Who’s Who in Diabetes Care

• Licensed practical nurses (LPNs) have had 12–18 months of training and passed a licensing exam. They assist doctors and registered nurses in providing basic care, such as instruction in injection technique, hypoglycemia treatment, or glucose monitoring. They may take phone information for the doctor and call you back with instructions. In Texas and California, LPNs are called licensed vocational nurses (LVNs).

• Registered nurses (RNs) have studied for 2–5 years at a nursing school and passed a national licensing exam. They monitor and educate patients and give medicines and treatments prescribed by doctors.

• A certified registered nurse practitioner (CRNP) is an RN who has received additional training and passed a certification exam. CRNPs conduct physical exams, order lab tests, diagnose and treat diseases, manage chronic health problems such as diabetes, and prescribe medicines. A CRNP may also be called an advanced practice nurse (APN, APRN, or ARNP). Clinical nurse specialists (CNSs) and certified nurse midwives (CNMs) are also classified as advanced practice nurses. Most APNs have an advanced degree or additional training.

• Some providers have special expertise in diabetes. A certified diabetes educator (CDE) must have at least 2 years and 1,000 hours of experience educating patients in managing their diabetes before taking the certification exam. RNs, dietitians, pharmacists, doctors, optometrists, psychologists, podiatrists (foot doctors), and exercise physiologists may take the CDE exam. CDEs identify what education needs people with diabetes have, help them set goals and gain the skills to achieve those goals, and assess their progress.

• A board certified–advanced diabetes manager (BC-ADM) is an advanced practice dietitian, pharmacist, or RN who holds a master’s degree or doctorate and who has passed a certification test. A BC-ADM must have at least 500 hours of experience clinically managing diabetes in the 4 years before taking the exam.

  BC-ADMs perform a variety of tasks depending on whether they are dietitians, pharmacists, or nurses. Duties can include adjusting medicines, planning exercise, making diet recommendations, counseling patients, and monitoring and treating complications. The BC-ADM specialty is new. So far, there are only a few hundred BC-ADMs in the United States. A BC-ADM may also be known as an advanced diabetes management practitioner or an advanced practitioner in diabetes management.

• Medical assistants (CMAs or MAs) do administrative tasks such as answering phones, filing records, and filling out insurance forms. They may have clinical duties supervised by a doctor. These might include taking blood pressures and medical histories, authorizing drug refills, and instructing patients about medicines and diet. Training may be on the job or through a vocational training program.

• Physician assistants (PAs) do some tasks of doctors under the supervision of a doctor. They take medical histories, perform physical exams, diagnose illnesses, and give treatment plans. In most states, they can write prescriptions. Becoming a PA requires at least 2 years of specialized training. Many PA programs require applicants to first have at least 2 years of college and health care work experience. A PA who has passed certification requirements may use the credential PA-C.

• A podiatrist or doctor of podiatric medicine (DPM) diagnoses and treats disorders of the foot and lower leg. These include corns, bunions, infections, and diabetes-related foot problems such as foot ulcers. To get a license, most states require podiatrists to have graduated from a college of podiatric medicine, performed 1 year of postdoctoral work, and passed an exam.

• Dietitians are trained to tailor meal plans to individuals’ health care needs. A registered dietitian (RD) has completed a bachelor’s or graduate degree in dietetics or nutrition, gained supervised practice experience, and passed a certification exam. RDs educate people with diabetes how to eat to improve diabetes control and how to balance food with medicines and activity. A licensed dietitian (LD) is a dietitian who has passed a state licensing exam.

• A registered pharmacist (RPh) has special training in the use of medications. RPhs have completed 5–6 years of college, served an internship, and passed a state licensing exam. An RPh can advise you about your medicines and about nonprescription products sold in drugstores. In the past, pharmacists could pursue either a bachelor of science (BS) degree or a doctor of pharmacy (PharmD) degree. After 2005, all new pharmacists will earn PharmD degrees. This involves completing a 4-year program after at least 2 years of college and passing a state licensing exam.

A variety of other health care professionals may also play a role in your care. These can include:

• Optometrists (DOs)

• Medical social workers (LMSWs)

• Family and behavioral therapists

• Exercise specialists

• Psychologists (PhDs in psychology)

• Occupational therapists (OTs)

• Physical therapists (PTs)