The purpose of the study was to develop care and professional education competencies that address prediabetes, diabetes, and cardiometabolic conditions at the individual and population levels and to promote self-assessment and professional development goals related to the knowledge, skills, and abilities required to effectively work with PWD and related conditions.
There are 130 million Americans currently living with, affected by, or at risk for diabetes. As a result, clinicians, nonclinical providers, and peer supporters are all indispensable in the delivery of person-centered, team-based diabetes care and education.1 The Association of Diabetes Care and Education Specialists (ADCES) recognizes the need and opportunity for expanded competencies that include a broad interprofessional team to support integrated and person-centered care to meet the standards for high-quality care for people with diabetes (PWD) and cardiometabolic conditions.
Based on evidence-based outcomes, the American Diabetes Association, the European Association for the Study of Diabetes, and ADCES recommend a person-centered approach to diabetes management that is holistic and includes self-management education and health behavior change for all PWD and related conditions.1-4 Every person living with diabetes deserves access to the information and resources necessary to reduce the health risk of diabetes and cardiometabolic conditions, which will allow them to achieve optimal quality of life (QOL).
It is critical that each member of the diabetes care team develop the skill set necessary to effectively care for and educate this population.5 To help achieve this goal, in 2020, ADCES implemented a modified Delphi study designed to identify and develop competencies for the expanded diabetes care team.6 The purpose of the study was to develop care and professional education competencies that address prediabetes, diabetes, and cardiometabolic conditions at the individual and population levels and to promote self-assessment and professional development goals related to the knowledge, skills, and abilities required to effectively work with PWD and related conditions.
The targeted audiences for these expanded competencies included the following: (1) community workers who serve as a bridge between populations and health care systems and (2) point-of-care clinicians who care for PWD and related conditions in the general health care system but who are not specialized in diabetes care and education beyond their current clinical training. They represent the front line of health care.
It is important to note that the competencies are meant to expand and augment existing competencies to recognize the expanded role the entire health care team has in providing diabetes care and education. They are not a revision to the existing competencies for diabetes care and education specialists (DCESs) that were published in 2020 or any other interprofessional competencies.2
The Delphi method, an approach used to obtain an expert opinion in a systematic manner, has been used in health and medicine for nearly 5 decades.7 It allows for organizing multiple expert opinions, values, and experiences from the interprofessional team into a consensus. The process applied here identified core competency domains that are inclusive of all professions who work with individuals and populations with diabetes. Experts represented nutritionists, community health workers, dental hygienists, health educators/coaches, dietitian technicians, pharmacist assistants, individual navigators, social workers, pharmacy technicians, students, care coordinators, master’s level nutritionists, dietary-health technicians, DCESs, nurses, and exercise physiologists.
The competencies identified were reached through a systematic consensus-building process, expert opinion, and a focus on the vision for optimal health and QOL for PWD and related conditions. The full article with the entire methods section outlining study design, environmental scan, stakeholder consultation, surveys, and analysis can be found here.
Previous ADCES competencies included 3 diabetes educator levels and 2 diabetes education associate/paraprofessional levels.2,8,9 Driven by stakeholder input, the 2 diabetes education associate/paraprofessional levels have been merged into 1 role titled “diabetes community care coordinator” (DCCC). This title was adopted by the ADCES Board of Directors in 2021 to identify the broad skill set in the diverse workforce caring for people with diabetes in the community and was used by the research team for this study. Health care team members who hold a license or certification and who do not intend to specialize in diabetes are referred to as “health professionals.” These roles are defined in Table 1 and discussed in detail in the following.
Driven by stakeholder input, the 2 diabetes education associate/paraprofessional levels have been merged into 1 role titled “diabetes community care coordinator” (DCCC).
The DCCC role is inclusive of a broad set of diabetes care team members focused on providing community-based, person-centered care and education and connecting individuals to health care teams and systems. DCCCs are recognized by the full care team for their understanding of local culture, environment, and social determinants of health within their community. The term was identified because it aptly describes the trusted liaisons who link individuals to diabetes-related resources, build relationships, and collaboratively work with people at any stage of readiness.
DCCCs include but are not limited to community health workers, health educators/coaches, medical assistants, certified nursing assistants, licensed practical nurses, registered nutrition/dietetic technicians, military medics and corpsmen, pharmacy assistants/technicians, physical therapy assistants, nutritionists, dental hygienists, emergency medical technicians, and those in other similar roles. As a frontline workforce, DCCCs serve as essential partners in mitigating inequalities and supporting self-care behaviors for people with, affected by, or at risk for diabetes.
Health professionals not specializing in diabetes (HCPs) are key members of the diabetes care team, and they have many opportunities to enhance the care and education provided to PWD. These frontline HCPs are well positioned to use a person-centered approach that will make significant differences in the lives of people with, affected by, or at risk for diabetes. They work within a defined scope of practice that is guided by their specific professional competencies, and they have completed academic preparation in health and science.
Examples of how HCPs interact with PWD include a registered dietitian nutritionist who is creating a postoperative care plan for a person with diabetes, a pharmacist who occasionally teaches blood glucose monitoring, or a registered nurse who provides bedside care in the medical/surgical unit of a hospital.
The description and competencies for this role have been addressed elsewhere.7
The intent of the competencies remains the same as described by Ryan et al3 in 2020, as follows: “intended to guide practice regardless of discipline and encourage mastery through continuing education, individual study, and mentorship.”
The intent of these sets of competencies remains the same as described by Ryan et al3 in 2020, as follows: “intended to guide practice regardless of discipline and encourage mastery through continuing education, individual study, and mentorship.”9
Although additional core competencies may be necessary for specific job roles, the competencies defined in this document pertain specifically to diabetes. The competencies are not intended to address the scope of practice, nor are they intended to override organizational policies and bylaws, protocols, state licensure, and other regulations.
Both sets of competencies for DCCCs and HCPs include a domain focused on person-centered care and education. In this approach, the beliefs, preferences, and values of the PWD are paramount. Diabetes care team members must be able to demonstrate respect for the individual and provide equitable and high-quality care for all persons they serve, incorporating individual beliefs, values, and preferences into the care they deliver. These competencies apply to all practice settings and delivery modes, including virtual interactions and competence in the use of technology to overcome barriers to self-care for PWD.
The ADCES urges DCCCs and HCPs to use these competencies to perform self-assessments and set professional development goals. The final set of 123 competencies is representative of 2 domains: (1) Clinical Management Practice and Integration and (2) Person-Centered Care and Education Across the Life Span.
DCCCs and HCPs who achieve the competencies contribute to a more proficient and empowered workforce, which can result in improved QOL and outcomes for people with, affected by, or at risk of diabetes.
Acquiring knowledge is a prerequisite to competency. Each competency has been carefully developed to illustrate a distinct knowledge set, skill, or ability. Note that the term “person” includes those with, affected by, or at risk for diabetes and those affected by the full spectrum of conditions including prediabetes and cardiometabolic conditions.
Table 2 outlines the competencies for DCCCs. Competencies listed under the domain of Support of Clinical Management Practice and Integration reinforce the importance of a strong foundation in the clinical management of diabetes and self-management through the ADCES7 Self-Care Behaviors™.10 Competencies listed under the domain of Person-Centered Care and Education Across the Life Span emphasize the need to identify and incorporate an individual’s needs and preferences when facilitating and delivering care and education.
Table 3 outlines competencies for HCPs whose primary focus is not diabetes. Competencies listed under Clinical Management Practice and Integration focus on the basics of clinical and self-management for diabetes and cardiometabolic conditions because HCPs have already completed academic preparation and clinical practice in their roles. Competencies listed under Person-Centered Care and Education Across the Life Span underscore the value of assessing individual needs and interests when selecting resources and delivering care and education.
The increase in diagnoses of diabetes, prediabetes, and cardiometabolic conditions and emerging trends in diabetes treatments, including diabetes technology, demand the need for a competent and diverse diabetes care team to address the health of the individual and population levels in the United States. It is critical for the diabetes care team to use the competencies to complete a baseline self-assessment of their individual skill set and determine their next steps for professional development.
ADCES calls on the diabetes care team, the DCCC, HCPs, and DCESs, to strive for excellence in their pursuit of optimal health and QOL for people with, affected by, or at risk for diabetes. ADCES remains dedicated to fostering a collaborative and comprehensive approach to providing person-centered care and education. The competencies for DCCCs and for HCPs who do not specialize in diabetes provide a pathway for the continued growth of the interprofessional team.
To view the full set of competencies, along with helpful resources, go to the competencies page on the ADCES website.
The increase in diagnoses of diabetes, prediabetes, and cardiometabolic conditions and emerging trends in diabetes treatments, including diabetes technology, demand the need for a competent and diverse diabetes care team to address the health of the individual and population levels in the United States
Donna Ryan, MPH, RN, RDN, CDCES, is with Ascension Health Florida in Pensacola, FL. Sandra Drozdz Burke, PhD, RN, CDCES, is with Capella University in St. Joseph, IL. Lauren Bronich-Hall, MS, RDN, CDCES, is with Health Illuminations in Jacksonville, FL. Joanne Rinker, MS, RDN, CDCES, LDN, is with MannKind Corp. in Valencia, CA. Kirsten Yehl, MS, MLIS, is with Association of Diabetes Care and Education Specialists in Chicago, IL. Michelle L. Litchman, PhD, RN, CDCES, is with the University of Utah in Salt Lake City, UT.
The authors would like to acknowledge the Association of Diabetes Care and Education Specialists for convening a research team to establish these competencies and the following team members for their contributions:
Betty Braun, LPN
Sonya Breitbart
S. Kim Bush, MPA
Christine Cline-Dahlman, CPhT
Angela Ellison, MSEd
Gail Hersh, CHW
Mercedes P. Jurkiewicz, RN, BSN, CDCES
Leslie E. Kolb, RN, BSN, MBA
Jose Lopez
Kimberly Wilson
Wendy Mobley-Bukstein, PharmD, BCACP, CHWC, CDCES
Floribella Redondo, CHW
Leda Rivas, MA
Betsy Rodriguez, RN, MSN, CDCES
Denise Smith, Pharm Technician
Collin Spencer, EMT.
Litchman had an investigator-initiated trial funded by Abbott Diabetes Care, Inc unrelated to this study. Ryan is on the National Diabetes Volunteers Leaders Council Board of Directors, Lilly Advisory Council, and KnowLabs Board of Directors. Yehl and Rinker are employees of the Association of Diabetes Care and Education Specialists (ADCES). Burke has no conflicts of interest. ADCES appointed the work group and provided a list of potential content experts.
This work was completed with the support of a grant from the Association of Diabetes Care and Education Specialists.