Kentucky has passed a law requiring a license to practice diabetes education in the state. In opposition to the law, the National Certification Board for Diabetes Educators (NCBDE) has written a position paper on the subject. 

By: John Parkinson, Clinical Content Coordinator,

Earlier this year, Kentucky became the first U.S. state to pass a bill requiring diabetes educators to have a license to practice diabetes education in the state.

Consequently, two well-known national organizations that provide diabetes education certification credentials have different takes on the Kentucky law. When Kentucky Governor Steve Beshear signed the law, the American Association of Diabetes Educators (AADE) was in support of its passage. “Ultimately, we think that this law will make it easier for people with diabetes to get information they need to effectively manage their disease,” explained Martha Rinker, AADE’s Chief Advocacy Officer. Rinker also added that the AADE was advocating for licensing in all the states with the belief that state licenses deliver and communicate a standard of care and ensure that people have an appropriate comfort level and respect for the discipline.

The National Certification Board for Diabetes Educators (NCBDE), on the other hand, opposes the Kentucky law, and wrote an official position statement about some of its specific issues it had with the Kentucky law.

While Kentucky is the only state with this type of law, other states including Indiana and Mississippi are also considering similar educator licensing laws. sat down with NCBDE CEO Lance Hoxie to discuss the NCBDE’s interpretation of the Kentucky law, NCBDE’s subsequent position paper, and possible amendments to the law they would like to see addressed. Why did the NCBDE decide to write an official position paper opposing the Kentucky law requiring licensing to practice diabetes education?

Hoxie: We think the Kentucky law, as written, misses the mark. It does so in a couple of ways. One, it creates a two-tiered system of eligibility. The first tier is for those that are currently licensed and exempted from this particular license requirement including physicians, nurses, dietitians, and those who are already certified diabetes educators (CDEs) or Board Certified in Advanced Diabetes Management (BC-ADM).  [CDE is the NCBDE’s certification and the BC-ADM is AADE’s.]

That then leaves a smaller cadre of people who may be delivering diabetes self management education who need to be licensed. That group, in order to be licensed, needs to complete an application, show evidence they have taken the AADE core concepts course, and fulfill some number of supervised hours of DSME. The law does not require applicants to take a valid, psychometric examination.

Our concern with the law is that it is a double standard by exempting the vast majority of medical professionals delivering a scope of services under their current licensing requirements and then sets up a lower standard for those who are not licensed.

There could be people potentially licensed in Kentucky who did not or could not pass the CDE or BC-ADM exams.

It is important to point out that neither licensure nor professional certification guarantees competency. Licensure and certification together minimizes opportunities to have those who are not qualified to work with patients. That is what the two are meant to do: protect the health and welfare of its citizens.

With respect to licensure in general, we are neutral. It should be left up to the citizens and legislature of the state. However, if they say a licensure law is needed to regulate DSME, then we believe that law ought to embrace certain requirements. Ideally, we would like to see those requirements parallel those of certification. Are there any other points of contention you have with the Kentucky Law?

Hoxie: The law specifically notes the AADE Core Concepts program. I’m a lay person so I’m just communicating information, but I’m told that the Core Concepts is an excellent program in the context of continuing education for refining and building upon your skills as a diabetes educator. However, NCBDE does not view it as a preparatory course for certification.

Furthermore, limiting the education to one program begs the question about all the other continuing education programs sponsored by other nationally recognized organizations such as the American Diabetes Association and the American Dietetic Association. And with Columbia Teacher’s College beginning its first class of post baccalaureate healthcare professionals to earn a master’s degree in diabetes education, I could, get a master’s degree at Columbia and not qualify for a Kentucky license.  Do you have any alternatives or means in which you would like to see the Kentucky Law amended?

Hoxie: We have corresponded with Kentucky and their representatives who sponsored the legislation, and have urged them to include, within the regulatory language that will administer the law, a psychometric exam. We are also hoping they will look at eligibility criteria that better parallels what we require and to consider educational programs provided by other nationally recognized organizations. In the NCBDE position paper written on the organization’s website, it states, “NCBDE will develop “model” state licensure legislation." Has NCBDE begun this process, and if so, what will be included in NCBDE’s version?

Hoxie: We wrote what we thought the law should embrace. Ideally it should use the same eligibility criteria that we use. There has to an exam, and it would benefit any state if they used existing mechanisms to administer the licensure program.  For example, they could use the NCBDE to administer the licensure requirements on the state’s behalf. By doing this, you minimize the infrastructure costs of redevelopment; you don’t have to reinvent the wheel. Despite what the law talks about with its minimal licensure costs to the applicant, those costs are going to go up.

We believe Kentucky should consider using models from other allied health professions such as orthotics and prosthetics, where laws in up to 10 states align with what the licensing boards in those fields require. Has Kentucky been responsive to NCBDE’s requests for further clarification of the law?

Hoxie: We have only recently responded to them (early June). We wrote them a letter and requested a follow-up meeting or conference call. We wanted to point out that we are not trying to be an obstacle to what they want to do; we want to help facilitate their interest in licensure in a way that is agreeable to everyone.

For those interested in finding out more about NCBDE’s position paper, readers can go here.

Originally posted by on September 15, 2011.