I know that many of you are talking about our State Licensure Initiative, and you have some
questions. In the articles below, we will present the ins and outs of the initiative so that every
AADE member will have the same answers.
First, I’d like to share with you the principles that have guided us in this effort:
- Diabetes Self-Management Training (DSMT) has demonstrated health benefits for individuals with
diabetes and results in cost savings to the healthcare system.
- The growing number of people with diabetes need and deserve access to diabetes self-management
- There are not enough qualified diabetes educators to deliver these needed services to the
growing population with diabetes.
- At this time, anyone can call themselves a diabetes educator and the scope of practice varies
greatly among programs and practitioners.
AADE represents diabetes educators and supports the delivery of quality DSMT. We are
dedicated to growing the specialty into a standardized, more recognized profession and encourage
more healthcare professionals to enter the field. More qualified diabetes educators mean better
patient care and outcomes.
The State Licensure Initiative evolved directly out of our efforts to meet this need. In the
articles that follow, you will find an overview of the licensure process, AADE’s recommendations
for the licensure requirement, the process for establishing a state license for diabetes educators,
and the various resources that exist to help you learn even more about the initiative.
Thank you for reading the Advocacy Newsletter!
Donna Tomky, MSN RN C-NP CDE FAADE, AADE President
AADE has long spearheaded efforts to increase recognition for diabetes education through
advocating for passage of federal legislation – the Diabetes Self-Management Training Act – that
seeks Medicare provider status for CDEs performing outpatient diabetes education.
However, the main barrier we’ve found to gaining provider status is that there is no legal
definition/scope of practice for diabetes education. Other healthcare professions have licensure or
registration requirements and a professional scope of practice that give them a legal standing for
recognition by the Centers for Medicare and Medicaid Services.
We recognized the need to establish a legal definition for the professional and a codified scope
of practice. The only way to accomplish this is through establishing state licensure for diabetes
State licensure ensures that all healthcare providers who deliver diabetes education will have
sufficient knowledge to provide safe, effective care to persons with diabetes. It also offers
patients a measure of protection by ensuring that the diabetes education they receive is provided
by a qualified professional with adequate training to meet a standard level of diabetes care.
Licensure would set the quality standards and the scope of practice for the diabetes educator—a
nd it creates the legal definition that we need in order to successfully advocate for increased
reimbursement and provider status for diabetes educators.
However, establishing state licensure is not an overnight endeavor—nor is there a standardized
procedure that can be followed in all states, as each state has their own legislative and
regulatory process. Once the process has been initiated, it could take several years until all of
the details have been worked out and implemented.
Through grassroots advocacy and targeted lobbying efforts on the state level, legislation must
be drafted, endorsed, and passed. After the legislation is passed, the regulatory bodies will set
the specific qualifications for the license in that particular state.
Again, the requirements for diabetes educator licensure will be determined on a state-by-state
basis during their regulatory process. However, AADE has proposed certain qualifications and
standards for individuals seeking a diabetes educator license.
AADE believes that DSMT is a crucial element in the health care of people with diabetes; it has
demonstrated health benefits for individuals and results in cost savings to the healthcare system.
AADE also recognizes that there are not enough qualified diabetes educators to deliver these needed
services to the growing population with diabetes.
Licensure sets the quality standards and the scope of practice for the diabetes educator. It
also sets the baseline requirements for professionals who may pursue an additional credential to
demonstrate their professional development and career advancement.
AADE does not have power over how the licensure standards are set. However, in an effort to (1)
assist in defining this legal scope of practice for the qualified diabetes educator, (2) protect
the patient, (3) help guide the process of establishing minimum quality standards for the delivery
of DSMT, and (4) protect the diabetes educator, AADE will advocate that the following
recommendations be considered by state regulatory licensing boards:
- Healthcare professional disciplines include, but are not limited to registered nurses,
registered dietitians, registered pharmacists, licensed mental health professionals, and exercise
- Bachelor’s degree or education that meets the states healthcare professional licensure
requirements for the primary discipline. Completion of AADE’s Core Concepts Course or a diabetes
education program sponsored by any advanced academic or continuing education organization that
meets state-determined standards and provides a minimum of 15 hours of learning in the biological
and social sciences, communication, counseling, and education.
- 5 hours of continuing education related to diabetes self-management education and training each
Professional Practice Experience:
- 250 hours – within a two (2) year time frame; specific to diabetes self-management education
and training. As evidence of experience in the care of people with diabetes.
Here is a high-level summary of the issues surrounding the state licensure
- Right now, anyone can say that they are a diabetes educator. There are thousands of healthcare
professionals in the U.S. who are providing different levels of care and education to people with
diabetes. But there is no “proof” that they are qualified to deliver DSMT. There are no
requirements that they must meet to claim the specialty and no specific coursework required for
them to complete.
- In reality, this means that diabetes education is essentially an unregulated and largely
unrecognized profession. There is no legal definition of the profession because it does not have a
standardized scope of practice.
- Professionals who have earned the BC-ADM and CDE® credentials have demonstrated exceptional
knowledge and experience in the field. However, the credential is not required to practice diabetes
- Even though healthcare professionals have to be licensed in their respective fields to be
eligible to sit for a credential, professional licensure boards (such as those for RNs and LDs)
have no jurisdiction over the practice of diabetes education or the diabetes educator.
- If licensure was limited to only those who have earned the BC-ADM and CDE® credentials, the
workforce of diabetes educators would be severely limited with little hope of meeting the needs of
the growing diabetes population--as there are only about 17,000 credentialed diabetes educators in
the country and nearly 26 million Americans with diabetes.
- Licensure would set the minimum quality standards and the scope of practice for the diabetes
educator. It is designed to ensure that everyone who claims to be a diabetes educator and delivers
diabetes education is adequately qualified and prepared before they can claim the professional
- The requirements for diabetes educator licensure will be determined on a state-by-state basis
during their regulatory process, after the legislation has been passed. AADE does not have power
over how the licensure standards are set.
- The licensure standards for each state will be determined during their individual regulatory
processes, but AADE has made specific recommendations for the requirements for
- AADE recognizes that professionals who have earned the BC-ADM or CDE® credential would surpass
the minimum qualifications for licensure and has reflected this in our recommendations for state
As we move forward with the State Licensure Initiative it is imperative that the AADE membership
not only understands the process of how licensure legislation gets passed but knows that we are
here to help guide and support the efforts from beginning to end!
The first step in starting the licensure process would be to contact James Specker, AADE
Advocacy Specialist, at
firstname.lastname@example.org or (312) 601-4873 to begin creating
a strategy and to determine how best to approach the licensure effort in your state. Each state is
unique and the processes will vary but the core of all the efforts is as follows:
- First, determine whether the diabetes educators in the state are interested in pursuing this
initiative. Legislation rarely gets passed unless there is public demand.
- Work with AADE to educate yourselves on how licensure is handled in your state and determine
the requirements for comparable licenses (RN, LD, LPN, etc). This helps in modifying the draft
legislation to be applicable to your states process. If funding is available for a contract
lobbyist, that individual or group would guide the drafting of the legislation
- Identify key individuals who reside in your state and will serve as liaisons and content
experts when communicating the issues with the state legislature. These will include diabetes
educators but also should include patients, parents of children with diabetes, program
coordinators, etc. AADE can assist with the training of these spokespersons if they do not have any
prior experience in the political arena.
- With the guidance of AADE and/or the state lobbyist, identify legislators – one each in the
Senate and the House – who will serve as the bill’s sponsors and champions. You will work with them
to draft the legislation. We can provide you with:
- Draft legislation used in other states
- Recommendations on requirements for licensure
- Fact sheets and needs assessments
- Work with your champions to build support and seek co-sponsors for the legislation. AADE will
guide you through the process, including:
- Generating an information blast to targeted areas in your state or through sending action
- Providing contact information for relevant members of the state legislature
- Once the legislation is introduced it will go to the appropriate committee, depending on the
state’s processes, for consideration and then, if applicable, to the floor for a vote. During this
time, the content experts need to be available, lobbying for the legislation with relevant
committee members and testifying at hearings in summoned. Representatives from AADE headquarters
and/or Board of Directors are available to accompany this group during the meetings or
- The regulatory process is the last step and will begin once the bill is passed in both the
State Senate and House, and after the Governor signs the bill.
On June 8, 2011 AADE hosted a town hall call on the state licensure initiative for AADE
Speakers included AADE President Donna Tomky, past President Deb Fillman, Vice President Tami
Ross, Chief Executive Officer Lana Vukovljak, and Chief Advocacy Officer Martha Rinker.
This was an opportunity for AADE members to learn more about the initiative, ask questions and
find out how to get a Diabetes Educator licensure effort started in your state.
Click on the podcast button below to listen to the entire call with questions from AADE members
and answers from the panel.
The American Association of Diabetes Educators is a member group and co-chair of the Diabetes
Advocacy Alliance (DAA). The DAA is a broad coalition of diabetes related organizations formed to
help address the growing health and economic threats from Diabetes Epidemic.
The following is a press release for the official launch of the DAA website.
(WASHINGTON) As part of its fundamental mission to inform policymakers about the severity of the
US diabetes epidemic and offer sound solutions, the Diabetes Advocacy Alliance™ (DAA) has launched
www.diabetesadvocacyalliance.org , a Website
that will help serve as a resource for diabetes-related news and policy information.
The American Association of Diabetes Educators (AADE) is a member of the DAA, a diverse,
14-member group of patient advocacy organizations, professional societies, trade associations,
nonprofit organizations, and corporations, sharing a common goal to defeat diabetes.
"Diabetes is a huge and growing problem," said Martha Rinker, DAA co-chair and Chief Advocacy
Officer of the American Association of Diabetes Educators. "In many ways, diabetes is bigger than
all of us. That's one of the primary reasons why this broad coalition of organizations has come
together and one of the reasons we believe it is critical to inform policymakers about the human
and economic impact."
According to the Institute for Alternative Futures (IAF), the number of people with diabetes
will swell by 64% to more than 50 million Americans in the year 2025. The costs will swamp the
health care system, with a price tag of almost $514 billion—an amount comparable to the total
budget of today's Medicare program and a 72% increase from 2010, according to IAF data.
The website will provide information on the costs and impact of diabetes, as well as information
about the diabetes-related activities of its members, including the AADE.
"We've seen policy reshape how this nation prevents public health challenges-- such as car
passenger safety through seat belt laws, preventing seasonal flu through vaccination, and saving
children's lives through car seat and bicycle helmet requirements," said DAA co-chair, Dr. Michael
Duenas, Associate Director, Health Sciences and Policy at the American Optometric Association. "We
need to have that same sort of attention paid to those at risk for type 2 diabetes."
For more information please visit the DAA website: