Role and Perspective of Certified Diabetes Care and Education Specialists in the Development of the 4T Program

The Diabetes Control and Complications Trial (DCCT) clearly delineated the benefits of intensive diabetes management in preventing long-term complications in people with insulin-dependent diabetes (1). Despite the data from the DCCT, a majority of youth with type 1 diabetes do not meet glycemic targets. One aspect of the DCCT intervention was frequent insulin dose adjustments by a care team member. Although this was a landmark clinical trial, translation of its findings into clinical practice has been challenging because of barriers in implementing glucose data-sharing technology and clinical time constraints. There is also a shortage of diabetes care team members (2) to review glucose data and communicate insulin dosing advice and provide diabetes self-management education and support (DSMES). In particular, there is a nationwide shortage of certified diabetes care and education specialists (CDCESs) (2).