Facilitated by the Minnesota Diabetes Steering Committee and There continues to be an epidemic of type 2 diabetes in Minnesota. …

National Certification Board for Diabetes Educators

2008 Certification Handbook for Diabetes Educators
Renewal by Continuing Education Application Deadline

September 15, 2008
Examination Application Deadlines Examination Dates

January 15, 2008 July 15, 2008

May 3, 2008 October 25, 2008

Table of Contents
Introduction ii Important General Information iii Application Deadlines, Fees, and Dates iv Mission 1 Definition of Diabetes Education 1 Purpose 1 Objectives 1 Responsibility for Certification 1 Statement of Nondiscrimination Policy 1 Eligibility Requirements for Initial Certification 1 Unacceptable Experience 2 Renewal of Certification 2 Eligibility Requirements for Renewal of Certification 3 Disciplinary Policy 3 Use of Certification Marks 3 Application Process Initial Certification
3 Renewal of Certification by Examination 3 Renewal of Certification by Continuing Education 4 Fees 4 Examination Dates 4 Test Center Locations 4 Requests for Sunday Testing 5 Requests for International Test Centers 5 Requests for Special Testing Accommodations 5 Adherence to Published Policies 5 Application Status 5 Changes After the Application is Submitted 6 Rejected Applications 6 Appeals 6 Withdrawals and Refunds 6 Audit Policy 6 Instructions for Completing Part I of the Application I-1 Checklist Initial Certification I-2 Checklist Renewal of Certification by Examination I-2 Instructions for Completing Part II of the Application I-3 Instructions for Completing Part III of the Application I-5 Checklist Renewal of
Certification by Continuing Education I-7 Application and Mailing Envelope Center Insert Examination Process Schedule for the Examination 6 Admission to the Test Center 6 Rules for the Examination 7 Content of Examination 7 Studying for the Examination 7 Sample Examination Questions 8 Examination Content Outline 9 References 11 Examination Security 11 Questions About the Examination 12 Post-Examination Process Report of Results 12 Confidentiality 12 Requests for Handscoring 12 Re-Examination 12 Certificates and Wallet Cards 12 Duplicate Score Report 12 Request for Special Testing Accommodations Form 13 Request for Sunday Testing Form 15 Index 17

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2008 Certification Handbook for Diabetes Educators

Introduction
The purpose of this Certification Handbook Handbook is to provide information and guidance to individuals who are interested in diabetes educator certification It is critically important to understand at the outset that the Certification Examination for Diabetes Educators Examination is designed and intended solely for health care professionals who have defined roles as diabetes educators, not for those who may perform some diabetes related functions as part of or in the course of other usual and customary occupational duties

2008 Initial Certification Requirements Review
Please review before completing application Yes No 1 As a clinical psychologist, registered nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, registered clinical exercise physiologist minimum of a masters degree, registered dietitian, or registered physician assistant, is your license or registration current, active and unrestricted? OR Do you hold a minimum of a qualifying masters degree from a United States college or
university accredited by a nationally recognized regional accrediting body in social work? 2 Has your practice experience in diabetes self-management education occurred since you received the license, registration or advanced degree as outlined above? 3 Has your practice experience in diabetes self-management education occurred within the United States or its territories? 4 Does that practice experience in diabetes self-management education total a minimum of 2 calendar years to the day within the last 5 years? 5 Have you already completed 1,000 hours of practice experience in diabetes self-management education within the last 5 years? 6 Do you practice as a diabetes educator a minimum of 4 hours per week? Note: If you are currently, or have previously been, employed as a diabetes educator in one or more part-time positions, each position must include diabetes self-management education a minimum of four hours per week If the answer to any of the above questions is no, you are not ready to apply for the Certification Examination for Diabetes Educators Before submitting an application, please refer to the application checklist on page I-2 in the instruction section of the
Handbook

See page 1 Initial Certification, 1 D for note regarding advanced degrees in nutrition, public health or health education

2008 Certification Handbook for Diabetes Educators

Important General Information
The Certification Program for Diabetes Educators is owned by the National Certification Board for Diabetes Educators NCBDE NCBDE is an autonomous specialty board responsible for the development and administration of the certification program for diabetes educators NCBDE is independent and separate from any other organization or association The Certified Diabetes Educator CDE credential is conferred only by NCBDE, a national, nongovernmental, not-for-profit certification organization Certification is valid for a period of five 5 years A registry of CDEs is maintained by NCBDE
This Handbook contains information about the diabetes educator certification process of NCBDE Individuals who elect to participate in the certification program are responsible for utilizing the most current Handbook and knowing its contents This publication and application replace all previous editions of the Certification Handbook for Diabetes Educators NCBDE updates the information, fees and
requirements in this Handbook on a regular basis and makes every effort to present all policies and directions clearly Questions regarding policies or clarification of information should be directed to the NCBDE national office NCBDE is not responsible for information that is not understood by the reader or obtained from any source other than NCBDE

NCBDE does not sponsor, endorse, financially benefit from, or participate in the development of any preparatory or review courses or published materials claiming to be study guides for the NCBDE Certification Examination for Diabetes Educators

Executive Office
National Certification Board for Diabetes Educators 330 E Algonquin Road, Suite 4 Arlington Heights, IL 60005 847 228-9795 Fax: 847 228-8469 Web: wwwncbdeorg E-mail: info@ncbdeorg

Testing Agency
Applied Measurement Professionals, Inc 18000 W 105th Street Olathe, KS 66061-7543 913 895-4600 Fax: 913 895-4651 Web: wwwgoAMPcom E-mail: info@goAMPcom

NCBDE and AMP endeavor to process all applications promptly and professionally Nevertheless, in the event an application is improperly accepted or rejected, or action on it is delayed due to an inadvertent processing error, NCBDE
liability to the applicant is limited to a complete refund of the application fee

2008 Certification Handbook for Diabetes Educators

iii

Application Deadlines, Fees, and Dates
Examination
May 3, 2008 Examination
Applications for this administration will be accepted beginning December 1, 2007 Applications received before this date will be returned

Mail Application After Initial Certification Renewal of Certification Lapsed available only to those whose credentials will or have expired 12/31/2007 December 1, 2007 December 1, 2007

Application Deadline Date postmark and Fee January 15, 2008 350 January 15, 2008 250 January 15, 2008 350

Late Application Deadline Date postmark and Fee N/A February 15, 2008 350 N/A

If you have not received notice of receipt by AMP, call after March 3, 2008 March 3, 2008

December 1, 2007

March 3, 2008

October 25, 2008 Examination
Applications for this administration will be accepted beginning June 2, 2008 Applications received before this date will be returned

Mail Application After Initial Certification Renewal of Certification Lapsed available only to those whose credentials expired 12/31/2007 June 2, 2008 June 2, 2008 June 2,
2008

Application Deadline Date postmark and Fee July 15, 2008 350 July 15, 2008 250 July 15, 2008 350

Late Application Deadline Date postmark and Fee N/A August 15, 2008 350 N/A

If you have not received notice of receipt by AMP, call after September 3, 2008 September 3, 2008 September 3, 2008

Renewal of Certification by Continuing Education
2008 Renewal by Continuing Education
Applications will be accepted beginning August 1, 2008 Applications received before this date will be returned

Mail Application After Renewal of Certification August 1, 2008

Application Deadline Date postmark and Fee September 15, 2008 250

Late Application Deadline Date postmark and Fee October 15, 2008 350

If you have not received notice of receipt by AMP, call after October 29, 2008

2008 Certification Handbook for Diabetes Educators

Mission
Through the development, maintenance and protection of the certification process and the Certified Diabetes Educator CDE credential, the National Certification Board for Diabetes Educators NCBDE recognizes and advances the specialty practice of diabetes education

Responsibility for Certification
This certification program is owned by NCBDE and all
decisions made by NCBDE with respect to the certification program are final Under an agreement with NCBDE, Applied Measurement Professionals, Inc AMP assists in the development, administration, and scoring of Examinations and provides related administrative services

Definition of Diabetes Education
Diabetes education, also referred to as diabetes selfmanagement education or diabetes self-management training, is performed by health care professionals who have appropriate credentials and experience consistent with the particular professions scope of practice For purposes of this Handbook, diabetes self-management education is used Diabetes self-management education is defined as the ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care This process incorporates the needs, goals and life experiences of the person with diabetes and is guided by evidence-based standards The overall objectives of diabetes self-management education are to support informed decision-making, self-care behaviors, problem-solving and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life
National
Standards for Diabetes Self-Management Education, American Diabetes Association Diabetes Care, Vol 30, No 6, June 2007

Statement of Nondiscrimination Policy
NCBDE does not discriminate among applicants on the basis of age, gender, race, religion, national origin, disability, or marital status All applications submitted for certification are individually reviewed on the basis of information submitted

Eligibility Requirements for Initial Certification
Individuals who have not previously taken or passed the Examination or whose CDE credentials lapsed prior to 12/31/2007 must meet the requirements To qualify for the Examination, the following must be met at the time of application and Examination: 1 Discipline A Clinical psychologist, registered nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician MD or DO or podiatrist holding a current, active, unrestricted license from the United States or its territories OR B Dietitian holding active registration with the Commission on Dietetic Registration, physician assistant holding active registration with the National Commission on Certification of Physician Assistants, or exercise physiologist holding active
certification as an American College of Sports Medicine Registered Clinical Exercise Physiologist minimum of a masters degree OR C Health care professional with a minimum of a masters degree in social work from a United States college or university accredited by a nationally recognized regional accrediting body OR D Health care professional with a minimum of a masters degree in nutrition, health education or specified areas of public health from a United States college or university accredited by a nationally recognized regional accrediting body
Eligibility on the basis of an advanced degree in nutrition, health education, or public health is no longer available, except those qualifying degrees that were completed and conferred by the degree granting institution by the end of 2005, provided that the professional practice experience in diabetes self-management education is also completed and an Application submitted no later than 5 years after the degree was conferred

Purpose
The purpose of the NCBDE certification program is to conduct certification activities in a manner that upholds standards for competent practice in diabetes self-management education The CDE credential
demonstrates that the certified health care professional possesses distinct and specialized knowledge, thereby promoting quality care for persons with diabetes Certification is a voluntary process used to assess and validate qualified health care professionals knowledge in diabetes education It is an evaluative process that demonstrates that rigorous eligibility requirements have been met Certification is not required by law for employment in the field, although some agencies may use board certification as a basis for employment, job promotions, salary increases, or other considerations

Objectives
Objectives of the certification program are to provide a mechanism to demonstrate professional accomplishment and growth provide formal recognition of specialty practice and knowledge at a mastery level provide validation of demonstrated dedication to diabetes education to consumers and employers promote continuing commitment to best practices, current standards and knowledge

2008 Certification Handbook for Diabetes Educators

Advanced degrees in public health must be in an area of concentration specific to health education, health promotion, health and social behavior, or health
communication A degree in any other track or concentration, including administration, health policy, epidemiology, biostatistics, or population studies, is not accepted To verify the program of study specific to the acceptable areas of concentration, an official transcript that indicates that an advanced degree was awarded and the area of concentration must be submitted with the Application for the Examination NOTE: Individuals who meet either A or B, and C or D above, must apply under A current license or B current registration

Professional Practice Experience All professional practice experience is defined as employment for compensation as a diabetes educator in the United States or its territories within the past five years Employment for compensation means to hold a job in which one is actively engaged in diabetes self-management education and for which paid income is comparable to other diabetes educators in the same area or region of the country Only experience occurring AFTER meeting the Discipline requirement can be counted toward the Professional Practice Experience requirement After meeting the Discipline requirement and before applying for the Examination, all of the
following requirements must be met: A A minimum of two years to the day of professional practice experience in diabetes selfmanagement education AND B A minimum of 1,000 hours of diabetes selfmanagement education experience AND C Current employment in a defined diabetes educator role providing diabetes self-management education a minimum of four hours per week, or its equivalent, at the time of application

membership or committee work in professional organizations providing medical assessment, diagnosis, or treatment conducting/participating in research activities in which the individual is not involved in diabetes self-management education dispensing/prescribing medications or diabetes supplies promoting or selling medications or diabetes supplies and products employment by manufacturers of diabetes products and/ or product services eg, insulin delivery devices having diabetes or caring for a family member with diabetes any work or other experience prior to receipt of license, registration or advanced degree required for certification eligibility any work experience in practice settings outside the United States or its territories any work experience completed more than
five years prior to the date of application any diabetes educator job in which diabetes self-management education is performed less than 4 hours per week employment in one or more concurrent part-time diabetes educator jobs in which diabetes self-management education is performed less than 4 hours per week in each job

Renewal of Certification
Renewal of certification must be completed during the calendar year in which a CDEs certification expires CDEs may renew either by continuing education or by taking the Examination Certification renewal demonstrates that professionals previously certified have maintained a level of contemporary knowledge in diabetes education NCBDE requires all CDEs to recertify every five 5 years to maintain certification status It is the responsibility of each CDE to stay abreast of changes in certification and/or renewal requirements and to recertify in a timely manner Valid dates of the credential should be monitored and application for renewal submitted by published deadlines Extensions of certification are not granted Renewal of certification by continuing education requires that CDEs complete 75 clock hours of continuing education in content areas
applicable to diabetes during the certification cycle Implementation of this plan on a prorated basis requires that CDEs whose credentials will expire 12/31/2008 must complete 60 clock hours of approved continuing education Continuing education activities completed between January 1, 2004 and the September 2008 deadline may be counted, provided they are completed at the time of application and the application is postmarked by the published deadline date Those who opt to use the late deadline date must understand that the extended date applies only to submitting the application, it does not apply to completion of continuing education activities

Application Fees Payment

Unacceptable Experience
There are activities that are not considered diabetes education employment for purposes of certification eligibility and should not be included as part of Professional Practice Experience While not an exhaustive list, the following are examples of such activities: diabetes related functions performed as part of or in the course of other routine occupational duties eg, routine nursing care, routine nutritional counseling, routine pharmacy practice providing continuing education to
professionals eg, teaching nurses, physicians supervising and managing other professionals volunteer activities, including diabetes camp any experience in a student capacity

2008 Certification Handbook for Diabetes Educators

Refer to the Instructions for Completing Part III of the Application section in this Handbook or visit the website wwwncbdeorg for additional information See page iv for a schedule of renewal application deadline dates and fees Beginning in 2010, certification renewal requirements will also include 1,000 hours of professional practice some time during the five-year certification cycle, in addition to either taking the Examination or renewing by continuing education Visit the website wwwncbdeorg for additional information

9 Unauthorized possession and/or distribution of any official NCBDE testing or Examination materials 10 Ineligibility for certification, as determined by NCBDE 11 Misrepresentation or fraud in any statement on the certification Application made to assist individual to apply for, obtain, or renew certification

Use of Certification Marks
Certification is a process by which recognition is granted to an individual who has satisfactorily
met all requirements Only after receiving official written notice of either passing the Examination or renewing certification may an individual use the mark CDE following his/her name The marks CDE, CERTIFIED DIABETES EDUCATOR, and CDE in the design forms approved by NCBDE are also used on certificates, lapel pins, cards, and promotional materials in accordance with NCBDE policies CDE CERTIFIED DIABETES EDUCATOR and Design and CDE are federally registered certification marks The CDE designation is not punctuated with periods An example of proper use of the CDE credential is as follows: Joan M Smith, RN, MSN, CDE

Eligibility Requirements for Renewal of Certification
1 Renewal Requirements for A CDEs whose credentials will expire 12/31/2008 and for those whose CDE credentials have already or will expire 12/31/2007 Must continue to hold the license or registration for the same discipline held at the time of initial certification This license or registration must be current, active, and unrestricted at the time of renewal B Individuals whose CDE credentials expired prior to 12/31/2007 See Eligibility Requirements for Initial Certification, page 1 2 Application Fees
Payment

Application Process
Initial Certification
To apply for the Examination, applicants must: 1 Submit a completed current Application, Parts I and II, and applicable fees, postmarked by the published application deadline date Submit copy of current active, unrestricted US license/ registration or required official transcripts

Disciplinary Policy
NCBDE may deny, revoke, or otherwise act on any application for certification or on any CDE credential when an individual is not in compliance with NCBDE requirements NCBDE has the right to suspend, withhold, revoke, censure, or take other appropriate action with regard to certification status for validated cause and to make such actions public Certification may be withheld, denied or revoked, or applications rejected for reasons including, but not limited to, the following: 1 Falsification of application information 2 Noncompliance with review and audit procedures 3 Revocation or suspension of current license or other credential, or other disciplinary action by a licensing or regulatory board or registration commission/agency 4 Validated unethical practice of diabetes education 5 Giving or receiving assistance during the Examination
6 Removing or attempting to remove Examination information or materials from the test center 7 Representing oneself falsely as a Certified Diabetes Educator 8 Obtaining or attempting to obtain certification, whether initial or renewal, by fraud or deception

All applications submitted become the property of NCBDE Those who apply are advised to retain a copy for personal reference Under no circumstances are applications, including copies, returned to applicants

Renewal of Certification by Examination
Renewal applies to CDEs whose credentials lapse 12/31/2008 and individuals whose CDE credentials have/will lapse 12/31/2007 [Note: Individuals whose CDE credentials lapsed prior to 2007 must use the Initial Certification application process] 1 Submit completed Part I of current Application, and applicable fees, postmarked by the published application deadline date Submit copy of current, active, unrestricted license/ registration Submit copy of most recent CDE certificate, wallet card, or verification from NCBDE of your certification status

2 3

All applications submitted become the property of NCBDE Those who apply are advised to retain a copy for personal reference Under no
circumstances are applications, including copies, returned to applicants
3

2008 Certification Handbook for Diabetes Educators

Renewal of Certification by Continuing Education
Renewal by continuing education applies to CDEs whose credentials lapse 12/31/2008 1 Submit completed Parts I and III of current Application and pay the applicable fees, postmarked by the published application deadline date 2 3 Submit copy of current, active, unrestricted license/registration Submit copy of most current CDE certificate, wallet card, or verification from NCBDE of your certification status

Test Center Locations
Cities used as test centers have been selected to provide the greatest accessibility to the most candidates The location of the testing center in each city may change from administration to administration, depending on the availability and/or conditions of the facility Candidates will be advised of the exact location by means of an admission ticket sent from the testing agency approximately two weeks prior to the Examination date The following cities will serve as test centers for the Examinations Additional centers are not available Choice of center must be indicated in the space
provided on Part I of the application Requests for change of test center locations must be submitted in writing and received by AMP no later than 30 days prior to the Examination date ALABAMA ALASKA ARIZONA CALIFORNIA AL0011 AK0021 AZ0034 CA0053 CA0055 CA0054 CA0056 CO0061 CT0071 FL0101 FL0102 FL0105 GA0111 HI0121 ID0131 IL0141 IN0151 IA0161 KS0171 LA0192 MD0211 DC0091 MA0221 MI0233 MN0241 MS0251 MO0261 MO0262 MT0272 NE0281 NJ0315 NM0321 NY0335 NY0331 NY0336 NY0338 NC0344 NC0343 OH0364 OH0361 OK0371 Montgomery Anchorage Glendale Los Angeles Irvine Oakland San Diego Denver New Haven Miami Orlando Tampa Atlanta Honolulu Boise Chicago Indianapolis Iowa City Wichita Baton Rouge Baltimore College Park Boston Livonia Minneapolis Jackson Kansas City St Louis Great Falls Omaha Lincroft Albuquerque Albany New York City Long Island Hempstead Rochester Charlotte Raleigh Cincinnati Cleveland Oklahoma City

Fees
Initial Certification 350 Renewal of
Certification 250 Renewal of Certification Late Application Option 350 Lapsed Certification 350 Fee payments may be made by credit card VISA , MasterCard, American Express or Discover, or by check Do not send cash Please allow up to six weeks after the application deadline for the processing of checks Declined credit cards and/or insufficient fund checks returned to AMP are subject to a penalty Repayment of a declined credit card or payment for an insufficient fund check and the penalty must be made with a cashiers or certified check or money order Unless and until all fees have been paid in full, application processing will not be completed Processing of payment does not confirm acceptance to take the Examination or that renewal by continuing education has been approved In the event an application for the Examination is rejected by NCBDE or withdrawn by the applicant, a 100 nonrefundable processing fee and any applicable late fee will be retained and the remainder of the application fee refunded No refund, including any applicable late fee, is provided upon withdrawal of an application from the renewal of certification by
continuing education process In the event an application for renewal of certification by continuing education is not accepted by NCBDE, a 100 nonrefundable fee and any applicable late fee will be retained and the remainder of the application fee refunded

COLORADO CONNECTICUT FLORIDA

GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS LOUISIANA MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEW JERSEY NEW MEXICO NEW YORK

Examination Dates
May 3, 2008 October 25, 2008

NORTH CAROLINA OHIO OKLAHOMA

2008 Certification Handbook for Diabetes Educators

OREGON PENNSYLVANIA PUERTO RICO SOUTH CAROLINA TENNESSEE TEXAS

UTAH WASHINGTON WISCONSIN

OR0382 PA0391 PA0392 PR0991 SC0412 TN0432 TX0441 TX0443 TX0440 UT0451 WA0481 WI0501

Portland Philadelphia Pittsburgh San Juan Columbia Nashville Dallas Houston San Antonio Salt Lake City Seattle Milwaukee

Applicants anticipating the need for food or beverages for medical reasons during the Examination should notify AMP in writing when submitting their applications and bring these items with them to the Examination

Adherence to Published Policies
Eligibility requirements, application deadlines, and fee payment
policies are strictly enforced by NCBDE and AMP Applications must be completed and postmarked by the specified deadline dates Applications postmarked after published deadline dates will be returned Absolutely no exceptions will be made If requested, applicants must respond with additional information to verify eligibility Applicants are advised to send applications to AMP using certified mail or traceable courier services Neither NCBDE nor AMP is responsible for lost, misdirected, late or undelivered mail A certified mail, certificate of mailing, or other courier receipt can serve as proof that the application was mailed by the deadline Deadlines are postmark dates on the mailing envelope when sent by US mail Private metered postmarks and mail receipts not dated by the US Postal Service are not acceptable as proof of timely mailing

Sunday test sites for May Examination Sunday test sites for October Examination

Requests for Sunday Testing
The Examination may be scheduled on a Sunday ONLY if religious convictions prohibit taking it on Saturday Sunday testing is available only on the day immediately following the published date of the Examination applied for The Request for Sunday
Testing form on page 15 must be completed and submitted with the application There is no additional fee when a Sunday Examination date is established Sunday test centers are listed in the previous section

Application Status Requests for International Test Centers
NCBDE will consider requests to establish test centers outside the United States In addition to the Examination fee, there is a fee of 980 to cover the cost of an international test center A letter requesting such arrangements and the fee must be submitted with the completed application If the request cannot be accommodated, the fee will be refunded A Receipt of Application If written acknowledgement of receipt of your application has not been received within 8 weeks after the application deadline, call the AMP Examination Services Department at 913 895-4600 This information is not available from the NCBDE national office B Review of Applications for the Examination Review of applications is completed approximately one month prior to the Examination administration date and notices sent to applicants as soon as possible Determinations of eligibility to take the Examination are communicated in writing via mail Neither the
NCBDE national office nor AMP Examination Services provides the status of an application via telephone, fax, or electronically Occasionally determinations of eligibility require additional time and are not available until shortly before the date of the Examination Applicants must be aware of this and plan accordingly NOTE: Applicants who elect to take review courses to prepare for the Examination should also be aware that the timing and costs of taking such courses are wholly unrelated to the NCBDE certification program C Review of Applications for Renewal by Continuing Education Review of applications is completed in November and notices sent to individuals as soon as possible Decisions regarding renewal by continuing education are communicated in writing via mail Neither the NCBDE national office nor AMP Examination Services provides the status of an application via telephone, fax or electronically

Requests for Special Testing Accommodations
NCBDE complies with the Americans With Disabilities Act ADA and provides reasonable and appropriate accommodations for those with documented disabilities taking the Examination and for other individuals taking the Examination with qualifying
medical conditions that may be temporary or are not otherwise covered by the ADA Accommodations may be made for these individuals, provided a request for special testing accommodations is submitted to AMP by the postmark application deadline and the request is approved The form for requesting special accommodations is included on page 13 Instructions for completion must be followed and both required documents submitted with the application Requests for accommodations are reviewed on an individual basis NCBDE will make reasonable efforts to provide requested special accommodations for individuals who have documented disabilities or qualifying medical conditions The decision as to whether a medical condition that is not covered by the ADA is considered a qualifying medical condition is at the sole discretion of NCBDE

2008 Certification Handbook for Diabetes Educators

Changes After the Application is Submitted
1 Examination AMP must be notified in writing within 21 days prior to the Examination date of any change in name, address, or telephone numbers that occurs after the application has been submitted Notice of change received less than 21 days before the Examination date will
not guarantee that the Examination admission ticket or Examination results will reach the proper person or the new address Neither NCBDE nor AMP is responsible for trying to locate such an individual Renewal of Certification by Continuing Education AMP must be notified within 10 business days of the September deadline of any change in name, address, or telephone numbers that occurs after the application has been submitted Notice of change received later will not guarantee that correspondence will reach the proper person or the new address Neither NCBDE nor AMP is responsible for trying to locate such an individual

Notice of withdrawal of an application for the Examination must be submitted in writing to AMP, postmarked no later than 30 days prior to the scheduled Examination date When notice is postmarked at least thirty days prior to the scheduled Examination date, the application fee, minus a 100 processing fee and any applicable late and penalty fees, will be refunded This 100 fee is nonrefundable and is used to offset the cost of application handling and processing completed prior to the applicants withdrawal Notices of withdrawal must be sent to: NCBDE EXAMINATION AMP
Examination Services Department 18000 W 105th Street Olathe, KS 66061-7543 Fax: 913 895-4651
Application fees are NOT transferable from one Examination to another There are no exceptions to this policy If the applicant wishes to take the Examination at another time, a new application and fee must be submitted No refunds are available to those who do not submit notice of withdrawal at least 30 days prior to the scheduled Examination date, or who do not report for the Examination on the scheduled date Requests for exceptions to the refund policy may be submitted in writing to NCBDE at the address listed on page iii and will be considered on a case by case basis Documentation pertinent to and supporting the reason for the exception must accompany all requests The application fee, minus a 100 processing fee and any applicable late and penalty fees, will be issued upon approval of the request Requests for exceptions must be postmarked no later than 30 days after the Examination date

Rejected Applications
1 Applications may be rejected under the following circumstances: A NCBDE determines that the applicant does not meet eligibility or renewal requirements B The application is
incomplete in any way or improperly completed C The application and/or fee are not submitted by the published postmark deadline date When an application is rejected for any of the reasons above, the application fee, minus a 100 processing fee and any applicable late and penalty fees, will be refunded Applications rejected when the payment for the application fees is not honored by the card issuer or bank The applicant will owe a 100 processing fee and any applicable late and penalty fees

Audit Policy
NCBDE reserves the right to audit at any time any application submitted for certification initial or renewal

Examination Process
Schedule for the Examination
The following schedule is observed at all test centers: 8:30 am Report to test center 9:00 am Examination begins 1:00 pm Examination ends All candidates should report to their assigned centers by 8:30 am A maximum of four hours is allowed for completion of the Examination No candidate arriving after testing has begun will be admitted

Appeals
Appeals are available only to individuals whose applications are rejected because of failure to meet eligibility requirements The procedure for filing an appeal is sent with the
notice of ineligibility Those who elect to appeal should be aware that the appeals process cannot be completed in time for successful appellants to take the Examination applied for Appeals are not available to individuals whose applications are rejected for any other reason, including being incomplete or improperly completed, or when for other reasons evaluation of the application cannot be completed

Admission to the Test Center
Approximately two 2 weeks before the Examination date, AMP will mail to each scheduled candidate a test center admission ticket including the exact address of the center This document must be brought to the test center on the day of the Examination
6

Withdrawals and Refunds
Once submitted, applications for renewal of certification by continuing education cannot be withdrawn and fees are not refunded

2008 Certification Handbook for Diabetes Educators

INSTRUCTIONS FOR COMPLETING PART I OF THE APPLICATION
Any applicant who does not/cannot provide required information, or who does not meet eligibility requirements based on the documentation submitted, will be declared ineligible Eligibility requirements are not waived nor are exceptions made

Part I To be
completed by ALL applicants
Complete each section as required Part I, Section 25 must be signed in ink Section 1 NAME Print your first name, middle initial, and last name Print only one letter in each box If your name has a generational suffix eg, Jr, enter the appropriate suffix under the heading Generation Section 2 SOCIAL SECURITY NUMBER Enter your Social Security number Be careful to enter this correctly; it will be your identification number for this application Section 3 DATE OF BIRTH Enter the digits for the month of your birth Next, enter the two digits for the day and the year of your birth Use two digits for month and day eg, 03 Sections 4, 5 WORK AND HOME TELEPHONE NUMBERS Provide the area code and telephone number where you can be reached weekdays between 9:00 am and 5:00 pm work telephone and weekdays after 5:00 pm home telephone Section 6 ADDRESS Enter only one number or character per box Leave a blank box between the number and the street name If your address is too long, abbreviate the street name Enter your apartment number, PO Box number, or any address addendum in the spaces provided to the right of the street address Abbreviate where possible Important: a
Examination the mailing address provided on the application will be used to mail the admission ticket, test results, and certificate unless a change of address is received by AMP no later than 21 days before the Examination b Renewal by Continuing Education the mailing address provided on the application will be used to mail all correspondence and certificate unless a change of address is received by AMP within 10 business days of the September deadline Section 7 CITY/STATE Print the name of the city Use the standard two-character abbreviation to indicate the state eg, IL for Illinois Section 8 ZIP CODE/POSTAL CODE Enter your zip code Section 9 COUNTRY Blacken the circle that corresponds with the country where you reside Section 10 E-MAIL ADDRESS Print your e-mail address Section 11 APPLICATION FEE Indicate the payment method If payment is being made via credit card, indicate the card type and follow the payment directions Make check or money order payable to AMP Sections 12, 13 OPTIONAL INFORMATION Blacken the appropriate circles for each of these sections Completion of these sections is optional and is requested only to assist in complying with general guidelines
pertaining to equal opportunity These data are for statistical purposes only Section 14 TYPE OF APPLICATION Blacken the circle that indicates the type of application you are submitting Section 15 RENEWAL OF CERTIFICATION If applicable, complete the section entirely Where additional information is required, print CLEARLY Proceed to Section 23 or Section 18 as directed Section 16 LAPSED If applicable, complete the section entirely Where additional information is required, print CLEARLY Proceed to Section 18 Section 17 INITIAL CERTIFICATION If applicable, complete the section entirely Where additional information is required, print CLEARLY

Proceed to Section 18 Section 18 TEST DATE Indicate the month, day and year of the Examination you are applying for Use two digits for the month and day eg, 03 Section 19 TEST CENTER CODE Enter the test center code for the city where you wish to take the Examination Test center codes are listed on pages 4-5 of the Certification Handbook Section 20 SPECIAL ACCOMMODATIONS REQUEST Complete this section if you have a qualifying disability and require special testing accommodations The Request for Special Testing Accommodations form on page 13
must be completed and submitted with your application Section 21 SUNDAY TESTING REQUEST If your religious convictions prohibit you from taking the Examination on Saturday, blacken this circle Ensure that you have also selected a test center designated for Sunday testing in Section 19 The Request for Sunday Examination form on page 15 must be completed and submitted with your application Section 22 INTERNATIONAL TEST CENTER REQUEST Blacken this section if you are requesting a test center in a country other than the United States Specific instructions for requesting an international test center are provided on page 5 under Requests for International Test Centers Payment of the additional 980 international test center fee MUST accompany your application and fee Note: Completing this section does not guarantee that an international test center can be arranged Section 23 PROFESSIONAL INFORMATION In A1 through E, blacken the circle that describes your practice Section 24 DISCIPLINE INFORMATION Provide the information requested in either Section A: License or Registration, or Section B: Advanced Degree Do not complete both Those completing Section A must enclose PHOTOCOPY of current
license, registration or certificate from the issuing credentialing body An official written verification from the appropriate credentialing body may also be submitted Originals should not be sent Proof of license or registration that will be current at the time of the Examination applied for must be submitted to AMP no later than two 2 weeks prior to the Examination date Individuals completing Section B must submit official transcripts of their masters or doctoral degrees Transcripts must show the specific degree awarded, major area of concentration, and the date the degree was conferred Student transcripts are not acceptable Section 25 SIGNATURE Applications MUST be signed and dated in ink Unsigned applications will not be accepted Note: Applicants anticipating the need for food or beverages for medical reasons during the Examination should notify AMP in writing when submitting their applications and bring these items with them to the Examination SUBMISSION OF APPLICATION When completed, use the attached envelope to mail the application, required documentation, and fees to: AMP, Examination Services Department 18000 W 105th Street, Olathe, KS 66061-7543 Write NCBDE in the upper
left corner of the envelope under your return address If the envelope is not available, use a blank envelope and address as noted above

I-1

CHECKLIST INITIAL CERTIFICATION
Use this checklist to ensure that you have completed all required procedures before submitting your application Have you completed all required sections of Part I of the application, including your signature in ink? Have you documented professional practice experience using the required Part II forms Experience in Diabetes-Self Management Education? Have you completed at least one Section A form? If you have less than 2 years OR 1,000 hours in diabetes selfmanagement education in the current position, but have previous positions that will fulfill the requirement to have 2 years and 1,000 hours, all previous employment must be documented separately on Section A Has your supervisor Section B OR, if self-employed, another health care professional Section C verified a minimum of 2 years and 1,000 hours in diabetes self-management education experience? If documenting self-employment experience, have you completed Section D for each of those positions? Have you completed Section E using the applicable grid,
including signature and date? Have you included a copy of your current license or verification letter of licensure, registration, OR an official transcript indicating that an advanced degree was awarded, the area of concentration, and the date conferred? If you anticipate the need for food or beverages for medical reasons during the Examination, have you included a written notification to AMP regarding this requirement? It is NOT necessary to complete a Request for Special Testing Accommodations form

Have you completed all necessary information in Part I, Section 11 and included a check or money order, payable to AMP, if necessary?
Have you kept copies of all application materials for your files? Retain this checklist and a copy of your application for your records Under no circumstances are applications, including copies, returned to applicants Optional: Send application by certified mail or traceable courier service See Adherence to Published Policies section, page 5 Acknowledgement of receipt of your application should be sent by AMP no later than 8 weeks after the application deadline Also for use by applicants whose CDE credentials lapsed prior to 12/31/2007

CHECKLIST
RENEWAL OF CERTIFICATION BY EXAMINATION
Use this checklist to ensure that you have completed all required procedures before submitting your application Have you completed all required sections of Part I of the application, including your signature in ink? Have you included a copy of your most recent CDE certificate, wallet card, or verification from NCBDE of your certification status? Have you included a copy of your current license or verification letter of licensure, registration, OR, if not previously submitted, an official transcript indicating that an advanced degree was awarded, the area of concentration, and the date conferred? If you anticipate the need for food or beverages for medical reasons during the Examination, have you included a written notification to AMP regarding this requirement? It is NOT necessary to complete a Request for Special Testing Accommodations form

Have you completed all necessary information in Part I, Section 11 and included a check or money order, payable to AMP, if necessary?
Have you kept copies of all application materials for your files?

Retain this checklist and a copy of your application for your records Under no circumstances are
applications, including copies, returned to applicants
Optional: Send application by certified mail or traceable courier service See Adherence to Published Policies section, page 5 Acknowledgement of receipt of your application should be sent by AMP no later than 8 weeks after the application deadline Also for use by applicants whose CDE credentials have or will lapse on 12/31/2007

CHECKLIST RENEWAL OF CERTIFICATION BY CONTINUING EDUCATION
See page I-7 for checklist
I-2

Certification for Diabetes Educators Application
To be submitted by all applicants
1 NAME: FIRST MI

Read the Certification Handbook in its entirety before completing the application The application may be rejected if it is incomplete
GENERATION

NCBDE Application Part I Submission of Application
When completed, use the attached envelope to mail the application, required documentation, and fees to: AMP, Examination Services Department 18000 W 105th Street, Olathe, KS 66061-7543 Write NCBDE in the upper left corner of the envelope under your return address If the envelope is not available, use a blank envelope and address as noted above Applications must be sent ONLY to AMP
5 HOME TELEPHONE NUMBER
AREA
CODE

NAME: LAST

2 SOCIAL SECURITY NUMBER

3 DATE OF BIRTH
MONTH DAY YEAR

4 WORK TELEPHONE NUMBER
AREA CODE

6 STREET ADDRESS Abbreviate if necessary

APT, PO, ETC Abbreviate if necessary

7 CITY

STATE

8 ZIP CODE/POSTAL CODE

9 COUNTRY UNITED STATES CANADA

10 E-MAIL ADDRESS

OTHER: _______________________________

APPLICATION FEE

Indicate total payment amount _____________________ Indicate payment method Check personal, corporate or cashiers check payable to AMP Money Order payable to AMP Credit Card: VISA MasterCard American Express Discover If payment is made by credit card, the following information must be provided:
Account Number: _________________________________________________________________ Expiration Date:_____________________________________________________________ Name as it appears on card: ______________________________________________________ Signature: _____________________________________________________________________ Please sign in ink only
14

OPTIONAL INFORMATION Information related to gender and ethnic background is requested only to assist in complying with general guidelines pertaining to equal opportunity Such data will be used
only in statistical summaries
12 GENDER optional MALE FEMALE 2 3 4 5 6 13 ETHNICITY optional 1 NATIVE AMERICAN/ NATIVE ALASKAN ASIAN/ASIAN-AMERICAN/ PACIFIC ISLANDER AFRICAN AMERICAN HISPANIC/LATINO CAUCASIAN OTHER specify ____________________________

TYPE OF APPLICATION
Renewal current CDE go to 15 Renewal Lapsed CDE credential expired go to 16 Lapsed Initial go to 17 Initial

LAPSED credential expiration date of 12/31/2007 or earlier

RENEWAL OF CERTIFICATION
Expiration Year:

Credential lapsed 12/31/2007 Credential lapsed prior to 12/31/2007 CDE Certificate Expiration Number: Year: If your name has changed, under what name did you previously certify? please print clearly ______________________________________________ go to 18Test Date
17

CDE Certificate Number:

INITIAL CERTIFICATION

If your name has changed, under what name did you previously certify? please print clearly ___________________________________________ Method of Renewal Continuing Education go to 23Professional Information Examination go to 18Test Date

A Have you applied to take this Examination before? MONTH YEAR N No Y Yes Identify the month and year of the last Examination applied for Under
what name? if different from Section 1 above please print clearly ________________________________________________ B Have you ever taken this Examination before? MONTH YEAR N No Y Yes Identify the month and year of the last Examination taken Under what name? if different from Section 1 above please print clearly ________________________________________________ go to 18Test Date

NCBDE 10/07

Application for 2008 Part I 1 of 2

NCBDE Application Part I
18 TEST DATE
MONTH DAY YEAR

19 TEST CENTER CODE

20 SPECIAL ACCOMMODATIONS REQUEST YES Complete the form included in the Handbook

21 SUNDAY TESTING REQUEST YES Complete the form included in the Handbook

22 INTERNATIONAL TEST CENTER REQUEST YES Include required documentation fee

2008
23

PROFESSIONAL INFORMATION

Blacken the circle that describes your practice A1 Primary Practice Setting 0 Hospital Inpatient Only 1 Hospital Outpatient Only 2 Both Hospital Inpatient/Outpatient 3 Physicians Office 4 Community Health Agency 5 Private Practice 6 Home Health Agency 7 Other specify: _________________________________ A2 Secondary Practice Setting 0 Hospital Inpatient Only 1 Hospital Outpatient Only 2 Both Hospital Inpatient/Outpatient
3 Physicians Office 4 Community Health Agency 5 Private Practice 6 Home Health Agency 7 Other specify: _________________________________ C Percent of Time Spent Providing Diabetes self-management education 0 Less than 25 1 26 to 50 2 51 to 75 3 More than 75 E Do you wish your name and address to be made available on NCBDE mailing lists? Y Yes N No B Experience in Diabetes self-management education 0 2 years 1 Over 2 years to 5 years 2 Over 5 years to 10 years 3 More than 10 years

D Highest Education Level Achieved 0 Associate Degree Nursing 1 Diploma in Nursing 2 Baccalaureate Degree 3 Masters Degree 4 Doctoral Degree 5 Medical Degree

PROFESSIONAL DISCIPLINE INFORMATION All applicants must complete either A or B Do not complete both
SECTION B: ADVANCED DEGREE 2 For clinical exercise physiologists, clinical psychologists, registered nurses, nurse practitioners, clinical nurse specialists, occupational therapists, optometrists, pharmacists RPh or PharmD, physical therapists, physicians, or podiatrists, indicate the month/day/year you first received your license/certificate to practice in your professional discipline, ie, the date your license/certificate was originally
conferred For physician assistants or dietitians, indicate the month/ day/year you were first registered, eg, for a registered dietitian, do not submit state license information; indicate the day you originally received registration with the Commission on Dietetic Registration Do NOT submit state license information See Eligibility Requirements for Initial Certification, 1 Discipline, page 1 for registration requirements
MONTH DAY YEAR

SECTION A: LICENSE OR REGISTRATION 1 Indicate the license or registration under which you are applying Identify one only A Registered Nurse RN B Nurse Practitioner NP C Clinical Nurse Specialist CNS D Registered Pharmacist RPh E Doctor of Pharmacy PharmD F Doctor of Medicine MD

Indicate the advanced degree under which you are applying 0 1 2 3 Social Work Nutrition Health Education Public Health

G Doctor of Osteopathy DO H Physician Assistant Certified PA-C I J Doctor of Podiatric Medicine DPM Physical Therapist PT

An official transcript that indicates the degree, date awarded and area of concentration/major must be submitted by 1 those applying for initial certification see Eligibility Requirements for Initial Certification, page 1, and 2
previously certified individuals whose credentials have lapsed and who are not applying for the Examination in the year immediately following the credential expiration see Eligibility Requirements for Renewal of Certification, B, page 3

K Occupational Therapist-Registered OTR L Doctor of Optometry OD Note: Individuals applying under Section A must submit a photocopy of current professional license/registration/certificate to practice, or a letter of verification of same from the corresponding credentialing agency Registered dietitians should not submit copies of state licenses

Individuals who meet both Section A and Section B
See Eligibility Requirements for Initial Certification page 1 must apply under Section A current license or registration

M Registered Dietitian RD N Clinical Exercise Physiologist RCEP O Clinical Psychologist

SIGNATURE Sign and date in ink the statement below
I certify that I have read, understand and agree to abide by the contents of the Certification Handbook for Diabetes Educators, and that the information provided on my NCBDE Application and any and all documents submitted by me or others in connection herewith are complete and accurate I
authorize NCBDE and its representatives to take any steps they deem necessary to verify the completeness and accuracy of the information provided, including but not limited to contacting education institutions, employers, supervisors and referral sources I understand and agree that if any of this information is found to be incomplete or inaccurate, or if I otherwise violate any of the NCBDE policies in the Certification Handbook, my application may be rejected, or my Examination results or renewal of certification delayed in processing, not released, or invalidated by NCBDE
______________________________________________________________________
Signature

________________________________________
Date

NCBDE 10/07

Application for 2008 Part I 2 of 2

INSTRUCTIONS FOR COMPLETING PART II OF THE APPLICATION
Part II Experience in Diabetes Self-Management Education
Part II must be completed by: applicants for initial certification,

applicants whose credentials lapsed prior to 12/31/2007
Note: Each diabetes educator position reported must be documented separately on the applicable forms
IMPORTANT: Instructions for Completion of Part II should be reviewed prior to completing the
application Applications received incomplete or incorrectly completed may be rejected

Guidelines for Completing Part II of the Application
All experience to be counted toward meeting professional practice eligibility requirements must have been performed in a defined role as a diabetes educator and must meet the definition of diabetes self-management education as published in the Handbook Diabetes related functions performed as part of or in the course of other routine occupational duties may not be counted See page 2, Handbook, for examples of experience not considered diabetes self-management education for purposes of certification To calculate the required minimum of two years to the day of professional practice experience within the past five years, begin with the date that you will be signing the application and work backwards to document at least two years, ie, 365 days x 2 or no less than 730 days Applications that do not document a cumulative total of at least 730 days of experience will be rejected The intent of this guideline is that the applicant must document a minimum of two entire years of employment to the day If you have been employed in more than one job as a
diabetes educator and there were time periods between jobs that you were not employed as a diabetes educator, do not include these periods of unemployment when calculating employment time All professional practice experience must be completed on or before the date you sign the application Experience that would occur after the application is signed and dated but before the date of the Examination for which you are applying should not be reported If you were employed in a diabetes educator position prior to the date that your advanced degree was conferred, that you were registered or received your license to practice, that experience may not be counted toward meeting professional practice experience requirements All professional practice experience in diabetes selfmanagement education must be paid employment positions

in the United States or its territories For purposes of this application, volunteer activities, including diabetes camp, are not considered employment positions
In addition to the requirement to have a minimum of two years of practice prior to the date the application is signed and dated, applicants must also have a minimum of 1,000 hours of diabetes
self-management education experience within the past five years To calculate, begin with the date the application is signed and work back five years Experience that occurred earlier than this date may not be counted Experience that did not occur in the United States or its territories may not be counted toward meeting either the minimum two years of experience or the minimum 1,000 hours of experience in diabetes self-management education As of the date you sign the application, you must be employed in a defined diabetes educator role performing diabetes self-management education a minimum of four hours per week or its equivalent Each position claimed as a diabetes educator must include no less than 4 hours per week/16 hours per month of diabetes self-management education Any position in which diabetes self-management education was less than 4 hours per week/16 hours per month should not be included, as it is not considered a specialty or defined role as a diabetes educator For employment positions in which diabetes self-management education is provided solely by electronic means, eg, by telephone or internet, responses to items 6-7 on Part II, Section B or items 8-9 on Part II,
Section C are required If you have previously applied for the Examination, it is important to submit the same or equivalent information regarding professional practice experience, as applications will be compared

Any applicant who does not or cannot provide required information, or who does not meet eligibility requirements based on the documentation submitted, will be declared ineligible Eligibility requirements are not waived nor are exceptions made
I-3

Instructions for Part II continued SECTION A PROFESSIONAL PRACTICE EXPERIENCE
Beginning with your current position as Job 1, and working chronologically backward, complete Section A for each diabetes educator position needed to document fulfillment of professional practice experience requirements If documenting more than one job, photocopy Section A Before completing this section, see the instructions for Section E: Summary of Practice Experience for guidelines on claiming hours

SECTION B PRACTICE VERIFICATION STATEMENT BY SUPERVISOR
Complete Section B for each employment position submitted If documenting more than one job, photocopy Section B Note: Section B should not be used for verification of self-employment Use
Section C Applicants may not verify their own experience Only experience that is verified by a supervisor can be counted toward meeting experience requirements When a supervisor no longer works where you are/were employed and cannot be located, include a notation to this effect on Section B In the absence of the person who was your immediate supervisor, the experience must be verified by another individual who can attest to the experience claimed and is in an administrative position authorized to do so Depending on the type of facility and the organizational structure, this could be the individual to whom the former supervisor reported, a hospital administrator, assistant administrator, chief executive officer, or director of human resources

SECTION C SELF-EMPLOYMENT VERIFICATION
Complete Section C for each self-employment position submitted If documenting more than one job, photocopy Section C Applicants may not verify their own experience Do not complete Section C if you are/were employed by another health care provider in private practice A department head, chief of staff, Certified Diabetes Educator or other licensed health care provider who knows you and is familiar
with your practice must complete the form Spouses, business partners, and employees of your practice may not verify experience

SECTION D SOURCES OF PATIENT/CLIENT REFERRALS
Complete Section D for each self-employment position submitted If documenting more than one job, photocopy Section D

SECTION E SUMMARY OF PROFESSIONAL PRACTICE EXPERIENCE
Complete and submit only ONE Section E with your application

Carefully read the following before completing the applicable grid
Document the cumulative total number of hours of diabetes self-management education experience by month for all diabetes educator positions claimed, the total hours per year, and the grand total hours Use numbers only; do not use shading or other marks to indicate experience Enter only the number of hours spent in diabetes self-management education Report only hours of diabetes self-management education that took place 5 years or less prior to the date the application is signed Only hours of diabetes self-management education experience a minimum of 4 hours per week/16 hours per month can be counted towards meeting eligibility requirements Report only hours of diabetes self-management education that occurred
before the date the application is signed Experience that may take place after the application is signed cannot be included Claim no more than 40 hours per week/160 hours per month for any diabetes educator position
I-4

The hours claimed per month on Section E should be calculated consistent with the hours claimed per week It is assumed that diabetes self-management education rarely involves every hour of a standard 40-hour week, therefore, do not report total hours on the job eg, 160 hours or more per month For any month where an applicant is documenting two or more jobs held simultaneously, only the total experience for the month should be recorded If an interruption in providing diabetes self-management education that took place 5 years or less prior to eligibility, the cumulative total of all jobs and self-employed positions must equal or exceed the minimum requirement of two years to the day Unemployment, leaves of absence, family leave, etc should be indicated by a dotted line in the boxes for those months Applicants are responsible for the accuracy of their calculations/applications

NCBDE Application Part II
Applicants
Name:___________________________________

SECTION A Professional Practice Experience
Applicants Name: __________________________________________________________________________ Job _________________________ Job Title: _________________________________________________________________________________________________________________ Department: ______________________________________________________________________________________________________________ Institution/Practice Site:_____________________________________________________________________________________________________ Street Address: ____________________________________________________________________________________________________________ City:____________________________________________________________ _______ State:___________________ Zip: _______________________ Name of Immediate Supervisor: _____________________________________________________________________________________________ Title of Immediate Supervisor: _______________________________________________________________________________________________ 1 Employment status: I am currently employed/self-employed in this position I am NOT currently
employed/self-employed in this position 2 Employment dates as diabetes educator: from month ____________ day _______ year ____________ to month _____________ day ________ year __________ 3 For this job, I am claiming _________ hours per week in diabetes self-management education Do not report hours as a range 4 I am claiming a total of ___________ hours in diabetes self-management education for the employment dates listed above 5 Practice setting check one only: Hospital Inpatient Only Hospital Outpatient Only Both Hospital Inpatient/Outpatient Physicians Office Community Health Agency Self-Employed/Private Practice Home Health Agency

Other specify____________________________________________________ 6 If you answered Other to item 5, provide a description of the setting Use a separate sheet of paper if necessary, and include your name and the last four digits of your social security number _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________ 7 Delivery method for diabetes self-management education that you provided in this job check one only: Face to face only Electronic only eg, telephone, internet Face to face and electronic

Application for 2008 Part II, Section A

NCBDE Application Part II
Applicants Name:___________________________________

SECTION B Practice Verification Statement by Supervisor
Note to Supervisor: Response to each item is required in order to process this application Do not complete or sign this statement unless Part I of the application and Part II, Section A for this position have been completed Applicants Name _________________________________________________ Job _______________ see Part II, Section A This applicant: Circle or provide documentation as required 1 Yes No holds an active unrestricted US license as a clinical psychologist, registered nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, registration as a clinical exercise physiologist minimum of a masters degree by the American College of Sports Medicine,
registration as a dietitian with the Commission on Dietetic Registration, or registration as a physician assistant by the National Commission on Certification of Physician Assistants OR is a health care professional with a minimum of a masters degree from a US college or university in one of the following areas of health care practice: nutrition, social work, health education, or specified areas of study in public health 2 Yes No provides/d diabetes self-management education: the ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care This process incorporates the needs, goals and life experiences of the person with diabetes and is guided by evidence-based standards The overall objectives of diabetes self-management education are to support informed decision-making, self-care behaviors, problem-solving and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life provides/d diabetes self-management education as defined above in an employment capacity a minimum of 4 hours per week or its equivalent Please review the information provided by the applicant on Part II, Section A for this
job, including employment dates and hours of diabetes self-management education being claimed Is this information correct? provides/d diabetes self-management education solely by electronic means

3 4 5

Yes No Yes No Yes No

If you answer yes to question 5, you must answer questions 6-7 below
6 _______ I attest that the diabetes self-management education delivered solely by electronic means by this applicant includes/d initials a provision for client referral to another health care professional when face-to-face education is/was indicated 7 Please describe the process for referring clients with a need for face-to-face education to another health care professional for that education Use a separate sheet of paper if necessary

If the answer to questions 1-4 is NO, or if any information differs from that reported by the applicant, provide an explanation, using a separate sheet of paper if necessary

Random audits of applications are conducted You may be contacted regarding the information contained in this application I have reviewed this application and attest that I am the applicants supervisor and that to the best of my knowledge all information is accurate, complete and truthful
Supervisors Name printed __________________________________ Supervisors Signature ___________________________________
Individual signing must be applicants immediate supervisor Original Signature Only

Date Signed______________________________________ Title_____________________________________________________________________ Department ________________________________________________________________________________________________________________ Institution __________________________________________________________________________________________________________________ Street Address _____________________________________________________________________________________________________________ City_________________________________________ State_______ Zip Code_____________ Daytime Telephone __________________________
include area code

E-mail Address _____________________________________________________________________________________________________________ Application for 2008 Part II, Section B

NCBDE Application Part II
Applicants Name:___________________________________

SECTION C Self-Employment Verification Form applicants self-employment experience only
Please note: 1
Response to each item is required in order to process this application 2 Self-employment/private practice experience may not be verified by the applicant, a spouse, business partner, or employee of the applicant Do not complete or sign this statement unless Part I of the application and Part II, Section A for this position have been completed by the applicant Applicants Name _________________________________________________ Job _______________ see Part II, Section A Circle or provide documentation as required 1 Yes No This applicant holds an active unrestricted US license as a clinical psychologist, registered nurse, occupational therapist, optometrist, pharmacist, physical therapist, physician, podiatrist, registration as a clinical exercise physiologist minimum of a masters degree by the American College of Sports Medicine, registration as a dietitian with the Commission on Dietetic Registration, or registration as a physician assistant by the National Commission on Certification of Physician Assistants OR is a health care professional with a minimum of a masters degree from a US college or university in one of the following areas of health care practice: nutrition, social work,
health education, or specified areas of study in public health 2 3 4 5 I have known the individual named above since ________________ in my capacity as ____________________________________ month/year Your professional position/title Yes No Yes No Yes No I am familiar with her/his practice as a diabetes educator I refer/referred patients to this practice The applicant provides/d diabetes self-management education: the ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care This process incorporates the needs, goals and life experiences of the person with diabetes and is guided by evidence-based standards The overall objectives of diabetes self-management education are to support informed decision-making, self-care behaviors, problem-solving and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life The applicant provides/d diabetes self-management education as defined above a minimum of four hours per week or its equivalent He/she provides/d diabetes self-management education solely by electronic means I attest that the diabetes self-management education delivered solely by
electronic means by this applicant includes/d a provision for client referral to another health care professional when face-to-face education is/was indicated

6 7

Yes No Yes No 8 9 ______
initials

If you answer yes to question 7 above, you must answer questions 8 and 9 below

Please describe the process for referring clients with a need for face-to-face education to another health care professional for that education Use a separate sheet of paper if necessary

If the answer to questions 1-6 is NO, or if any information differs from that reported by the applicant, provide an explanation, using a separate sheet of paper if necessary

Random audits of applications are conducted You may be contacted regarding the information contained in this application I have reviewed this application and attest that to the best of my knowledge all information is accurate, complete and truthful Name printed ________________________________________________ Signature ___________________________________________________
Original Signature Only

Relationship to Applicant _________________________________________________________ Date Signed _______________________________ Department
_______________________________________________________ Title ____________________________________________________ Institution __________________________________________________________________________________________________________________ Street Address _____________________________________________________________________________________________________________ City_________________________________________ State_______ Zip Code_____________ Daytime Telephone __________________________
include area code

E-mail Address ____________________________________________________________________________________________________________ Application for 2008 Part II, Section C

NCBDE Application Part II
Applicants Name:___________________________________

SECTION D Sources of Patient/Client Referrals Form applicants self-employment experience only
1 Complete Section D only if you are/were self-employed as a diabetes educator in private practice 2 Applicants who are claiming self-employment experience must report sources of patient/client referrals, including names, addresses and telephone numbers, the length of time each has been a referral source, and number of patients/clients referred
Health care professionals who may not have referral sources eg, physicians must describe the process by which persons with diabetes come to their practices Use a separate sheet of paper if necessary Complete information must be provided for each referral source

Referral Sources
Name of Referral Source Address and Telephone Length of Time as Referral Source Number of Patients/ Clients Referred

I do not have referral sources for my private practice The following information describes the process by which persons with diabetes come to my practice

______________________________________________________________ Signature of Applicant

Application for 2008 Part II, Section D

NCBDE Application Part II
Applicants Name:___________________________________

SECTION E Summary of Professional Practice Experience
IMPORTANT: Review Instructions for Completing Part II of the Application, on pages I-3 and I-4 prior to completing this section You must document that you have been practicing in diabetes self-management education in the US or its territories for a minimum of two years to the day within the past five years see Professional Practice Experience, page 2 If the total number of days
does not meet the required minimum by the date the application is signed, you should not apply You must document that you have completed a minimum of 1,000 hours of diabetes self-management education in the US or its territories within the past five years see Professional Practice Experience, page 2 If the total number of hours does not meet this minimum by the date the application is signed, you should not apply You must also document current employment as a diabetes educator a minimum of four hours per week/16 hours per month see Professional Practice Experience, page 2 Do not document employment as a diabetes educator more than five years to the day prior to the date of application If you are applying for the May 2008 Certification Examination, complete the grid below by documenting by month the cumulative total number of hours spent in diabetes self-management education for all diabetes education jobs claimed YEAR 2002 2003 2004 2005 2006 2007 2008 GRAND TOTAL If you are applying for the October 2008 Certification Examination, complete the grid below by documenting by month the cumulative total number of hours spent in diabetes self-management education for all diabetes
education jobs claimed YEAR 2003 2004 2005 2006 2007 2008 GRAND TOTAL JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL

ATTESTATION: This statement must be signed and dated in ink by the applicant I certify that I have read, understand and agree to abide by the contents of the Certification Handbook for Diabetes Educators, and that the information provided on my NCBDE Application and any and all documents submitted by me or others in connection herewith are complete and accurate I authorize NCBDE and its representatives to take any steps they deem necessary to verify the completeness and accuracy of the information provided, including but not limited to contacting education institutions, employers, supervisors and referral sources I understand and agree that if any of this information is found to be incomplete or inaccurate, or if I otherwise violate any of the NCBDE policies in the Certification Handbook, my application may be rejected or my Examination results delayed in processing, not released, or invalidated by NCBDE

Applicants Signature___________________________________________________________________ Date
_________________________ Application for 2008 Part II, Section E

INSTRUCTIONS FOR COMPLETING PART III OF THE APPLICATION
Renewal by Continuing Education Only
Part III Summary of Continuing Education Activities Renewal of certification by continuing education activities requires that CDEs meet eligibility requirements and complete 75 clock hours of continuing education in content areas applicable to diabetes during the certification cycle Implementation on a pro-rated basis requires that CDEs whose credentials will expire 12/31/2008 provide documentation of 60 clock hours of approved continuing education Continuing education activities completed between January 1, 2004 and September 15, 2008 may be counted, provided they are completed at the time of application and the application is postmarked by the published deadline date Those who opt to use the late deadline date must understand that all continuing education activities must be completed by the published September deadline date Instructions 1 In addition to Part I, Part III must be completed by CDEs who are applying for renewal of certification by continuing education Complete and sign page 1 of Part III and complete as many
of the other pages of Part III as needed to document continuing education activities Photocopy Part III if necessary 2 Do not use abbreviations or acronyms 3 Print or type all information legibly 4 The number of hours counted for each activity must be reported as the number of clock hours spent by the participant completing the continuing education activity applicable to diabetes Do not report contact hours 5 If content applicable to diabetes is not evident from the title, include on a separate sheet of paper a brief description of how the activity is applicable to diabetes 6 Do not submit certificates of completion or other evidence of attendance You will be requested to submit a copy of supporting documentation verifying completion of each activity only if your application is selected for audit 7 Keep a copy of your application as well as copies of all certificates of completion, verification of attendance, brochures or other relevant material Any CDE who does not or cannot provide required information, or who does not meet eligibility requirements based on the documentation submitted, will be declared ineligible

Guidelines for Completing Part III of the
Application
Self-Assessment It is expected that health care professionals specializing in diabetes self-management education will want to demonstrate through renewal of certification that their knowledge and skills are up-to-date and that they are able to practice proficiently and safely It is hoped that all CDEs who select renewal of certification by continuing education will engage in a personal assessment to identify professional needs and participate in appropriate activities Renewal by Continuing Education Cycles After initial certification, all continuing education must be completed between the following January 1 and the application deadline date for renewal, ie, September 15, five years later
For subsequent certification periods, all continuing education must be completed between the day after the application deadline date ie, September 16 and the application deadline date for renewal, ie, September 15, five years later

Continuing education: must be approved by a provider on the NCBDE List of Recognized Providers must be applicable to diabetes All subject matter on the Certification Examination Content Outline published in the 2008 Certification Handbook for Diabetes
Educators is considered applicable to diabetes must be completed between January 1, 2004 and the September application deadline date for renewal of certification by continuing education for those on the prorated cycle or as defined by the renewal of continuing education cycles policy All continuing education activities must be completed prior to the application deadline and before submitting the application must be at a professional level that enhances the quality and effectiveness of diabetes self-management education practice does not have to be discipline specific nor does it have to come from any specific area of concentration, eg, social workers may attend a diabetes related nursing program and use those clock hours for renewal of certification Activities that are acceptable for renewal of certification by continuing education Continuing education courses Independent study Seminars On-line programs Workshops Telephonic or video conference programs Conferences
I-5

Activities that are not acceptable for renewal of certification by continuing education Academic courses Other certification/credentials awarded Elected office or serving on Boards and/or Committees
Articles or books written by the certificant Journal clubs or professional reading Presentations or lectures by the certificant Posters or poster sessions and exhibits Preceptorships or mentor hours Research Volunteer activities Recognized Continuing Education Providers To meet the requirement for recertification, continuing education programs must be provided by or approved by one of the following:
American Association of Diabetes Educators AADE American Diabetes Association ADA American Dietetic Association ADA International Diabetes Federation IDF Accreditation Council for Pharmacy Education ACPE Accredited or Approved Providers Accreditation Council for Continuing Medical Education ACCME Accredited or Approved Providers American Academy of Family Physicians AAFP American Academy of Nurse Practitioners AANP American Academy of Optometry AAO American Academy of Physician Assistants AAPA American Association of Clinical Endocrinologists AACE American College of Endocrinology ACE American College of Sports Medicine ACSM American Medical Association AMA American Nurses Association ANA American Nurses Credentialing Center ANCC Accredited or Approved Providers American
Occupational Therapy Association AOTA American Physical Therapy Association APTA American Psychological Association APA American Podiatric Medical Association APMA Commission on Dietetic Registration CDR Accredited or Approved Providers National Association of Clinical Nurse Specialists NACNS National Association of Social Workers NASW Continuing education from accredited academic institutions within the United States or its territories granting degrees related to professional practice are also accepted

Continuing Education Hour
When the continuing education option is selected for recertification, all continuing education activities must be reported in clock hours, ie, the actual time spent on the continuing education activity, not contact hours, credits, or units awarded by the recognized provider One clock hour equals 60 minutes In many professions, a 60-minute hour is equivalent to 1 contact hour, ie, 60 minutes equals 1 contact hour In nursing prior to 2007, however, a 50-minute hour was equivalent to one contact hour, ie, 50 minutes equaled 1 contact hour To provide a common measure for continuing education activities, NCBDE requires that activities be reported in clock
hours If a recognized provider awarded 2 contact hours for a continuing education activity that was two hours in length, 2 clock hours would be reported to NCBDE for that activity For that same two-hour program prior to 2007, if the provider awarded 24 contact hours for nurses on the basis of a 50 minute hour, it would be necessary to convert those contact hours to clock hours This would be done by multiplying 24 contact hours by 50 minutes, which is 120 minutes or 2 hours Presentations Participants may include in the time to be counted as clock hours the course overview, introductions, the educational presentation, and questions and answers Time may not be counted for general announcements, breaks, lunch, exhibits, or poster sessions Self study programs on-line or written booklets Participants may count the actual time spent on completing the activity Clock hours submitted cannot be more than the number of contact hours/credits/units awarded by the recognized provider

14 I-6

Lapsed Credentials Individuals whose CDE credentials have lapsed must take the Examination Individuals whose CDE credentials have expired may apply for the spring and/or fall Examination in the year
immediately following expiration of the credential without having to meet initial eligibility requirements Certification is NOT extended between the time of credential expiration and passing the Examination

Audit Policy NCBDE reserves the right to audit at any time any application submitted for renewal of certification by continuing education Applications will be selected at random for audit CDEs whose applications are selected for audit must submit copies of certificates of completion, verifications of attendance issued by a recognized provider, or other relevant proof of completion or attendance issued by the recognized provider for each continuing education activity submitted Each document must include the name of the attendee, title of the activity, dates the program was attended or completed, the recognized providers, and the total number of credits or contact hours awarded

For additional details on this renewal option, refer to the NCBDE web site wwwncbdeorg or contact NCBDE at 847-228-9795 or info@ncbdeorg

CHECKLIST RENEWAL OF CERTIFICATION BY CONTINUING EDUCATION
Use this checklist to ensure that you have completed all required procedures before submitting your
application

Part I of the Application Have you completed all required sections of Part I of the application, including your signature in ink? Have you included a copy of your most current CDE certificate, wallet card, or verification from NBCDE of your certification status? Have you included a copy of your current license or verification letter of licensure, registration, OR, if not previously submitted, an official transcript indicating that an advanced degree was awarded, the area of concentration, and the date conferred? Part III of the Application Summary of Continuing Education Activities Have you reported your activities in clock hours? Have you completed all required sections of Part III of the application, including your signature in ink? Have you completed all continuing education activities? Do not submit the application before all continuing education activities have been completed If content applicable to diabetes is not evident from the title, have you included a brief description of the continuing education activity? Fees Have you completed all necessary information in Part I, Section 11 and included a check or money order, payable to AMP, if necessary? Copy Have
you kept copies of the application including continuing education documentation materials for your files?
Retain this checklist and a copy of your application for your records Under no circumstances are applications, including copies, returned to applicants

Mail/Send Application Make sure that your application is postmarked no earlier than August 1, 2008 and no later than September 15, 2008 unless making use of Late Application Option see important information applicable to this option under Renewal of Certification section, page 2
Optional: Send application by certified mail or traceable courier service See Adherence to Published Policies section, page 5 Acknowledgement of receipt of your application should be sent by AMP no later than 8 weeks after the application deadline
15 I-7

NCBDE Application Part III
Applicants Name: __________________________________________

PART III SUMMARY OF CONTINUING EDUCATION ACTIVITIES
Renewal by Continuing Education Only
Renewal of certification by continuing education activities requires that CDEs meet eligibility requirements and complete 75 clock hours of continuing education in content areas applicable to diabetes during the certification
cycle Implementation on a pro-rated basis requires that CDEs whose credentials will expire 12/31/2008 provide documentation of 60 clock hours of approved continuing education Continuing education activities completed between January 1, 2004 and September 15, 2008 may be counted, provided they are completed at the time of application and the application is postmarked by the published deadline date Those who opt to use the late deadline date must understand that all continuing education activities must be completed by the published September deadline date Providers must appear on the NCBDE List of Recognized Providers Hours must be reported in clock hours, not contact hours IMPORTANT: Instructions for Completing Part III of the Application, pages I-5 to I-7, should be reviewed prior to completion of this form Clock Hours Being Claimed

Title

Provider Do not use abbreviations or acronyms

Date Attended or Completed

8 SUBTOTAL THIS PAGE: TOTAL:

Page 1 of ______

ATTESTATION: This statement must be signed and dated in ink by the applicant I hereby certify that I have read, understand and agree to abide by the contents of the Certification Handbook for Diabetes
Educators and that the information provided on the Summary of Continuing Education Activities form and all other documents submitted by me are complete and accurate I authorize NCBDE and its representatives to take any steps they deem necessary to verify the completeness and accuracy of the information provided I understand and agree that if any information is found to be incomplete or inaccurate or if I otherwise violate any of the NCBDE policies in the Certification Handbook, my application may be rejected or denied Certificants Signature___________________________________________________________ Date ___________________________________ Application for 2008 Part III

NCBDE Application Part III
Applicants Name: __________________________________________ Provider Do not use abbreviations or acronyms Date Attended or Completed Clock Hours Being Claimed

Title

23 SUBTOTAL THIS PAGE: TOTAL:

Initials_________ Page 2 of ______ Application for 2008 Part III

NCBDE Application Part III
Applicants Name: __________________________________________ Provider Do not use abbreviations or acronyms Date Attended or Completed Clock Hours
Being Claimed

Title

38 SUBTOTAL THIS PAGE: TOTAL:

Initials_________ Page 3 of ______

NCBDE Application Part III
Applicants Name: __________________________________________ Provider Do not use abbreviations or acronyms Date Attended or Completed Clock Hours Being Claimed

Title

53 SUBTOTAL THIS PAGE: TOTAL:

Initials_________ Page 4 of ______

NCBDE Application Part III
Applicants Name: __________________________________________ Provider Do not use abbreviations or acronyms Date Attended or Completed Clock Hours Being Claimed

Title

68 SUBTOTAL THIS PAGE: TOTAL:

Initials_________ Page 5 of ______

NOTE: NCBDE and AMP are not responsible for delays caused by weather or the candidates unfamiliarity with the route to, or the location of, the test center Candidates are advised to familiarize themselves with any and all information necessary to arrive on time If a candidate has not received an admission ticket one 1 week before the test date, the AMP Examination Services Department should be contacted by telephone
at 913 8954600 Neither AMP nor NCBDE is responsible when candidates do not receive admission tickets, unless the candidate notifies AMP by telephone prior to the Examination date Two forms of identification are required to gain admission to the test center One must be a current, valid, and permanent identification bearing your photograph and signature, ie, drivers license not temporary, state or federally issued identification, military identification, or US passport If you do not have a drivers license or other acceptable identification, you may provide a notarized photograph bearing your signature The second form must include your name and signature to allow verification of the signature on the first form If your name is different than it appears on either form of identification, you must bring proof of your name change marriage license, divorce decree, or court order All candidates are required to sign the registration roster prior to admission Personalized checks, credit cards, drivers licenses without photographs, employment badges, and professional organization membership cards are not acceptable as primary identification, only as secondary identification Candidates who are
absent, late, or refused admission for lack of proper identification must submit new applications and fees for another scheduled administration Neither applications nor fees are transferable to another administration Exceptions to these policies are not made by NCBDE or AMP, and refunds are not issued Changes in test center arrangements CANNOT be made later than 30 days prior to the Examination date See page 4

No electronic devices including telephones or signaling devices such as pagers and alarms are permitted in the Examination room Personal digital assistants PDAs and other hand-held computers are also prohibited

Content of Examination
The Examination is a written examination composed of 200 multiple-choice, objective questions with a total testing time of four 4 hours It is based on a content outline developed from a job analysis completed in 2004, which surveyed diabetes educators about the tasks they performed Questions on the Examination are linked directly to a task or tasks Each question, therefore, is designed to test if the candidate possesses the knowledge necessary to perform the task or has the ability to apply it to a job situation On the Examination Content
Outline pages 9-10, the number of questions on the Examination from each content area is provided next to each major outline heading I through III and also next to the subheadings within the major content headings With the advice and assistance of AMP, NCBDE prepares the Examination The questions are developed and reviewed for relevancy, consistency, accuracy, and appropriateness by individuals with expertise in diabetes education Twenty-five of the 200 questions are new questions that have not been used on a previous Examination Inclusion of these questions allows for collection of meaningful statistics about new questions but are not used in the determination of individual Examination scores These questions are not identified and are scattered throughout the Examination so that candidates will answer them with the same care as the questions that make up the scored portion of the Examination This methodology assures candidates that their scores are the result of sound measurement practices and that scored questions are reflective of current practice

Studying for the Examination
The content of the Examination is not based on any one text, reference book or journal To prepare for
the Examination, NCBDE suggests that the applicant review the Examination Content Outline pages 9-10 If there are particular subject areas where additional study may be indicated, reference materials specific to those areas may need to be identified To assist in this process, NCBDE has compiled a list of suggested references page 11 The references are suggestions ONLY Their inclusion does not imply that Examination content is based on them, that all content will be covered, or that studying any of the references will ensure success on the Examination It should also not be inferred that Examination questions are based on any particular book or journal or that studying particular references or attending any review course guarantees a passing score NCBDE does not sponsor, endorse, financially benefit from, or participate in the development of any preparatory or review courses or published materials claiming to be study guides for the Examination

Rules for the Examination
1 2 3 4 5 6 Pencils will be provided Hand-held, battery- or solar-operated, nonprogrammable calculators are permitted No books or other reference materials may be taken into the Examination room No Examination
materials, documents, or memoranda of any sort may be taken from the Examination room The Examination will be held only on the day and at the time scheduled No questions concerning content of the Examination may be asked during the testing period The candidate should listen carefully to the instructions given by the proctor as well as read the directions in the Examination booklet

2008 Certification Handbook for Diabetes Educators

Sample Examination Questions
In the following questions, choose the one best answer

1 In persons with diabetes, the symptoms of serious psychological depression may resemble A B C D the dawn phenomenon the onset of nephropathy symptoms of chronic hypoglycemic episodes symptoms of chronic high blood glucose levels

7 A person with type 1 diabetes on a split-mixed dose of insulin complains of waking up with morning headaches If the fasting capillary blood glucose level is 290 mg/dl, this person should be advised to A increase evening meal dose of intermediate-acting insulin B increase morning dose of short-acting insulin C check blood glucose at 3 am D eliminate bedtime snack 8 One of the most important keys to successful management of type 2 diabetes
is teaching the person A B C D meal planning regular urine testing signs and treatment of hypoglycemia selection and use of over-the-counter medications

2 According to the most recent American Diabetes Association Guidelines, a diagnosis of diabetes mellitus may be confirmed by the findings of A B C D weight loss polydipsia and polyuria two random plasma glucose levels of 145 mg/dl two fasting plasma glucose levels of 135 mg/dl

3 According to the most recent American Diabetes Association Nutrition Guidelines, the recommended fat content for a diabetes meal plan is A B C D individualized 10 of calorie intake 30 of calorie intake dependent on patients age

4 According to DCCT participants striving for good control, some adverse effects of intensive treatment were A B C D multiple injections causing lipohypertrophy marked hormonal changes requiring more insulin weight gain and risk of severe hypoglycemia insulin resistance caused by hyperinsulinemia

9 A 48-year-old man with type 2 diabetes wants to begin an exercise program He has had diabetes for 8 years, takes no medication, monitors blood glucose twice a day, has no complications from diabetes, is 130 of ideal body weight, and
follows a 1600 calorie meal plan What adjustments to food intake, if any, should be suggested to him? A He should carry a fast-acting carbohydrate with him B He should increase his diet by 300 calories to prevent hunger during exercise C He should increase his carbohydrate intake before exercising D There should be no change in diet 10 A man with type 1 diabetes is on a split-mixed dose regimen For the past 5 days, his before-lunch glucose readings have been consistently high, but all other tests during the day have remained in the normal range Which of the following insulin doses, if any, should be increased? A B C D morning intermediate-acting insulin morning short-acting insulin evening meal intermediate-acting insulin no change in insulin dose CORRECT ANSWERS TO SAMPLE QUESTIONS 1 2 3 4 5 D D A C C 6 7 8 9 10 B C A D B

5 Metformin is an oral antidiabetic agent different than that of sulfonylurea drugs Some features of the drug are that it A stimulates insulin secretion and increases hepatic glucose production B causes hypoglycemia C lowers hyperglycemia in persons with diabetes, but does not lower blood glucose levels in persons who do not have diabetes D results in weight
gain and increase in plasma insulin levels 6 Which of the following is a major clinical feature of hyperosmolar hyperglycemic nonketotic syndrome? A B C D large ketones profound dehydration nausea and vomiting severe acidosis

2008 Certification Handbook for Diabetes Educators

National Certification Board for Diabetes Educators Examination Content Outline
I Assessment 40 A Learning/Self-Care Behaviors 15 1 Assess goals and learning needs 2 Assess learning readiness attitudes, developmental level, perceived learning needs, etc 3 Assess learning style 4 Assess barriers to learning literacy level, language, cultural values, religious beliefs, health beliefs, psychosocioeconomic, etc 5 Assess physical capabilities/limitations visual acuity, hearing, functional ability, etc B Medical/Health/Psycho-Socioeconomic Status 10 1 Collect diabetes-specific health history duration, symptoms, complications, adherence to standards, treatment, etc 2 Collect general health history allergies, medical history, nutrition history, etc 3 Assess previous and current medication regimen prescription and non-prescription drugs, alternative remedies, adverse reactions, etc 4 Assess treatment fears
hypoglycemia, hyperglycemia, needles, weight gain, etc 5 Assess family/caregiver dynamics and social supports 6 Assess substance use alcohol, tobacco, caffeine, etc 7 Assess psychosocial/developmental/mental health status adjustment to diagnosis, etc 8 Identify specific barriers to diabetes self-care regimen cognitive ability, language, cultural, psychosocial, physical, economic, etc 9 Conduct diabetes-specific physical assessment lower extremities, injection and blood glucose monitoring sites, blood pressure, weight, height, body mass index, acanthosis nigricans, etc 10 Assess laboratory results and trends blood glucose, A1C, lipid profile, renal/liver function, etc C Current Knowledge and Practices Related to Diabetes Care 15 1 Assess diabetes education, knowledge, and selfmanagement skills 2 Assess nutritional habits food and beverage choices, portion sizes, timing of meals and snacks, eating environment, etc 3 Assess exercise/physical activity history and/or level 4 Assess monitoring techniques and equipment blood glucose and ketones, etc 5 Assess record keeping activities blood glucose, food, activity, etc 6 Assess medication administration insulin administration technique and
use of delivery systems, timing and dosage of medication, adherence, etc 7 Assess use of health care resources primary care physician and other health care providers, insurance, etc II Intervention 120 A Collaborate with Patient/Family/Caregiver/Healthcare Team to Develop: 15 1 Individualized diabetes education plan based on assessment learning objectives, sequence of information, selection of content, etc 2 Instructional methods discussion, demonstration, role playing, simulation, electronic media, etc 3 Behavioral goals B Teach Principles and Integrate into Practice 70 1 General issues a Classifications and diagnosis ADA Guidelines b Non-modifiable risk factors heredity, history of gestational diabetes, acanthosis nigricans, etc c Modifiable risk factors lifestyle behaviors, etc d Pathophysiology auto-immunity, insulin resistance, fuel metabolism, etc e Interaction of physical activity, food, medication, and stress f Treatment options choices, availability, cost, risk/benefit, etc g Goals of treatment blood glucose, A1C, blood pressure, lipids, quality of life, prevention, etc h Purpose of laboratory tests A1C, lipids, kidney and liver function tests, etc 2 Living with diabetes a
Psychosocial adaptation coping skills, depression, anxiety, etc b Role/responsibilities of care patient, family members, team, etc c Decision making/behavior change skills d Safety sharps disposal, medical ID, driving, etc e Hygiene dental/skin/feet, etc 3 Metabolic monitoring a Glucose testing sites, meter selection, etc b Ketones c A1C d Blood pressure e Regimen and record keeping f Lipids/cholesterol 4 Nutrition principles and guidelines a American Diabetes Association nutrition recommendations macro/micronutrients, etc b Carbohydrates in blood glucose control postprandial blood glucose, food source, sugar substitutes, fiber, etc c Lipid management total fat, saturated fat, monounsaturated fat, etc d Food and medication integration e Food label interpretation f Alcohol g Principles of weight management h Changes in usual schedules problem-solving i Special considerations gastroparesis, renal insufficiency, celiac, etc 5 Physical activity a Benefits and precautions b Exercise/activity plan c Post exercise delayed onset hypoglycemia d Food/medication/monitoring adjustment 6 Pharmacologic management of diabetes a Medications oral agents and insulin, administration, side-effects,
etc b Delivery systems pump therapy, insulin delivery devices, etc
9

2008 Certification Handbook for Diabetes Educators

c Medication adjustment d Drug interactions e Non-prescription preparations over the counter drugs, supplements, vitamins, minerals, etc 7 Acute complications and treatments a Hypoglycemia glucose tablets, glucagon, etc b Hyperglycemia c Diabetic ketoacidosis DKA d Hyperglycemic hyperosmolar nonketotic syndrome HHNS 8 Chronic complications and treatments a Screening and prevention of complications smoking, hypertension, etc b Eye disease retinopathy, cataracts, glaucoma, etc c Sexual dysfunction d Neuropathy autonomic, peripheral, etc e Nephropathy f Vascular disease cerebral, cardiovascular, peripheral, etc g Lower extremity problems foot ulcers, Charcot foot, etc 9 Special management issues a Honeymoon period, dawn phenomenon, Somogyi effect b Hypoglycemia unawareness c Sick days d Surgery and special procedures e Travel f Adolescents, toddlers, and infants g Geriatric populations h Pre-conception and pregnancy i Disordered eating bulimia, etc j Multiple, chronic illnesses hypertension, depression, hyperactivity, autoimmune, etc k Dental and gum disease l Skin
problems wound care, yeast infection, ulcers, etc m Changes in usual schedules shift, religious and cultural customs, etc n School and day-care accommodations o Assistive and adaptive devices talking meter, magnifier, etc 10 Interpret current diabetes research and translate findings into practical applications C Review, Evaluation, Revision, and Documentation 20 1 Interpret weight changes, blood glucose, food, medication, and physical activity records 2 Evaluate effectiveness of teaching in the following: a Achievement of objectives b Progress towards behavioral goals c Self-management skills d Psychosocial adaptation

3 Document results of assessment, intervention, and outcomes 4 Establish an ongoing plan for achieving and evaluating objectives and behavioral goals D Follow-up and Referral Recommendations 15 1 Identify problems requiring intervention by other health care professionals a Medical nutrition therapy b Exercise prescription c Mental health d Medical care foot care, dilated eye exam, preconception counseling, etc e Financial and social services f Risk reduction smoking cessation, obesity, preventative services, etc g Medication consult h Home care, community resources
visual, hearing, language, etc 2 Facilitate communication between patient, providers, and referral source to ensure health care and education needs are addressed 3 Facilitate access for diabetes support: groups, camps, community resources, etc III Program Development and Administration 15 A Develop and implement diabetes patient education program 1 Perform needs assessment target population, etc 2 Develop curriculum identify program goals, content outline, lesson plan, teaching materials, etc 3 Choose teaching methods and materials for target populations 4 Market and promote diabetes patient education program 5 Document program for outside review JCAHO, ADA-ERP, NCQA, etc 6 Maintain patient information/demographic database 7 Ensure patient confidentiality HIPAA, etc 8 Promote standards of care 9 Implement infection control principles B Evaluate the following: 1 Program outcomes number of people served, provider satisfaction, patient satisfaction, effectiveness of diabetes education materials, etc 2 Patient outcomes behavior changes, A1C, lipids, weight, quality of life, ER visits, decreased work absences, etc 3 Continuous quality improvement activities C Promote diabetes advocacy
third party reimbursement, schools, policy makers, health fairs, etc

2008 Certification Handbook for Diabetes Educators

References
The reference list found on this page may be of help in preparing for the Examination There has been no attempt to include all acceptable references nor is it suggested that the Examination is necessarily based on these references Individuals wishing to obtain any of the cited references should contact the organization or company that publishes them It should not be inferred that Examination questions are necessarily based on any particular book or journal or that studying particular references or attending any review course guarantees a passing score on the Examination See Content of Examination and Studying for the Examination sections on page 7 for additional information
ACSMs Guidelines for Exercise Testing and Prescription, 7th Edition 2006 American College of Sports Medicine Baltimore, MD: Lippincott Williams and Wilkins American Dietetic Association and American Diabetes Association Exchange Lists for Meal Planning 2003 Anderson, B, Funnell, M The Art of Empowerment: Stories and Strategies for Diabetes Educators, 2nd Edition 2005
Alexandria, VA: American Diabetes Association Anderson, B, Rubin, R Practical Psychology for Diabetes Clinicians, 2nd Edition 2002 Alexandria, VA: American Diabetes Association Armstrong, DG, Lavery, LA Editors Clinical Care of the Diabetic Foot 2006 Alexandria, VA: American Diabetes Association The Art and Science of Diabetes Self-Management Education 2006 Chicago, IL: American Association of Diabetes Educators Beaser, RS Joslins Diabetes Deskbook 2003 Boston, MA: Joslin Diabetes Center Childs, B, Cypress, M, Spollett, G Editors Complete Nurses Guide to Diabetes Care 2005 Alexandria, VA: American Diabetes Association Clinical Practice Recommendations latest edition Diabetes Care, Current Volume, Supplement 1, January American Diabetes Association CQI: A Step-by-Step Guide for Quality Improvement in Diabetes Education 2005 Chicago, IL: American Association of Diabetes Educators Dietary Guidelines for Americans 2005 2005 Department of Health and Human Services and the Department of Agriculture Doak, C, Doak, L and Root, J Teaching Patients with Low Literacy Skills, 2nd Edition 1995 Philadelphia, PA: LippincottRaven Franz, MJ, Bantle, JP American Diabetes Association Guide to Medical
Nutrition Therapy for Diabetes 2003 Alexandria, VA: American Diabetes Association

Franz, MJ, Reader, D, Monk, A Implementing Group and Individual Medical Nutrition Therapy for Diabetes 2002 Alexandria, VA: American Diabetes Association Handbook of Exercise in Diabetes 2002 Alexandria, VA: American Diabetes Association Intensive Diabetes Management, 3rd Edition 2003 Alexandria, VA: American Diabetes Association Johnson, PD Teenagers with Type 1 Diabetes: A Curriculum for Adolescents and Families 2003 Alexandria, VA: American Diabetes Association Kahn, CR Editor Joslins Diabetes Mellitus, 14th Edition 2004 New York, NY: Lippincott, Williams and Wilkins Kaufman, FR Diabesity: The Obesity-Diabetes Epidemic That Threatens America And What We Must Do to Stop It 2005 Westminster, MD: Bantam Dell Medical Management of Pregnancy Complicated by Diabetes, 3rd Edition 2000 Alexandria, VA: American Diabetes Association Medical Management of Type 1 Diabetes, 4th Edition 2004 Alexandria, VA: American Diabetes Association Medical Management of Type 2 Diabetes, 5th Edition 2004 Alexandria, VA: American Diabetes Association Pastors, JG Editor Diabetes Nutrition QA for Health Professionals 2003
Alexandria, VA: American Diabetes Association Rollnick, S, Mason, P, Butler, C Health Behavior Change, A Guide for Practitioners 2002 Churchill Livingstone Ross, TA, Boucher, JL and OConnell, BS Editors Guide to Diabetes Medical Nutrition Therapy and Education 2005 Chicago, IL: American Dietetic Association The Scope of Practice, Standards of Practice, and Standards of Professional Performance for Diabetes Educators 2005 Chicago, IL: American Association of Diabetes Educators Therapy for Diabetes Mellitus and Related Disorders, 4th Edition 2004 Alexandria, VA: American Diabetes Association Thomas, AM Guide to Gestational Diabetes Mellitus 2005 Chicago, IL: American Dietetic Association Warshaw, HS, Kulkarni, K ADA Complete Guide to Carb Counting 2004 Alexandria, VA: American Diabetes Association Wolpert, H Editor Smart Pumping for People with Diabetes 2002 Alexandria, VA: American Diabetes Association

Examination Security
The content of the Examination is confidential The removal or attempt to remove questions or other Examination material from the test center is prohibited Any candidate who gives or receives assistance during the Examination is in violation of test security and
subject to prosecution Examinations of any candidates in violation of test security will not be processed Attempts to copy or recreate questions in any manner will disqualify the candidate from taking or completing, or result in automatic failure of, the Examination
11

2008 Certification Handbook for Diabetes Educators

Questions About the Examination
On the day of the Examination, candidates may write comments on their answer sheets about any Examination question, the administration of the Examination, or the test center facilities Individual responses to comments will not be provided Under no circumstances are candidates or other individuals allowed access to the Examinations or to specific questions including obtaining copies at any time

Confidentiality
1 Individual Examination scores are released ONLY to the candidate No results will be provided by telephone, electronic mail or facsimile Questions concerning Examination results must be referred in writing to NCBDE or AMP Examination Services Department

Requests for Handscoring
Systematic quality control measures are taken to insure accurate scanning of answer sheets for the Examination Candidates who do not pass the
Examination may request a manual verification of the computer scoring by submitting a written request to AMP A fee of 15 for rescoring must be included with the request, check payable to AMP, and a copy of the score report Requests must be received within 100 days of the Examination date Upon receipt of a written request and fee, the candidates answer sheet will be inspected and handscored This process takes approximately 30 days To ensure correct reporting of results, the testing agency selects a random sampling of Examinations of candidates who score within one unit of passing These tests are manually rescored as a quality control measure before results are mailed Thus, it is extremely doubtful that any Examination results will be changed from fail to pass if rescored Candidates whose scores are close to passing are encouraged not to request verification of their scores

Post-Examination Process
Report of Results
Examination results will be mailed to candidates approximately six weeks after the Examination date The passing score, established by NCBDE in consultation with psychometricians from AMP, is 70 scaled score units Scaled scores are reported for the following reason: new
versions of the Examination are introduced each year with a certain number of questions having been replaced in each content area This may cause different versions forms of the Examination to vary somewhat in difficulty To ensure fairness, a statistical method called equating is used to adjust for these differences In the equating process, the minimum raw score number of correctly answered questions required to equal the passing scaled score of 70 is statistically adjusted equated The difficulty of the Examination form determines the actual number of questions which must be answered correctly to achieve a scaled score of 70 The new raw passing score is determined after comparing the difficulty of the new Examination form to the previous Examination form A candidate must obtain or exceed a scaled score of 70 units in order to pass The Examination score report sent to candidates includes the following: 1 2 An overall report of Pass or Fail A Total Scaled Score, which is statistically derived from the Total Score This number is between 0 and 99 units It is not a percent A Total Score the number of correctly answered questions

Re-Examination
There is no limit to the number of times
unsuccessful candidates may take the Examination, provided eligibility requirements in effect at the time of applying for re-examination are met The current Application must be completed and submitted with applicable fee each time

Certificates and Wallet Cards
Approximately three months after score reports for those who pass the Examination or letters of successful completion of renewal of certification by the continuing education method are mailed, complimentary certificates and wallet cards are provided by NCBDE

In addition to the candidates total scaled score and the scaled score required to pass, raw scores are reported for the three major categories on the Content Outline The number of questions answered correctly in each major category compared to the total number of questions possible in that category is reported on the score report eg, 15/20 Content categorical information is provided to assist candidates in identifying areas of relative strength and weakness; however, passing or failing the Examination is based ONLY on the scaled score Although a degree of confusion might be avoided by reporting only scaled scores to candidates, NCBDE and AMP believe that by reporting
raw scores in addition to scaled scores, candidates can learn important information about their areas of weakness by examining raw subscores by content areas

Duplicate Score Report
A duplicate score report must be requested in writing within a year of the Examination date Requests must include name, social security number, mailing address, Examination date, test center, and signature and be submitted to NCBDE, 330 E Algonquin Road, Suite 4, Arlington Heights, Illinois 60005 The fee for a duplicate score report is 20; a check or money order made payable to NCBDE for this amount must accompany the request

2008 Certification Handbook for Diabetes Educators

Name: ___________________________________ Last 4 Digits Social Security : _____________ Test Center: ______________________________

Request for Special Testing Accommodations
NCBDE is committed to providing reasonable accommodations in its Examination processes to individuals with documented disabilities, in accordance with the American with Disabilities Act ADA, and to others with qualifying medical conditions that may be temporary or are not otherwise covered by the ADA If you have a disability that requires special
accommodations for the Examination, you must submit two 2 additional documents with your application in order for your request to be considered 1 This form ie, Request for Special Testing Accommodations must be completed and signed by you, the applicant AND 2 On official letterhead of the professional qualified to diagnose and evaluate the disability or medical condition, a report describing the disability or medical condition The report must include: a description of the disability or medical condition; functional limitations due to stated disabilities; specific recommendations regarding accommodations required and explanation of the reasons the accommodations are needed; name, address, telephone number, qualifications/professional credentials, and original signature of the health care professional providing the required documentation

Applicant Information
Last 4 Digits Social Security ___ ___ ___ ___ __________________________________________________________________________________________________________________________
Last Name First Name Middle
Name

__________________________________________________________________________________________________________________________
Address

__________________________________________________________________________________________________________________________
City State Zip Code Phone Number

Special Accommodations
I request special accommodations for the ______ / ______ administration of the Certification Examination for Diabetes Educators
Month Year

Reason for needing special accommodations:
Physical disability

Chronic health problem Temporary Accidental injury Visual disability

Hearing disability Learning disability Other specify________________________________

Accommodations requested check all that apply: ______ Accessible testing center ______ Special seating ______ Large print Examination ______ Reader ______ Circle answers in Examination booklet ______ Extended testing time time and a half

______ Separate testing area ______ Other specify __________________________________________________________ __________________________________________________________ __________________________________________________________
__________________________________________________________

Comments: _______________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Signed: ________________________________________________________________________ Date:____________________________________
Return this form and required correspondence with your Examination application to: AMP, Examination Services Department, 18000 W 105th Street, Olathe, KS 66061-7543 If you have questions, call the Examination Services Department at 913 895-4600

2008 Certification Handbook for Diabetes Educators

Name: ___________________________________ Last 4 Digits Social Security : _____________ Test Center: ______________________________

Request for Sunday Testing
Sunday Testing Policy
Applicants whose religious convictions prohibit taking the Examination on Saturday may request a Sunday
administration by completing a Request for Sunday Testing form Sunday testing is available only on the day immediately following the published Examination date for which the applicant has applied The special request form must be signed by an official of the applicants religious affiliation and sealed by a notary public To request Sunday testing, complete the information below and have an official of your religious affiliation sign and date the form in the presence of a notary public and submit it with your Examination application Failure to properly complete the form and return it by the application postmark deadline will result in your being scheduled to take the Examination on Saturday

Examination Information
I am requesting to take the Examination on Sunday __________________________________________________________________
month, day, year

___________________________________________________________________________________________________________
Address

___________________________________________________________________________________________________________
City State Zip Code

I request permission to be tested on Sunday because my religious convictions prohibit me from being tested on the Saturday Examination date ___________________________________________________________________________________________________________
Signature Date

Religious Certification
I am an official of the religious institution with which the above individual is affiliated I certify that the religious beliefs of this person prohibit him/her from taking an Examination on Saturday Please print or type officials name and address of religious institution:

_______________________________________________________
Officials Name

_______________________________________________________
Title

Impress with notary seal or stamp

_______________________________________________________
Officials Signature

_______________________________________________________
Religious Institution

Signed and sworn to before me this __________ day of
________________________________________ , 20_____ _________________________________________________
Notary Public Signature

_______________________________________________________
Address

_______________________________________________________
City Phone State Zip Code

_______________________________________________________

_________________________________________________
Commission Expires

Return this form with your Examination application to: AMP, Examination Services Department, 18000 W 105th Street, Olathe, KS 66061-7543 If you have questions, call the NCBDE national office at 847 228-9795
2008 Certification Handbook for Diabetes Educators 15

2008 Certification Handbook for Diabetes Educators

Index
Adherence to Published Policies 5 Admission to the Test Center 6 Appeals 6 Application Deadlines, Fees, and Examination Dates iv Application Process 3 Application Status 5 Audit Policy 6 Certificates and Wallet Cards 12 Changes After the Application is Submitted
6 Checklist Initial Certification I-2 Checklist Renewal of Certification by Continuing Education I-7 Checklist Renewal of Certification Examination I-2 Confidentiality 12 Content of Examination 7 Definition of Diabetes Education 1 Disciplinary Policy 3 Duplicate Score Report 12 Eligibility Requirements for Initial Certification 1 Eligibility Requirements for Renewal of Certification 3 Application and Mailing Envelope Center Insert Examination Content Outline 9 Examination Dates 4 Examination Process 6 Examination Security 11 Fees 4 Important General Information iii Instructions for Completing Part I of the Application I-1 Instructions for Completing Part II of the Application I-3 Instructions for Completing Part III of
the Application I-5 Introduction ii Mission 1 Objectives 1 Post-Examination Process 12 Purpose 1 Questions About the Examination 12 Re-Examination 12 References 11 Rejected Applications 6 Renewal of Certification 2 Renewal of Certification by Examination 3 Renewal of Certification by Continuing Education 4 Report of Results 12 Request for Special Testing Accommodations Form 13 Request for Sunday Testing Form 15 Requests for Foreign Test Centers 5 Requests for Handscoring 12 Requests for Special Testing Accommodations 5 Requests for Sunday Testing 5 Responsibility for Certification 1 Rules for the Examination 7 Sample Examination Questions
8 Schedule for the Examination 6 Statement of Nondiscrimination Policy 1 Studying for the Examination 7 Test Center Locations 4 Unacceptable Experience 2 Use of Certification Marks 3 Withdrawals and Refunds 6

2008 Certification Handbook for Diabetes Educators

National Certification Board for Diabetes Educators NCBDE
330 E Algonquin Road, Suite 4 Arlington Heights, IL 60005 847 228-9795 Fax: 847 228-8469 Web: wwwncbdeorg E-mail: info@ncbdeorg

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