vivian-fernandezACDE President Vivian Fernandez MS, RD, CDE, BC-ADM talks about the burgeoning organization and her goals for this year.

By: John Parkinson, Clinical Content Coordinator,

Seeing a need for additional advocacy for certified diabetes educators (CDE), the National Certification Board of Diabetes Educators (NCBDE) decided to support the launch of the Academy of Certified Diabetes Educators (ACDE) in 2013. This upstart organization for CDEs is a non-profit with a primary misssion to serve CDEs with ongoing opportunities as well as protect these underappreciated and dedicated medical providers.

At the head of the organization is President Vivian Fernandez. Vivian was selected for the presidency role by the ACDE board for a term that runs for one year from Jan 2015 to Jan 2016.

Fernandez has had a variety of experience working in both clinical and corporate settings. From her first moment working in the diabetes clinical setting, she knew she found her calling.

Even after practicing for many years, she still loves the moments when she witnesses patients’ eyes light up after they realize they understand what they need to do with their diabetes management.

Fernandez is not only passionate about making a difference in patients’ lives, she is a big believer in the CDE credential and in keeping the advancement of the credential at the forefront of diabetes education. She sees the lack of value insurers and the medical industry as a whole place on diabetes education, the closure of diabetes self-management education (DSME) programs, and the lack of adequate reimbursement as some of the biggest ongoing issues that are being echoed amongst CDEs.

With so much going on within her medical field, Fernandez became involved with the ACDE.

As this is a burgeoning organization that will need to show relevance and solvency relatively quickly, Fernandez believes 2015 is a vital year for ACDE.

To learn more about ACDE, spoke to Fernandez recently about the organization’s plans and what her goals are during her tenure as president. Can you talk a little about your professional background?

Fernandez: I have spent much of my entire professional life in the field of diabetes. I have been a CDE for the last 28 years and an RD for 35 years. In my first professional position, I worked my way up from a diabetes educator up to Diabetes Program Director at my first hospital. With my first professional experience with treating diabetes, I fell in love with the profession. I found diabetes education to be encompassing of caring for the pt. with diabetes, taking care of their physical, social and mental health.

To this day, I have found I really connect with other CDEs. I don’t know if it is because we are passionate about diabetes or some common theme we all experience professionally, but I really respect and value my fellow CDEs.  

From that first hospital, I then worked at Joslin with 5 endocrinologists and a group of incredible CDEs which gave me invaluable experience.

Presently, I work for Novo Nordisk as a Medical Liaison-DM.  In this position, I teach healthcare providers about all facets of diabetes and diabetes care. What are some of the challenges facing fellow CDEs today?

Fernandez: Today’s healthcare environment poses many challenges to CDEs. I have seen diabetes centers in my hometown of Miami close down due to poor reimbursement, yet the incidence of diabetes continues to grow.  

We have seen this scenario throughout many parts of the U.S.  Many of my fellow CDEs are fearful of losing their jobs.

I also find many healthcare plans are shortsighted. CDEs have proven to reduce hospitalizations which can cost a healthcare plan up to $17,000 a visit to the ER. CDEs also help with increased adherence to medication and lifestyle therapy up to 24% [Source: Diabetes Educators Can Improve Patient Acceptance and Adherence in Diabetes, D. Dixon, PharmD, MHA, CDE, October 2014, Highlights from AADE Annual Meeting, MD Conference Express].

A CDE should be available at every hospital outpatient center as well as part of endocrinology and primary care provider (PCP) group practices. Doctors are extremely busy in their practices and don’t have time to instruct patients regarding the optimal education and management of diabetes. This is what CDEs do and they do an excellent job at it.

I believe we are underutilized because healthcare plans look at what it costs to educate a patient with diabetes. They might only pay for 10 hours of diabetes education but in the long run, those 10 hours are well worth the investment, especially when they are avoiding complications and hospitalizations.

When you look at the pie chart of diabetes expenses, hospitalizations constitute 53% of total costs. All other expenses such as medications and doctor’s visits are much smaller. If you can reduce hospitalizations, you can greatly reduce the cost of treating diabetes.  Data shows that diabetes education saves money and decreases healthcare utilization. Robbins et al found that hospitalization rates for patients who had no educational visits during follow-up was 38.1 per person per 100 years; the hospitalization rate was 34 percent lower (25.0 per person per 100 years) for patients who had at least one educational visit. [Source:  Robbins JM, Thatcher GE, Webb DA, Valdmanis VG. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. Diabetes Care. April 2008.] 

In Europe, diabetes education is truly done in a team setting. CDEs manage diabetes programs and take responsibility for the patients, supported by the endocrinologist, and other members of the healthcare team. This is the way we should do that here in the U.S. We should have diabetes centers of excellence with one endocrinologist overseeing the management and treatment of diabetes. It certainly would be cost-effective.

We shall see if things change with the Affordable Care Act, but in the meantime, my fellow CDEs are very nervous, especially about losing their jobs.

To become a CDE you have to be registered in a healthcare discipline such as an RN, RD, RPh, MSW, MD, DO, and have 1,000 hours of practical, clinical, direct patient education experience. You are then qualified to take the certification exam, and be recertified every five years. CDEs are very talented, passionate, educated people who are trained to be the advocate of pts with diabetes. Can you talk about how ACDE came into being?

Fernandez: ACDE was publically launched in 2014 to serve the growing community of nearly 20,000 CDEs. It is a non-profit membership organization whose sole purpose is to uphold and advocate for the CDE. Through support and awareness, ACDE advocates for professional recognition and advancement of the CDE credential and the healthcare professional who has prestigiously earned this credential.  

Two states, Kentucky and Indiana, have passed the requirement for licensure to practice diabetes education. The problem is in these two states there has been no certifying exam to go with the licensure. This is what many CDEs are against. We cannot allow people to become licensed without becoming certified diabetes educators first. This is part of rationale for creating this professional association.

Florida is considering passage of a similar bill as well as other states.  

We (ACDE) have asked another professional association, the American Association of Diabetes Educators (AADE) to partner with us to make sure that licensure is accompanied with a certifying exam.

We have seen the handwriting on the wall, looking at the state of healthcare and if we didn’t stand up for the CDE, we felt our positions would be in jeopardy, and our CDE credential would not be validated in today’s world. For those not familiar with ACDE, can you talk about what the organization’s mission is?

Fernandez: ACDE’s mission is to advocate for the ongoing needs of the CDE thus providing the CDE with the opportunity to advance their practice, enhance diabetes education for people affected by diabetes and educate the public about the value of diabetes education provided by CDEs. The Academy serves as a unified voice for our multi-disciplinary field, advocating for the CDE credential with healthcare providers, the public, legislators, policy makers, and insurance providers.

Our mission is to uphold the CDE not only for ourselves but for our patients who have diabetes, and policymakers and insurers that it is done by a CDE versus someone who has not had the training or taken the test. We do not want the credential watered down or misused in any way. For those who are not yet members, what are the benefits of ACDE membership?

Fernandez: The benefits of ACDE membership are as follows:
1. Our monthly newsletter, The ACDE Connection, which contains a wealth of resources and current up-to-date information, which CDEs need.  We’re getting great feedback about the usefulness of our unique newsletter from our readers!
2. An online platform allowing members to engage in dialogue with peers and colleagues, including CDEs as well as other healthcare professionals.
3. Networking with other CDEs nationwide. We have scheduled a networking reception in Boston in June at the same time as American Diabetes Association’s meeting. We have over 2,700 members. We would love to meet with them and talk about what they need.
4. Webinars provided at no cost, both live and recorded, on subjects germane to CDEs.  And, a listing of free CEU webinars from other organizations
5. Access to standard of care protocols and other professional resources focused to enhancing clinical practice.
6. Updates on industry news and trends, including licensure.
7. Direct links to organizational sites to obtain continuing education hours.
8.  Listing of relevant professional meetings
9.  Access to a very active Career Center. This service enables employers, hospitals and industry to post CDE job opportunities throughout the U.S. If someone is thinking of relocating, they can see some of what is available in the diabetes field. This is a place where CDEs can go that advocates for them. Are there any eligibility requirements to become a member?

Fernandez: All HCPs who are CDEs or wish to become CDEs can join ACDE. We support the individual CDE member as well as the healthcare professional whose goal is to become a CDE. Membership is currently free so we encourage all CDEs to join as well as up and coming CDEs. Most of our members have been CDEs for more than 20 years who are willing to mentor other younger HCPs.

As we discovered in our survey that many of our CDEs are over the age of 55 and they are all going to retiring in 10 years, so this organization is going to look to mentor new CDEs. ACDE is looking into hiring a grant writer. What will this person being doing for the organization and what do you hope to accomplish with bringing on this person?

Fernandez: ACDE has hired two grant writers. These writers will solicit grants to enable ACDE increase and enhance the services we provide our most important member--the CDE. We have hired a grant writer for educational grants through pharmaceutical companies and other resources, which is where our webinars will come from.

The goals for these grants is that we can be financially independent and provide our mission to support the CDE. Can you talk about your goals as president of ACDE?

Fernandez: My goals as president are as follows:
1. To uphold the CDE credential across the nation, including diabetes education licensure in individual states.  ACDE feels strongly that states who license “Diabetes Educators” for reimbursement need to be CDEs. That is my number one goal.
2. My second goal is to provide no cost diabetes education webinars for the more “seasoned” CDE, those educators who have been in practice for over 15 years as most of our members are.  
3. My next goal is to secure grants to become financially independent so we can better serve the needs of the CDE.
4. As a non-profit organization, another one of my goals is to invest our time, effort and finances into upholding the CDE credential across the country with health care providers, insurance providers, institutions, and all those who care for patients with diabetes.
5. And lastly, I want to partner with other diabetes organizations such as ADA, AACE and AADE to uphold the CDE credential and enhance reimbursement for CDEs, because they are getting very little reimbursement now. I think we all need to band together because if not the patient suffers.

We also need legislators to write bills that diabetes education needs to be certified and it needs to be done by CDEs.
To learn more about ACDE, go to their website here.