Certified Diabetes Educator ‘Ambassadors’ Enhance Diabetes Management

Nurse-managed protocols improved outpatient care in chronic illnesses
Nurse-managed protocols improved outpatient care in chronic illnesses
The use of certified diabetes educator ambassadors may improve diabetes management while reducing the burden on the shortage of endocrinologists.

NASHVILLE, Tenn. — New data suggest that employing certified diabetes educator (CDE) “ambassadors” may help patients with diabetes achieve significant improvements in diabetes management while alleviating the shortage of endocrine specialists available to treat this increasingly prevalent illness.

Results from the study were presented at the American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress.

CDE ambassador professionals are trained by endocrinologists and practice in primary care settings. To assess their impact, researchers at the State University of New York (SUNY) at Buffalo conducted a retrospective review of 100 patients with type 2 diabetes whose care was being managed by a CDE ambassador in a primary care setting.

The investigators compared medical test results of those receiving care from a CDE ambassador with those who were not. The CDE ambassadors continued to consult with the endocrinologist trainer on an as-needed basis. The primary care provider (PCP) had to authorize any changes to the patients’ diabetes regimens that were suggested by the CDE ambassador.

The researchers found that the differences between the two groups were substantial. In the CDE ambassador intervention group, the patients’ HbA1c levels, weight, BMI, blood pressure (BP) measurements, LDL cholesterol and triglyceride levels showed marked improvements during the study’s 4.5-month period.

In contrast, another group of patients with diabetes from the same practice who were not referred to a CDE ambassador experienced no significant changes in any of the measures.

“There are 29 million diabetics with 21 million diagnosed in U.S. Their numbers are increasing continuously, with a parallel increase in micro-and macrovascular complications. With limited numbers of endocrinologists, we need to innovate novel ways of using our resources more effectively,” said Paresh Dandona, MD, PhD, who is the director of the Diabetes and Endocrinology Center of Western New York at SUNY at Buffalo.

He said the improvements that occurred in ambassador-guided patients’ glycemia, BP, lipids and body weight could potentially lead to significant reductions in macrovascular and microvascular complications as well as an improvement in the quality of life for these patients. 

In addition, this treatment approach can help reduce the magnitude of expenditures for managing these complications, according to Dandona.

“Empowering the CDE with active support/education from endocrinologists is a more effective way of using these committed nurses and dieticians, as our study indicates. A reduction of 1.6% in HbA1c in less than 6 months with final mean HbA1c of 6.8% is a spectacular achievement, as indicated by previous trials for outcomes (DCCT and UKPDS). This fall is greater than that of any new antidiabetic drug,” Dandona told Endocrinology Advisor

“The most important message for the endocrinologists is that they could harness the energies of the CDEs more effectively, not only in their own offices but also by creating networks of care with primary care physicians around them.”


  1. Al-Atrash F et al. Abstract #275. Presented at: American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.