysiology (e.g., auto-immunity, insulin resistance)
   d. Interaction of exercise, food, and medication
   e. Treatment options (e.g., choices, availability, cost, risk/benefit)
   f. Goals of treatment (e.g., blood glucose, A1C, lipids, quality of life)
   g. Meaning of diabetes-related laboratory tests (e.g., microalbumin, cholesterol)
   
   
2. Discuss living with diabetes with patient (family/caregiver):
   a. Psychosocial adaptation (e.g., coping skills)
   b. Patient role/responsibilities
   c. Decision making/behavior change skills
   d. Discrimination issues
   e. Insurance
   f. Community/health care resources
   
   
3. Instruct patient (family/caregiver) in daily self-care skills:
   a. Blood glucose monitoring
   b. Ketone testing
   c. Record keeping and analysis
   d. Foot/skin/dental care
   e. Sharps disposal
   f. Medical identification
   
   
4. Instruct patient (family/caregiver) in nutrition principles and guidelines:
   a. General principles (American Diabetes Association nutrition recommendations)
   b. Carbohydrates in blood glucose control (e.g., postprandial blood glucose, food source, sugar substitutes, fiber)
   c. Fat in lipid management (e.g., total fat, saturated fat, monounsaturated fat)
   d. Matching medications to food intake
   e. Food label interpretation
   f. Alcohol
   g. Vitamins, minerals and supplements
   h. Principles of weight management
   i. Changes in usual schedules (e.g., problem-solving)
   j. Special considerations (e.g., gastroparesis, renal insufficiency)
   
   
5. Instruct patient (family/caregiver) in guidelines for physical activity:
   a. Benefits and precautions
   b. Exercise/activity plan
   c. Post-exercise hypoglycemia
   
   
6. Instruct patient (family/caregiver) in pharmacologic management of diabetes:
   a. Medications (e.g., oral agents and insulin, administration, side-effects)
   b. Delivery systems (e.g., pump therapy, insulin pens)
   b. Medication adjustment
   c. Drug interactions
   d. Use of non-prescription preparations (e.g., over-the-counter drugs)
   e. Glucagon
   
   
7. Instruct patient (family/caregiver) in acute complications and treatments:
   a. Hypoglycemia
   b. Hyperglycemia
   c. Sick days
   d. Diabetic ketoacidosis (DKA)
   e. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
   f. Dental and gum disease
   g. Skin problems (e.g., wound care, yeast infections)
   
   
8. Instruct patient (family/caregiver) in chronic complications and treatments:
   a. Screening and prevention of complications (e.g., smoking, hypertension)
   b. Eye disease (e.g., retinopathy, cataracts, glaucoma)
   c. Sexual dysfunction
   d. Neuropathy (e.g., autonomic, peripheral)
   e. Nephropathy
   f. Macrovascular disease
   g. Lower extremity problems
   h. Skin problems (e.g., ulcers)
   
   
9. Instruct patient (family/caregiver) in special management issues related to diabetes:
   a. Honeymoon period, dawn phenomenon, Somogyi (rebound) phenomenon
   b. Surgery
   c. Travel
   d. Pre-conception care
   e. Multiple, chronic illnesses (e.g., hypertension, depression, hyperactivity)
   f. Shift/schedule variations
   
   
10. Instruct patient (family/caregiver) of current diabetes research and new developments

C. Implementation

1. Initiate patient's:
   a. Food plan
   b. Exercise/activity regimen
   c. Medication regimen
   d. Monitoring regimen
   e. Laboratory tests
   
   
2. Recommend to patient and/or family/caregiver changes in patient's:
   a. Food plan
   b. Exercise/activity regimen
   c. Medication regimen
   d. Monitoring regimen
   e. Laboratory tests
   
   
3. Recommend to health care team changes in patient's:
   a. Food plan
   b. Exercise/activity regimen
   c. Medication regimen
   d. Monitoring regimen
   e. Laboratory tests
   
   
4. Adjust patient's:
   a. Food plan
   b. Exercise/activity regimen
   c. Blood glucose monitoring regiment
   
   
5. Treat hypoglycemia
   
   
6. Treat hyperglycemia
   
   
7. Recommend diabetes-related equipment (e.g., blood glucose meters, assistive devices, injection devices)
   
   
8. Assist patient/family/caregiver in coping with diabetes and complications (e.g., depression, anger, sexual dysfunction)
   

D. Review, Evaluation, Revision, and Documentation

1. Interpret client's weight changes, blood glucose, food, medication, and exercise records
   
   
2. Evaluate effectiveness of teaching in the following:
   a. Achievement of measurable objectives
   b. Progress toward behavioral goals
   c. Self-management skills
   d. Psychosocial adaptation
   
   
3. Establish new goals based on current program
   
   
4. Document results of assessment, intervention, and outcomes
   

E. Follow-up and Referral

1. Identify problems requiring intervention by other health care professionals
   
   
2. Refer or recommend referral to appropriate specialist for:
   a. Medical nutrition therapy
   b. Exercise prescription
   c. Mental health
   d. Medical care (e.g., foot care, ophthalmologist)
   e. Financial and social services
   f. Risk reduction (e.g., smoking cessation, obesity)
   g. Medication review (e.g., pharmacist)
   
   
3. Facilitate communication between patient and providers to ensure health care and education needs are addressed (e.g., case management)
   
   
4. Provide feedback to referral source

III. PROGRAM DEVELOPMENT AND ADMINISTRATION

A. Perform needs assessment (e.g., target population)

B. Develop curriculum (e.g., content outline, lesson plan, teaching materials)

C. Choose teaching methods and materials for target populations

D. Develop and implement diabetes patient education program

E. Market and promote diabetes education program

F. Evaluate the following:

1. Patient satisfaction with program/facilities/instruction
   
   
2. Effectiveness of diabetes education materials
   
   
3. Program outcomes (e.g., number of people served, provider satisfaction)
   
   
4. Patient outcomes (e.g., A1C, quality of life, ER visits)

G. Document program for outside review (e.g., JCAHO, ADA)

H. Advocate for people affected by diabetes (e.g., third party reimbursement, schools, policy makers)

I. Maintain patient information/demographic database

J. Ensure patient confidentiality

K. Participate in quality assurance activities (e.g., capillary blood glucose monitoring, adherence to diabetes protocols)

L. Provide consultation and updates about diabetes program, standards, and quality assurance programs

M. Promote standards of care

N. Lead or facilitate diabetes support groups

O. Follow infection control principles

P. Promote diabetes screening and prevention activities (e.g., risk reduction, weight loss programs)

IV. SPECIAL POPULATIONS

A. Develop and assess treatment plans and goals for the following:

1. Pregnancy
   
   
2. Children with type 1 and type 2 diabetes
   
   
3. Adolescents with type 1 and type 2 diabetes
   
   
4. Elderly
   
   
5. Functional impairments (e.g., physical, surgical, mental)
   
   
6. Ethnic groups