Diabetes is a disease of the endocrine system. Endocrine or endocrinology nurses may work with people who have diabetes, and go by the title diabetes nurse. As diabetes mellitus has become an increasingly common problem, there’s a growing need for diabetes nurse educators and disease management specialists able to provide patients with the information and treatment they need to effectively manage their diabetes.
A diabetes nurse can be a staff nurse who helps monitor and educate patients, or an advanced practice registered nurse (nurse practitioner or clinical nurse specialist) who can take on the added responsibilities of advanced diabetes management and education. These additional responsibilities often include adjusting the type and dosage of medication, providing nutritional therapy and exercise planning, and providing behavioral and psychosocial counseling. Advanced practice nurses who sub-specialize in endocrinology may serve as a diabetic’s primary healthcare provider.
Diabetes Self-Management Educators
A primary role for nurses is that of a diabetes self-management educator who provides information to patients with pre-diabetes and diabetes in an effort to help patients make informed decisions about prevention and managing their condition. With a focus on helping people make lifestyle changes that contribute to improved health, the duties of a diabetes educator include:
- Working with patients to assess their needs and to develop a plan that includes educational interventions and self-management support strategies appropriate for the patient
- Providing education that helps the patient accomplish self-management goals
- Evaluating patients periodically to determine if they are meeting their goals or if they need other interventions and future reassessments
- Developing, with the cooperation of the patient, a personalized follow-up plan for ongoing self-management support
- Documenting the assessment and education plan, as well as interventions and outcomes
Diabetes nurse educators provide services in hospitals, physician offices, pharmacies, patients’ homes, and other settings. Advanced practice registered nurses typically serve under a primary specialization in their patient population focus, allowing them to further specialize as adult, gerontological, or pediatric diabetes educators.
Certificate programs and nursing continuing education in diabetes management is available for both nurses with an undergraduate degree and for advanced practice nurses who already hold MSNs. These post-baccalaureate and post-graduate certificate programs typically cover the following areas:
- Pathophysiology, classification, and diagnosis of diabetes mellitus
- Complications associated with diabetes
- Oral medications and insulin therapy
- Non-drug therapies for diabetes, including exercise, nutrition, and other lifestyle and behavioral modifications
While some MSN programs with a diabetes nursing specialization are available, it is much more common for nurses interested in advanced practice to pursue graduate-level education in a primary patient population focused specialization, such as one designed for adult, pediatric, or family nurse practitioners or clinical nurse specialists. Advanced practice registered nurses interested in diabetic care may take diabetes-related classes during their graduate program, and could arrange to have diabetic care included in the clinical experience component of their education.
Diabetes Nurse Educator Certification
Registered Nurses are eligible for certification as Certified Diabetes Educators (CDE) through the National Certification Board for Diabetes Educators. In addition to holding a current, active RN license, nurses must have a minimum of two years of professional experience as an RN. They must also have no fewer than 1,000 hours of experience in diabetes self-management education, with a minimum of 400 hours of experience during the year just before applying for certification, as well as 15 clock hours of continuing education related to diabetes within the two years before applying.
The certification exam is given twice a year, in the spring and fall, for a one-month period, through AMP Assessment Centers. The breakdown of the exam is as follows:
- Assessment (45 questions)
- Intervention (112 questions)
- Program Development and Administration (18 questions)
Renewal of certification takes place every five years. CDEs who can document a minimum of 1,000 professional practice hours in diabetes self-management education can renew by either meeting continuing education requirements or by taking the exam. CDEs who don’t meet this practice hour requirement must have acceptable continuing education hours and pass the exam again.
Advanced practice nurses with a master’s degree or higher are eligible for Board Certified – Advanced Diabetes Management Certification (BC-ADM) from the American Association of Diabetes Educators (ADE). Applicants must have at least 500 clinical practice hours in advanced diabetes management during the four-year period immediately prior to taking the certification exam. (Note that before 2010, advanced diabetes management certification for nurses was through the American Nurses Credentialing Center. The ADE took over the certification effective January 1, 2010.)
The exam contains 150 questions, broken down as follows:
- Foundational Knowledge (15 questions)
- Assessment and Data Collection (19)
- Diagnosis/Problem Identification (19)
- Planning and Intervention (45)
- Evaluation (22)
- Public and Community Health (8)
- Quality Improvement and Research (11)
- Leadership and Professional Practice (11)
Recertification takes place every five years during which time at least 1,000 practice hours, in addition to continuing education hours, must be completed.
The American Association of Diabetes Educators (ADE) is open to all healthcare professionals involved in integrating self-management into caring for people with diabetes and related chronic conditions.
Salary and Demographics
The most recent salary survey of diabetes educators conducted by the American Association of Diabetes Educators was published in 2008. The survey showed a median salary of $64,900 a year. This median figure was among all diabetes educators, including those without advanced education and certification. The survey revealed that 51 percent of diabetes educators were nurses, forty percent of which were RNs, seven percent were clinical nurse specialists, and four percent were nurse practitioners.