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The CDE option: Dental hygienists are naturally suited to become certified diabetes educators

Nov. 15, 2016
Authors explain why dental hygienists are naturally suited to become certified diabetes educators.

Editor's Note: After the article below was published in the November 2016 issue of RDH, the National Certification Board for Diabetes Educators provided three links to provide additional information into a career pathway as a certified diabetes educator. We encourage readers to view this information.

By Sarah Cook, EFDA, RDH, BS, Kaelin Markle, EFDA, RDH, BS, and Emily Holt, RDH, MHA, CDA, EFDA

An average of 347 million people worldwide are currently diagnosed as diabetic.1 Dental health professionals have an opportunity to not only help these individuals, but to also begin a new career focusing on the education of individuals with diabetes. A certified diabetes educator (CDE) is a health professional certified to promote self-management for diabetic patients. This certification gives health professionals the opportunity to branch off from their main profession and help diabetic patients manage their disease in their everyday lives.2

What advantages do dental hygienists have compared to other health-care professionals when providing education to those affected by diabetes?

Since diabetes mellitus affects so many individuals worldwide, the need for CDEs is high. Dental hygienists are knowledgeable about the common risk factors for diabetes mellitus, including obesity, hypertension, and genetics.3 Several other diseases are linked to diabetes mellitus, including polycystic ovarian syndrome, cystic fibrosis, and pregnancy, among others.3,4 When comorbidities exist, different courses of treatment may be required for diabetes mellitus.4 A specialist such as a CDE may be more qualified to assist patients with comorbidities in managing their conditions.

Management of diabetes mellitus

Dental hygienists are very familiar with providing individualized care to patients. The management of diabetes mellitus also has many different concepts and is managed individually for each causative factor. Diabetic patients may not only take medication for treatment but are required to follow special diets and exercise in most cases. As many as one in three American adults have pre-diabetes that can advance into diabetes mellitus without intervention.5

Diabetes mellitus and pre-diabetes are handled differently in treatment since medication is not necessary for pre-diabetes; diet and exercise alone can reverse the condition.5 A CDE could help a pre-diabetic patient create a plan to reverse the condition before it becomes diabetes mellitus.

Cystic fibrosis patients must have high calorie diets to maintain their lung function impaired by their disease.4 Even though these patients still take the average insulin medication, it is important for the CDE to work with them to create a specialized diet to fit all of their needs.4

Patients with gestational diabetes must have moderate to strict glucose control due to a higher risk for developing complications during in the pregnancy, such as pregnancy loss, high birth weight babies, and perinatal deaths when poor glucose control is found.6 This requires women with gestational diabetes to have regular appointments with the physician to maintain good glucose levels.6 A CDE would be the ideal provider for this type of patient.

CDEs provide face-to-face intervention, which has a high value over phone-based management programs. Phone-based management programs have not been shown to significantly affect the patient's condition in order to gain control over the diabetes mellitus.1

It has been found that diabetes mellitus is not only caused by several other diseases, but can be a risk factor for developing other conditions if it is not managed properly.7 These include renal disease, cardiovascular disease, nerve damage, hearing impairment, skin conditions, and Alzheimer's Disease.5

Another condition seen in individuals with uncontrolled diabetes mellitus is diabetic neuropathy.8 Trials indicate that simply maintaining glucose control in both type I and type II diabetes mellitus can drastically reduce the risk of developing diabetic neuropathy.8 A study performed on patients with type 1 diabetes mellitus also revealed that having strict glucose control decreases the chance that patients develop retinopathy or renal disease compared to patients with just "good" glucose control.9 This same study revealed that strict glucose control can also lead to hypoglycemia, which can also serve as a problem for individuals with diabetes mellitus.9 Because of this, it makes it difficult to maintain a proper balance for the patient, which is where a CDE could impact the delivery of care for the patient.

A good role for dental hygienists

Dental hygienists are already trained in how to manage the oral complications from diabetes mellitus and understand the methods used to control the disease. With a high percentage of Americans being affected by diabetes mellitus, treating patients with diabetes mellitus is a frequent occurrence for many dental hygienists. We know that even the patient's periodontal condition plays a role in improving the patient's ability to maintain good glucose control.10 They are already educators for patients with diabetes mellitus pertaining to the link between oral infection and control of diabetes mellitus.10 Dental hygienists are naturals at face-to-face interaction with patients, which could allow them to transfer over to being a CDE with ease.

Dental hygienists may be involved in volunteer sealant programs or other activities to show support to the community and helping others by volunteering. A study has shown that low socioeconomic, minority groups tend to have more difficulties maintaining diabetes mellitus than others in the community due to a lack of any education on proper glucose control.11 Functioning in the role of CDE allows dental hygienists to have the opportunity to volunteer and make a difference in the community. Having a dental specialty background also gives dental hygienists the opportunity to bring a different viewpoint to workplaces that do not usually make oral care a priority.

A career as a CDE has the ability to open up many different job opportunities for dental hygienists. In many settings, a CDE has the opportunity to work in hospitals, clinics, home health-care centers, and physician offices.2 In this job, a CDE will help patients with diabetes mellitus manage their medications, diet, exercise, and check-up schedule.2 A CDE not only helps diabetic patients plan for an everyday lifestyle but also how to manage their conditions while out of town or on vacations.2 After reviewing multiple websites on the Google search engine, the average salary for a CDE seems to be comparable to the salary of a dental hygienist, but compensation depends on the area of the country and the type of facility for employment.

In some cases, a certification in diabetes mellitus education may not seem like the right professional fit. A dental hygienist interested in increasing the level of care provided for patients with diabetes mellitus, however, can pursue other options for furthering education. Universities offer certificate programs to educate professionals on diabetes management.13 Even though this would not provide the certification to become a CDE, it can still help dental hygienists to better educate patients in the dental office on how to manage their conditions. These courses can range from around $500 and are usually offered to most health professionals.13

Individuals who are considering a change in career but still want to keep a job in the medical field with the excitement of helping others and individualized care should consider a certification in diabetes education. For more information visit the National Certified Diabetes Educators website at ncbde.org.

Dental hygienists who seek the role of becoming a CDE will be able to use the skills that they already know, in addition to the skills they develop during CDE observation hours to give diabetes mellitus patients well rounded care. The additional training required to become a CDE will also benefit dental hygienists to provide complete clinical care to diabetic patients. RDH

Requirements to become a CDE

The National Certification Board for Diabetes Educators (CBDE) regulates the program for becoming a CDE.12 Four requirements must be completed to become a CDE. Applicants must:

  • Have a minimum of two years of professional experience in the health field.12
  • Complete a minimum of 1,000 hours of diabetes self-management education, 40% of which must be in thze past year.5
  • Apply for testing and pay a $350 fee, which will lead to the final step of taking a certification test.2

Courses are offered through the American Association of Diabetes Educators to prepare for the exam, but are not mandatory. These courses include workshops, online modules, books, and live courses.5

The exam itself is offered twice a year, once in the spring and once in the fall, and is given at a specified testing site in your area.2 The initial exam is $350, as listed above, and then a processing fee of $100 is charged.2

The upkeep of this certification involves a renewal every five years, at the cost of $250.2

Author acknowledgement: The authors would like to thank Emily Holt for her assistance in developing this topic and helping with the editing and revising process.

Sarah Cook, EFDA, RDH, BS, is a recent graduate from the University of Southern Indiana and plans on practicing dental hygiene in western Kentucky. Kaelin Markle, EFDA, RDH, BS, is a recent graduate from the University of Southern Indiana. She is currently living and working in southwestern Indiana. Emily Holt, RDH, MHA, CDA, EFDA, is a clinical associate professor of dental hygiene at the University of Southern Indiana. She can be contacted at [email protected]">href="mailto:[email protected]">[email protected].


1. Pal K, Eastwood SV, Michie S, et al. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD008776. DOI: 10.1002/14651858.CD008776.pub2.
2. Examination Administration Details. National Certification Board for Diabetes Educators Web site. http://www.ncbde.org/certification_info/examination-details/. Published in 2015. Accessed September 29, 2015.
3. Diabetes and Teeth. The American Dental Association Web site. Available at: http://www.mouthhealthy.org/en/az-topics/d/diabetes. Published in 2015. Accessed September 29, 2015.
4. Onady GM, Stolfi A. Insulin and oral agents for managing cystic fibrosis-related diabetes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004730. DOI: 10.1002/14651858.CD004730.pub3.
5. Guidance for Becoming a Diatbetes Educator/CDE. American Association of Diabetes Educators Web site. Available at https://www.diabeteseducator.org/education-career/becoming-a-diabetes-educator. Published in 2015. Accessed September 15, 2015.
6. Middleton P, Crowther CA, Simmonds L. Different intensities of glycaemic control for pregnant women with pre-existing diabetes. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD008540. DOI: 10.1002/14651858.CD008540.pub3.
7. Diabetes and Oral Health Problems. American Diabetes Association Web site. Available at http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/diabetes-and-oral-health.html. Published in 2015. Accessed September 29, 2015.
8. Callaghan BC, Little AA, Feldman EL, Hughes RAC. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD007543. DOI: 10.1002/14651858.CD007543.pub2.
9. Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, SiebenhoferA. Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD009122. DOI: 10.1002/14651858.CD009122.pub2.
10. Simpson TC, Weldon JC, Worthington HV, et al. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD004714. DOI: 10.1002/14651858.CD004714.pub3.
11. Attridge M, Creamer J, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD006424. DOI: 10.1002/14651858.CD006424.pub3.
12. Eligibility Requirements. National Certification Board for Diabetes Educators Web site. http://www.ncbde.org/certification_info/eligibility-requirements/. Published in 2015. Accessed September 29, 2015.
13. Diabetes Management Certificate Program. University of Southern Indiana Web site. Available at: https://www.usi.edu/health/certificate-programs/diabetes-management-certificate-program. Published in 2015. Accessed September 29, 2015.