November/December 2021 Issue
Expanded Roles in Diabetes Care
By Hope Warshaw, MMSc, RD, CDCES, BC-ADM, FADCES
Today’s Dietitian
Vol. 23, No. 9, P. 30
Seven RDs discuss changes in their specialty, and share their successes and what they’ve learned.
RDs who work in diabetes care and other areas of dietetics have been expanding their roles and responsibilities for years. No longer are these dietitians confined to the walls of a hospital or outpatient clinic delivering Diabetes Self-Management Education and Support (DSMES) programs and MNT. Instead, they’ve spread their wings in countless directions.
Today, RDs work in primary care and endocrinology practices, manage and triage populations of people with prediabetes and diabetes, and deliver care via digital health platforms. Many companies that market diabetes-focused devices, technologies, and pharmaceuticals now employ dietitians. And RDs are back in the inpatient arena but now are tackling tasks that focus on glycemic management, patient safety, and reducing hospital lengths of stay.
In this article, Today’s Dietitian (TD) discusses the changes that have taken place within the diabetes care and education specialty and profiles seven RDs who hold the credential of Certified Diabetes Care and Education Specialist (CDCES) (see “CDCES vs DCES” at the end of this article) and possibly another credential: Board Certified in Advanced Diabetes Management (BC-ADM) (see “The BC-ADM Credential” at the end of this article). Read on to learn how they’re embracing the Association of Diabetes Care & Education Specialists’ (ADCES) new name and vision. It’s a dynamic and rapidly evolving time to be involved in diabetes care.
A Bit of History
In 2019, the American Association of Diabetes Educators (AADE), an interdisciplinary organization in existence since 1974, comprising various health care providers, made the decision to change the title of its specialty from diabetes educator to diabetes care and education specialist (DCES).1,2 “AADE volunteer leaders and staff made this bold move based on market research data and keen insights on the dynamic changes occurring in diabetes management and health care delivery at large gleaned from members and stakeholders,” says Kellie Rodriguez, RN, MSN, MBA, CDCES, ADCES 2021 president and director of the Global Diabetes Program at Parkland Health & Hospital System in Dallas.
Following the announcement, the AADE made another bold move. The association changed its name in 2020 to the Association of Diabetes Care & Education Specialists (ADCES) after nearly 50 years and after exploration with a rebranding consultancy.3 “The association’s new name and name for the specialty better reflect who we are and what we do to help health care organizations and people with diabetes achieve their desired health outcomes,” Rodriguez says. Along with these recent name and title changes, other diabetes-related entities have changed their names and titles (see “New Names and Titles” at the end of this article).
Specialty Expansion for Today and Beyond
To support these changes, ADCES developed and continues to promote a vision for the specialty that contains six pillars (see figure below). These pillars represent areas in which health care professionals with the DCES credential are expanding their roles and responsibilities within health care environments. From population health to leveraging technology to driving care integration, these pillars, and the varied work of these clinicians, intersect and are inextricably linked. “DCESs strive to offer optimal care and education to a broad and diverse array of people, including those at risk of developing diabetes and those with cardiometabolic conditions and/or with diabetes and related comorbidities,” says Jan Kavookjian, PhD, MBA, FAPhA, FADCES, 2022 president-elect of ADCES and an associate professor of health outcomes research and policy at Auburn University’s Harrison School of Pharmacy in Auburn, Alabama. The current strategic plan of ADCES delineates how the organization will operationalize its vision (diabeteseducator.org/practice/new-vision-for-the-specialty).
Click to enlargeRodriguez and Kavookjian offered calls to action at the ADCES 2021 Annual Conference. “Now we must live our brand and harness our ‘val-YOU’ proposition,” Rodriguez said (see “Resource” at the end of this article). “We must now hardwire the new vision into health care systems, practice settings, or myriad places DCESs deliver collaborative, caring, outcomes-impacting, and integrated services,” Kavookjian said.
Let’s meet the following trailblazers who are doing what Rodriguez and Kavookjian hope all those working in diabetes care and education will achieve, and more. These colleagues have their CDCES as well as other credentials and have expanded their roles in diabetes care and education in a variety of health care settings. They discuss why they’ve acquired their certifications, the value they bring to their expanded roles, and what has been most rewarding in their careers, as well as offer words of wisdom to those interested in working in the specialty of diabetes care and education.
Alison Evert, MS, RDN, CDCES, FADCES
Seattle
TD: Describe your work setting, roles, and responsibilities.
Evert: I’m manager of nutrition and diabetes education programs at 14 University of Washington (UW) Medicine Primary Care Clinics. I serve as quality coordinator for DSMES programs, assist with diabetes population health initiatives, and provide regular diabetes continuing education for primary care providers.
TD: How long have you been an RDN and CDCES?
Evert: I’ve been an RDN for 42 years and CDCES for 34.
TD: Why did you earn and maintain your CDCES?
Evert: In 1987, I began a new job as an outpatient RD. I quickly realized diabetes was my niche. Adding the CDCES credential was just a logical addition. I loved providing DSMES and found group education conducive to learning. In this role, I was mentored by a wonderful registered nurse (RN) colleague. This early mentoring experience was pivotal and inspired me to mentor others.
TD: What value has the CDCES credential brought to your career?
Evert: It has allowed me to be hired in various practice settings. Throughout my career, I’ve stretched the boundaries and broken down barriers that RDs can face. For example, I obtained a medical assistant license that enables me to insert insulin pump infusion sets and continuous glucose monitoring sensors, and teach insulin injection technique. When the UW Diabetes Care Center experienced declining enrollment, I collaborated with our primary care network to deliver these services in their clinics. In doing so, I created a new position for myself.
TD: What experiences best prepared you for your current role?
Evert: Going to graduate school 20 years after becoming an RD to earn my master’s degree enabled me to be hired at the UW Diabetes Care Center. Often, as the only RD at a work site, I’ve learned to speak up. I advocate for our critical role on the interdisciplinary care team. Experiences as an advocate and in collaborative team-based care have helped me inspire RDs and RNs working in primary care to confidently share what they know.
TD: What pearls of wisdom can you offer RDs and other nutrition professionals interested in acquiring the CDCES credential?
Evert: Keep learning. Seek out opportunities to be mentored and to mentor. Push boundaries. And volunteer across all diabetes-related associations.
TD: What is the most rewarding aspect of your career?
Evert: Mentoring RDs to earn the CDCES credential, developing a glucose-lowering medication initiation and adjustment policy, and navigating the daunting world of billing and reimbursement.
TD: What area or areas of the ADCES Vision most exemplifies your current role?
Evert: Include related conditions: hypertension, obesity, and cardiometabolic. Drive integration. Achieve quadruple aim.
Brooke Benton, MS, RD, LDN, CDCES
Hampstead, North Carolina
TD: Describe your work setting, roles, and responsibilities.
Benton: I am the senior clinical director at Cecelia Health, a virtually delivered, tech-enabled chronic disease coaching platform. I lead a team of health care professionals who have their CDCES credential and provide care using telehealth.
TD: How long have you been an RD and CDCES?
Benton: I’ve been an RD for 21 years and CDCES for 16.
TD: Why did you earn and maintain your CDCES?
Benton: I was introduced to this field in one of my first jobs after graduate school. I quickly knew I found my passion. With guidance from mentors, I became a CDCES.
TD: What value has the CDCES credential brought to your career?
Benton: Personal achievement, career fulfillment, and advancement.
TD: What experiences best prepared you for your current role?
Benton: I provided diabetes care and education one on one for many years. I also gained skills to creatively teach and empower people to implement self-care, and my years of counseling gave me the insight and understanding I needed to lead my CDCES team to achieve optimal outcomes and patient satisfaction.
TD: What pearls of wisdom can you offer RDs and other nutrition professionals interested in acquiring the CDCES credential?
Benton: First, obtain high-quality experience as you accumulate direct care hours for CDCES credentialing. Second, find a CDCES mentor to guide you as you advance your career, and third, stay up to date. Never stop learning!
TD: What’s the most rewarding aspect of your career?
Benton: It’s when the people I counsel have that “a-ha” moment and feel empowered and confident to better manage their diabetes.
TD: What area or areas of the ADCES Vision most exemplifies your current role?
Benton: Promote person-centered care. Leverage technology. Focus on behavioral health.
Alex V. Nguyen, RD, CDCES
Dallas
TD: Describe your work setting, roles, and responsibilities.
Nguyen: I’m director of medical affairs at Insulet Corporation, manufacturer of Omnipod Insulin Management Systems. I coordinate and manage the involvement of various teams of employees within the company as well as people who work outside of the company to achieve the company’s key initiatives.
TD: How long have you been an RD and CDCES?
Nguyen: I’ve been an RD for 17 years and CDCES for 14.
TD: Why did you earn and maintain your CDCES?
Nguyen: Obtaining the CDCES credential was essential to being hired at Insulet and maintaining it is essential in my role.
TD: What value has the CDCES credential brought to your career?
Nguyen: Getting this credential opened the door for me to step deeper into diabetes management, to take on aspects of diabetes care beyond MNT, and discover my passion in diabetes technologies.
TD: What experiences best prepared you for your current role?
Nguyen: Working as a CDCES in a large managed care group in Southern California, I gained experience working with people with diabetes throughout the lifespan. This expertise led me to clinical roles in industry, where I built on my past experiences to advance and support technology adoption.
TD: What pearls of wisdom can you offer RDs and other nutrition professionals interested in acquiring the CDCES credential?
Nguyen: Pass on the sage counsel from a mentor, and always apply for jobs you’re interested in, even if you don’t meet the minimum requirements. Career advancement is about overcoming barriers. In the act of overcoming, you learn what skills you may not have for certain positions, and you map out how to gain new skills.
TD: What is the most rewarding aspect of your career?
Nguyen: Although I currently don’t provide direct care, I recognize that the work I do has impact on the diabetes community at large. This is what drives me.
TD: What area or areas of the ADCES Vision most exemplifies your current role?
Nguyen: Leverage technology. Promote person-centered care.
Donna Butler Ryan, MPH, RN, RDN, CDCES, FADCES
Pensacola, Florida
TD: Describe your work setting, roles, and responsibilities.
Ryan: I’m regional director of community and population health for Ascension. I oversee diabetes and nutrition services for adults and pediatrics. I’m also involved in transitional care management and remote patient monitoring.
TD: How long have you been an RDN and CDCES?
Ryan: I’ve been an RDN for 40 years and CDCES for 26.
TD: Why did you earn and maintain your CDCES?
Ryan: The CDCES credential validates my work at an expert level and has been the driver of my career advancement.
TD: What value has the CDCES credential brought to your career?
Ryan: I sought and received my RN degree 15 years after becoming an RD. Being dually licensed has afforded me a unique, valuable perspective. My combined specialties make me a valuable team member and leader.
TD: What experiences best prepared you for your current role?
Ryan: The CDCES certification has been a springboard for other opportunities. It has facilitated my career as speaker, author, and local and national leader.
TD: What pearls of wisdom can you offer RDs and other nutrition professionals interested in acquiring the CDCES credential?
Ryan: Get out of your comfort zone. Seek out opportunities to speak, be interviewed, and write articles and blogs. Keep learning and upskilling, and volunteer. You will grow and learn from colleagues you wouldn’t otherwise connect with.
TD: What is the most rewarding aspect of your career?
Ryan: It was during my role as 2018 ADCES president. I was deeply involved with charting the current ADCES Vision (see figure “Six Pillars of ADCES’ Strategic Plan” above) and strategic plan towards a sustainable and productive future for DCES.
TD: What area or areas of the ADCES Vision most exemplifies your current role?
Ryan: Achieve quadruple aim. Drive integration.
Becky Sulik, RDN, LD, CDCES
Idaho Falls, Idaho
TD: Describe your work setting, roles, and responsibilities.
Sulik: I’m director of education at Rocky Mountain Diabetes Center, where I oversee seven DCES professionals. I provide care to children and adults with type 1 diabetes, serve on the quality management team, train patients and providers on diabetes technologies, support diabetes clinical research trials, and assist prescribing providers with data monitoring and therapy adjustments.
TD: How long have you been an RD and CDCES?
Sulik: I’ve been an RD for 25 years and CDCES for 23.
TD: Why did you earn and maintain your CDCES?
Sulik: I was eager to distinguish myself as a specialist in diabetes. I maintain the credential because it demonstrates my efforts to excel in diabetes care with providers, employers, payers, and people with diabetes.
TD: What value has the CDCES credential brought to your career?
Sulik: The CDCES credential has facilitated increased pay, recognition, and bargaining power with payers. The resulting trust I’ve earned from prescribing providers I work with has enabled me to expand my role and value. This credential also affords me the opportunity to collaborate nationally on diabetes care–related advisory and advocacy boards.
TD: What experiences best prepared you for your current role?
Sulik: What has prepared me were the opportunities to learn more about the relationship between reimbursement and outcomes, and more importantly, train on measuring and communicating this to decision makers. This has been essential in increasing my visibility and competency.
TD: What pearls of wisdom can you offer RDs and other nutrition professionals interested in acquiring the CDCES credential?
Sulik: Speak the language of value. Learn to communicate the value you bring to improving care and reducing costs. Step out of the nutrition box. Work with diabetes technologies and the data they provide to you as a provider and to people you counsel.
TD: What is the most rewarding aspect of your career?
Sulik: Working at the top of my scope of practice in collaboration with prescribing providers. My biggest reward is the long-standing relationships with the people I care for and counsel.
TD: What area or areas of the ADCES Vision most exemplifies your current role?
Sulik: Leverage technology. Achieve quadruple aim.
Priscilla Flowers Thomas, MS, RN, RDN, LDN, CDCES, CCM
Bowie, Maryland
TD: Describe your work setting, roles, and responsibilities.
Thomas: I’m project manager at TLC-MD for PreventionLink of Southern Maryland (preventionlinkmd.com), a public-private partnership funded by a Centers for Disease Control and Prevention grant. I’m hired by TLC-MD under Syntric Solutions, LLC, the company I co-own and for which I serve as president. In my role with TLC-MD, I manage recruitment and enrollment of primary care practitioners in PreventionLink, increase access to the National Diabetes Prevention Program, as well as DSMES and cardiac rehabilitation programs.
TD: How long have you been an RN, RD, and CDCES?
Thomas: I’ve been an RN for 42 years, an RD for 13, and CDCES for 28.
TD: Why did you earn and maintain your CDCES?
Thomas: A CDCES colleague started me on this career path. However, diabetes is personal. I have family members with diabetes who have experienced complications due to lack of knowledge, barriers to adequate self-care, delays in diagnosis, and inadequate treatment due to therapeutic inertia.
TD: What value has the CDCES credential brought to your career?
Thomas: I can use my knowledge, skills, and resources to make a difference in the lives of people who look like me by reducing the risk of type 2 diabetes and improving diabetes care and related conditions.
TD: What experiences best prepared you for your current role?
Thomas: I’ve been a nutrition educator for the Supplemental Nutrition Assistance Program, worked in community clinics and outpatient hospital settings, and served as a diabetes case manager and manager for a Medicaid health plan. My current role uses and builds on all my previous experiences.
TD: What pearls of wisdom can you offer RDs and other nutrition professionals interested in acquiring the CDCES credential?
Thomas: Know your value. Collaborate with colleagues. Give yourself the flexibility to learn on the job.
TD: What is the most rewarding aspect of your career?
Thomas: Being a problem solver. Building trusted relationships. Working collaboratively with multiple stakeholders to develop and implement innovative solutions.
TD: What area or areas of the ADCES Vision most exemplifies your current role?
Thomas: Achieve quadruple aim. Include related conditions. Leverage technology.
Sandra Arevalo Valencia, MPH, RDN, CDN, CDCES, CLC, FADA
Nyack, New York
TD: Describe your work setting, roles, and responsibilities.
Arevalo: I’m director of community and patient education at Montifiore Nyack Hospital. I coordinate delivery of health education to the community on nutrition, diabetes, cancer, and other chronic diseases. I also provide individual and group education on diabetes, nutrition, and wellness for inpatients and outpatients.
TD: How long have you been an RDN and CDCES?
Arevalo: I graduated as a dietitian-nutritionist in 1997 in Colombia, South America. In the United States, I completed my dietetic internship and received my master’s in public health. I’ve been an RD since 2005, so that makes 16 years, and I’ve been a CDCES for 11.
TD: Why did you earn and maintain your CDCES?
Arevalo: I love interacting with people with diabetes and believe I can make an impact on their lives.
TD: What value has the CDCES credential brought to your career?
Arevalo: Specializing in diabetes and the related knowledge gained by studying for the CDCES exam helped me stand out. With the prevalence of diabetes today, those with a CDCES credential have the advantage of finding a job and being promoted to program management positions.
TD: What experiences best prepared you for your current role?
Arevalo: Obtaining my MPH degree provided me with skills to create curricula and programs.
TD: What pearls of wisdom can you offer RDs and other nutrition professionals interested in acquiring the CDCES credential?
Arevalo: If you want to specialize in diabetes, counsel more people with diabetes. Be creative in expanding your role. Jump in; don’t wait to be asked to take on a new role or create a new service.
TD: What is the most rewarding aspect of your career?
Arevalo: Creating successful health education programs for Latinos and underserved and high-risk populations.
TD: What area or areas of the ADCES Vision most exemplifies your current role?
Arevalo: Promote person-centered care.
— Hope Warshaw, MMSc, RD, CDCES, BC-ADM, FADCES, is the owner of Hope Warshaw Associates, LLC, a diabetes- and nutrition-focused consultancy based in Asheville, North Carolina. During the last 30-plus years, Warshaw has expanded her role to include diabetes and nutrition communications. She’s the author of numerous books published by the American Diabetes Association and is a contributor to both consumer- and clinician-facing nutrition and diabetes publications. Warshaw served as the ADCES President 2016 and currently serves as the 2021–2022 chair-elect of the Academy of Nutrition and Dietetics Foundation.
References
1. Powers MA. A review of recent events in the history of diabetes nutritional care. Diabetes Educ. 1992;18(5):393-400.
2. Association of Diabetes Care & Education Specialists. Fact sheet. https://www.diabeteseducator.org/docs/default-source/about-aade/aade-fact-sheet-2017.pdf?sfvrsn=2. Published 2020. Accessed August 31, 2021.
3. Association of Diabetes Care & Education Specialists. The Huddle: announcing the Association of Diabetes Care and Education Specialists: repositioning the association and the specialty for the future, with Kellie Antinori-Lent. Simplecast website. https://thehuddle.simplecast.com/episodes/announcing. Published January 22, 2020. Accessed August 31, 2021.
[Sidebars]
The BC-ADM Credential
Q: What is the BC-ADM credential, and should RDs seek it?
A: Board Certified-Advanced Diabetes Management (BC-ADM), initiated in 2000, is a credential owned by the Association of Diabetes Care & Education Specialists that can be acquired instead of or in addition to the Certified Diabetes Care and Education Specialist certification by master’s-prepared, advanced-level diabetes care practitioners.1 Health care practitioners who hold the BC-ADM credential manage the complex needs of people with diabetes. Practitioners with this certification can, within their scope of practice, adjust medications, counsel on lifestyle modifications, conduct research, and mentor students and colleagues.2
— HW
References
1. Certification. Association of Diabetes Care & Education Specialists website. https://www.diabeteseducator.org/education/certification. Accessed August 31, 2021.
2. Board Certified-Advanced Diabetes Management (BC-ADM®). Association of Diabetes Care & Education Specialists website. https://www.diabeteseducator.org/education/certification/bc_adm. Accessed August 31, 2021.
CDCES vs DCES
Q: What’s the difference between a Certified Diabetes Care and Education Specialist (CDCES) and a health care provider with the DCES (Diabetes Care and Education Specialist) title?
A: Members of the Association of Diabetes Care & Education Specialists (ADCES) are being encouraged to use the term “diabetes care and education specialist” as their title; however, this isn’t a certification or credential. What’s worth noting is that the CDCES credential isn’t a prerequisite of ADCES membership. In fact, nearly 40% of members don’t have it (see table above).
The CDCES certification has existed since 1986. Learn more about eligibility, the exam, how to maintain the credential, and more at cbdce.org. “The CDCES credential indicates assurance that the practitioner has specific knowledge, skills, and experience in diabetes management and education,” says Becky Sulik, RDN, LD, CDCES, chair-elect of the Certification Board for Diabetes Care and Education (see profile above). She says RDs who work in diabetes care and education will benefit from becoming a CDCES because employers, payers, and people with diabetes and their caregivers recognize this credential.
— HW
Resource
The ADCES Value Toolkit is now available. The Diabetes Care and Education Specialist Value Toolkit highlights ways Diabetes Care and Education Specialists can impact diabetes care, outcomes, and cost. Health care practitioners and others involved in diabetes care delivery can use this new toolkit to explore the value Diabetes Care and Education Specialists provide and access resources to fully optimize services across the health care spectrum. To access the toolkit, visit DiabetesEducator.org/ValueToolkit.
— HW
New Names and Titles
• American Association of Diabetes Educators is now called the Association of Diabetes Care & Education Specialists (ADCES) (diabeteseducator.org).
• Diabetes Educator is now called Diabetes Care and Education Specialist.
• ADCES’s research journal The Diabetes Educator is now called The Science of Diabetes Self- Management and Care.
• Certified Diabetes Educator is now called Certified Diabetes Care and Education Specialist.
• National Certification Board for Diabetes Educators is now called the Certification Board for Diabetes Care and Education (cbdce.org).
• Diabetes Care & Education Dietetic Practice Group of the Academy of Nutrition and Dietetics is now called Diabetes Dietetic Practice Group (dce.org/home).
— HW