I read a post or a comment several months ago and the writer referred to a “DSN” as if it were a commonly used acronym. I discovered that DSN translates to Diabetes Specialist Nurse, a title within the UK’s National Health Service system.
Recently I’ve come across the term “diabetic nurse.” The context leads me to believe that this title may exist in some HMO or other network to take care of people with diabetes in some region of the US. At face value, I interpret a diabetic nurse as a nurse with diabetes!
Does anyone know if that’s common parlance in their neck of the woods? Just curious.
In Canada, a CDE has to be a nurse, so I’ve often heard them called “diabetes nurses” and am not sure I’ve ever heard the term “CDE” used in Canada. I think in the US anyone can become a CDE. I’ve never heard the term “diabetic nurse”, though.
I have such a nurse. She is called ‘diabetes nurse’ at my doctor’s clinic. If I want to speak to my internist, I have to go through her. There aren’t enough doctors in my small community and she basically determines if my need to see him is warranted. I did ask her the first time I met her if she had diabetes because I wanted to know why she specialized in D. She told me she just chose the field because there were many job opportunities.
I think the CDE certificate in the US requires a prerequisite medical license like a doctor, nurse, or dietitian. I don’t think they allow someone with diabetes only to sit for the certification exam.
There are certain exceptions. I’m thinking of getting mine after I complete my Master’s this spring, but my area is Medical Sociology, and I plan to do research on diabetes. You have to have a health-related degree and apply for an exception.
CDE in the USA can be an RN, dietician, or pharmacists who passed all the exams and experience requirements of working with patients in diabetes management-- or so I’m told
My friend is an RN and has done all the prerequisites for the CDE (he’s also a T1) but tells me it’s very hard to document the experience requirement unless you’re working in an endos office
As far as I know there is no licensed specialty of “Diabetes Nurse” in the US. Each state varies. In the US, you become a CDE. To become a CDE you need to be licensed in a health area (including those licensed is what might be considered by one to be whacko areas, i.e. homeopathy), a dietician or nutritionist (including naturopathists) or someone holding a masters or higher degree in a health profession (i.e. Phds). In addition to this you need 2 years working in the field and at least 1000 hours (half a year) providing education.
The high hurdles mean that the ranks of CDE’s (which only was established in 1986) can be pretty thin as many people turn away from the field. If you ever visit AADE you will see an aging population. In truth, much of the CDE field has become irrelevant to most of us as educators often have little of value to provide to a veteran. Most of the focus is on providing education to the newly diagnosed and they have essentially locked in a monopoly on covered (by insurance and Medicare) education for newly diagnosed.
In truth, everyone “predicts” a huge demand for CDE’s, but in practice there is a huge problem. The CDE field is very isolationist and has place high hurdles on entry and sought very strict laws to require that only CDEs can provide education. As anyone active here knows, CDEs are not the sole oracle on the mountain. Efforts to develop “lay” educator models seem to have fallen flat. And we are now faced with real conundrums. Many if not most efforts to implement the Diabetes Prevention Program (DPP) (which I hate by the way) are using “lay” educators, not CDEs. We essentially have people that know nothing about diabetes and are using some deeply flawed curriculum to educate masses of people with pre-diabetes (which is really just diabetes). Does anyone see a problem here?
My “diabetic nurse” was the equivalent of a physician’s assistant who saw to my care until Elvis–the doctor–got on stage. What “diabetic nurse” in this context meant was that she works with diabetic patients as part of a team. It does not necessarily mean that the said nurse has any specific training that gave her that title. But it doesn’t preclude it, either.
In most of the US nurse practioners and physicians assistants can be licensed to prescribe and adjust insulin. And often you get more face time and attention from them. Unfortunately I think there are still barriers as some insurance won’t cover various things from mid-level practitioners. Are others using and comfortable with seeing nurse practitioners or physicians assistants rather than a full blown MD/DO or endo?
CDE is a state license. In New Jersey, you need to have at least an RN medical license with some years of experience, plus additional training and clinical hours in a diabetes-specific environment in order to even apply for CDE. I think some states allow you to get CDE with only an RD (Registered Dietician) license, and others require both an RN/NP/PA/MD/DO license and and RD license in order to qualify for the diabetes-specific training for CDE.
FWIW, in many areas, type 2s (which is probably 90% of Medicare new diagnoses?) don’t get access to CDEs. When I was diagnosed, I was sent away from the doctor’s office with a 1000-mg-sodium diet sheet (which had a load of errors in it) and an ADA Exchange diet sheet (not even the more complicated book that came out about the same time) and told to try to find a way to sort-of combine the two because it was probably impossible to find anything to eat if I tried to follow both, to the letter, at the same time.
I believe Medicare is generally quite liberal about covering diabetes education. Perhaps the problem is that there aren’t any CDEs in your area or they don’t accept Medicare reimbursement.
I’ve never been on Medicare. What I know is Medicare tends not to be as aggressive about health maintenance as private insurance. But the issue is that while most PWD have T2DM, most PWT2DM’s diabetes treatment is provided exclusively (and minimally/minimalistically) by our PCPs. If we want CDEs, we have to seek them out on our own, often pay out-of-pocket (unless they are covered by our health insurance — in which case we still have to cover deductibles and copays), we don’t get endos unless our PCPs believe we need insulin (and then only after trying more orals and combinations of orals than are part of the ADAs Standards Of Care/best-practices guidelines).
@Brian_BSC
For 6 years, we saw the ped endo ,once per year, & the NP for all other appts. We preferred the NP. She was much more knowledgeable/supportive of technology, paid much closer attention to the labs (& caught 2 dx that were overlooked by the endo), & was fully supportive of some of our thinking outside the box such as lchf. We saw a CDE at each visit as well, where we answered the same questions every visit (have you made any changes to pump settings since your last visit, etc) & received our A1c results. None of them ever offered any helpful info. Our time with the NP was never wasted.
The company I work for has a health advocate that my wife and I can work with and she is a specialized diabetic nurse. We can ask her any billing, insurance or diabetes related questions and she can help answer our questions and also works with us (and takes care of things for us)…as an intermediary between us and the a) hospital / medical team as well as b) our insurance.
We haven’t utilized her as much as we probably should, but we did a lot in the beginning of our journey, back in February.
I’m in the US, Insurance is BCBS, Company I work for is Northrop Grumman.
