Everything You Need to Know About the CDCES Exam

Certified Diabetes Care and Education Specialists help people with diabetes and prediabetes develop the knowledge, skills, and confidence needed to manage their health.

The CDCES credential is offered by the Certification Board for Diabetes Care and Education, or CBDCE. It validates specialized knowledge in diabetes prevention, care, education, technology, medication management, self-management support, and person-centered treatment.

If you are considering the CDCES credential, this guide explains who qualifies, what the exam covers, how it is scored, and how to prepare.

What Is a Certified Diabetes Care and Education Specialist?

A Certified Diabetes Care and Education Specialist is a health professional with specialized knowledge and experience in diabetes prevention, prediabetes, and diabetes care and management.

CDCES professionals educate, support, and advocate for people affected by diabetes throughout the lifespan. Their work promotes self-management and helps individuals pursue behavioral and treatment goals that reduce risk and improve health outcomes.

The CDCES credential was previously known as the Certified Diabetes Educator, or CDE, credential.

What Does a CDCES Do?

A CDCES works collaboratively with people who have diabetes or prediabetes, their support systems, and other members of the healthcare team.

Depending on professional role and scope of practice, a CDCES may:

• Assess physical, psychosocial, educational, and self-management needs
• Develop individualized diabetes care and education plans
• Teach glucose monitoring and interpretation
• Support safe and effective medication use
• Explain insulin delivery and diabetes technology
• Help individuals set realistic behavioral goals
• Provide nutrition and physical activity education
• Support prevention and treatment of acute and chronic complications
• Address diabetes distress and other psychosocial concerns
• Connect people with financial, healthcare, and community resources
• Monitor progress and evaluate outcomes
• Advocate for access to medications, supplies, education, and care

Who Is Eligible to Take the CDCES Exam?

Initial certification requires candidates to meet requirements in four areas:

1. An eligible professional discipline
2. Professional practice experience in that discipline
3. Diabetes care and education experience
4. Diabetes-related continuing education

All requirements must be satisfied before submitting the application.

Which Professional Disciplines Qualify?

Candidates may qualify through an approved license, registration, certification, or advanced social work degree.

Eligible Licensed Professionals

Candidates may qualify with a current, active, and unrestricted license from a U.S. state or territory as a:

• Clinical psychologist
• Registered nurse, including a nurse practitioner or clinical nurse specialist
• Occupational therapist
• Optometrist
• Pharmacist
• Physical therapist
• Physician
• Podiatrist

Eligible Registered or Certified Professionals

Candidates may also qualify as a:

• Dietitian or dietitian nutritionist actively registered with the Commission on Dietetic Registration
• Physician assistant actively certified by the National Commission on Certification of Physician Assistants
• American College of Sports Medicine Certified Clinical Exercise Physiologist
• Master Certified Health Education Specialist

Social Work Degree Pathway

A healthcare professional may qualify with at least a master’s degree in social work from an appropriately accredited U.S. college or university.

CBDCE may require an official transcript if the application is selected for audit.

How Much Professional Experience Do You Need?

Candidates must complete at least two years of professional practice in the discipline under which they are applying.

For example, a registered nurse must have at least 2 years of practice experience. A registered dietitian nutritionist must have at least two years of practice experience in that discipline.

Candidates with a master’s degree or higher in a health-related field may claim a one-year waiver. Under the waiver, the candidate must have at least 1 year of professional practice in the qualifying discipline.

How Many Diabetes Care and Education Hours Are Required?

Candidates must complete at least 1,000 hours of diabetes care and education experience within the five years prior to applying.

At least 20% of those hours, or 200 hours, must be completed during the most recent year before the application.

Diabetes care and education may be delivered face-to-face or electronically, including by telephone, internet, or web conference.

What Counts as Diabetes Care and Education Experience?

CBDCE defines diabetes care and education as a person-centered process that helps someone with diabetes or prediabetes develop and sustain the knowledge, skills, and behaviors required for self-care.

Qualifying responsibilities may include:

• Assessing diabetes care and education needs
• Developing individualized education and care plans
• Helping individuals establish self-management goals
• Delivering education and interventions
• Providing ongoing support and resources
• Monitoring progress toward goals
• Evaluating intervention effectiveness
• Documenting assessments, plans, interventions, and outcomes
• Contributing to diabetes self-management education and support services

The work should incorporate evidence-based standards, collaborative care, practical problem-solving, lifestyle change, psychosocial considerations, and strategies that support ongoing self-management.

How Much Continuing Education Is Required Before Applying?

Initial certification candidates must complete at least 15 clock hours of continuing education applicable to diabetes during the two years before applying.

The activities must be provided or approved by an organization on CBDCE’s list of recognized continuing education providers.

Is a Qualifying Case Study Required?

No. The current 2026 eligibility requirements do not include a separate qualifying case study. Candidates must meet the professional discipline, practice experience, diabetes care and education experience, and continuing education requirements.

How Much Does the CDCES Exam Cost?

The initial or expired-certification application fee is $350. The fee includes the examination.

Applicants approved through CBDCE’s unique qualifications pathway pay $200 for the first examination application and $350 for subsequent applications.

CBDCE regularly updates its fees and policies, so candidates should confirm the current fees and policies before applying.

When Can You Take the CDCES Exam?

Applications and testing are available throughout the year.

Once an application is approved, the candidate has 90 days to schedule and complete the examination. Candidates who do not test within the approved window forfeit the application and fees and must submit a new application.

Where Is the CDCES Exam Administered?

The computer-based exam is administered through PSI. Candidates may test at an approved PSI testing center or use live remote proctoring when available and appropriate.

Remote candidates must meet PSI’s technology, identification, security, workspace, and system compatibility requirements.

What Is the CDCES Exam Format?

• Total questions: 175 multiple-choice questions
• Scored questions: 150
• Unscored pretest questions: 25
• Testing time: 4 hours
• Answer options: Four options per question
• Delivery: Computer-based testing through PSI
• Testing locations: PSI testing center or live remote proctoring

The 25 pretest questions are not included in the final score and are not identified during the exam. Candidates should answer every question.

What Score Do You Need to Pass?

Scores are reported on a scale from 0 to 99. The minimum passing scaled score is 70.

A scaled score of 70 does not mean that a candidate must answer exactly 70% of the questions correctly. The raw score required to pass may vary slightly among exam forms because CBDCE uses statistical equating to account for differences in difficulty.

What Is on the CDCES Exam?

The examination content outline effective July 1, 2024, contains three major domains.

The percentages above are calculated from the 150 scored questions identified in the official content outline.

Domain 1: Assessment

37 scored questions

The Assessment domain evaluates how candidates gather and interpret physical, psychosocial, behavioral, educational, and self-management information.

Physical and Psychosocial Assessment

Study:

• Diabetes diagnosis, duration, symptoms, complications, and treatments
• Comorbidities and healthcare utilization
• Diabetes-specific physical assessment
• Biometric and laboratory data
• Medication history and allergies
• Mental health and adjustment to diagnosis
• Substance use
• Social drivers of health
• Healthcare access and social support
• Food and housing insecurity
• Cognitive, physical, cultural, spiritual, and language considerations
• Family and caregiver dynamics
• Life transitions, fears, and diabetes-related myths

Self-Management Behaviors and Knowledge

Review:

• Understanding of the disease process
• Eating and physical activity habits
• Medication practices and preferences
• Glucose, ketone, weight, dietary, and activity monitoring
• Use of diabetes resources
• Diabetes devices, applications, and patient portals
• Risk reduction
• Problem-solving ability

Learning Assessment

Study:

• Learner goals and needs
• Readiness to learn and change behavior
• Preferred learning approaches
• Literacy, numeracy, health literacy, and digital literacy
• Developmental stage and physical abilities
• Language and cultural preferences
• Psychosocial and economic considerations
• Learning disabilities

How to study: Practice selecting the assessment that provides the most useful information before developing an education or treatment plan.

Domain 2: Care and Education Interventions

105 scored questions

Care and Education Interventions represents 70% of the scored exam. This domain covers disease management, individualized education, self-care behaviors, medications, technology, complications, and outcome evaluation.

Disease Process and Approach to Treatment

Study:

• Diabetes diagnosis and classifications
• Pathophysiology
• The honeymoon period and dawn phenomenon
• Modifiable and nonmodifiable risk factors
• Nutrition, physical activity, sleep, and stress
• Pharmacologic treatment options
• Glycemic, blood pressure, and lipid goals
• Cardiovascular and kidney risk reduction
• Quality-of-life considerations

Individualized Education Plans

Review how to:

• Develop a plan based on a complete assessment
• Collaborate with the person receiving care and the healthcare team
• Select appropriate instructional methods
• Establish specific, measurable, achievable, relevant, and time-bound goals
• Adapt education to the individual’s preferences, readiness, and barriers

Nutrition

Study:

• Nutrition recommendations and meal-planning approaches
• Carbohydrate types and carbohydrate counting
• Fats and protein
• Alcohol precautions
• Food and medication timing
• Food-label interpretation
• Weight management
• Dietary and herbal supplements
• Gastroparesis, celiac disease, metabolic surgery, and disordered eating
• Food allergies and aversions

Physical Activity

Review:

• Benefits and risks of physical activity
• Frequency, intensity, time, and type of activity
• Activity considerations for comorbidities
• Delayed post-exercise hypoglycemia
• Adjustment of food, medication, and monitoring for planned or unplanned activity

Medication Management

Study:

• Current diabetes medication classes
• Mechanisms of action
• Administration requirements
• Adverse effects and contraindications
• Medication adjustment
• Glycemic efficacy
• Cardiovascular and kidney benefits
• Weight effects
• Cost and access
• Hypoglycemia risk
• Insulin delivery systems
• Immunization recommendations

Monitoring and Interpretation

Review:

• Blood glucose monitoring
• Continuous glucose monitoring
• Device selection and use
• Glycemic metrics
• Ketone testing
• A1C interpretation
• Blood pressure
• Weight and lipids
• Kidney and hepatic function

Acute Complications

Study the causes, prevention, recognition, and treatment of:

• Hypoglycemia
• Hypoglycemia unawareness
• Hyperglycemia
• Diabetic ketoacidosis
• Hyperosmolar hyperglycemic state

Chronic Complications and Comorbidities

Review:

• Eye disease
• Neuropathies
• Kidney disease
• Cardiovascular, cerebrovascular, and peripheral vascular disease
• Lower-extremity problems
• Wounds and dermatologic concerns
• Infections
• Dental and gum disease
• Sexual dysfunction
• Depression and cognitive dysfunction
• Thyroid disease
• Obesity and sleep apnea
• Polycystic ovarian syndrome

Problem-Solving and Living With Diabetes

Study how diabetes care may change during:

• Illness and sick days
• Surgery and other procedures
• Shift work and schedule changes
• Religious or cultural observances
• Travel
• Emergencies
• Pregnancy and the postpartum period
• Transitions between care settings
• Childhood, adolescence, and older adulthood

Also review psychosocial wellbeing, safety, hygiene, school and employment issues, insurance, disability, discrimination, caregiver roles, and adaptive devices.

Evaluation, Documentation, and Follow-Up

Review how to:

• Evaluate progress toward behavioral and treatment goals
• Assess self-management skills
• Monitor psychosocial well-being
• Evaluate changes in eating, activity, weight, medications, and glycemic metrics
• Revise an education or care plan
• Document interventions and outcomes
• Communicate follow-up needs and referrals

How to study: Practice integrating clinical knowledge with person-centered education. The best response should account for safety, individual goals, treatment effectiveness, health literacy, access, and readiness for change.

Domain 3: Standards and Practices

8 scored questions

This domain covers the professional standards, systems, policies, and collaborative practices that support diabetes care and education.

Study:

• National Standards for Diabetes Self-Management Education and Support
• National Diabetes Prevention Program standards
• Evidence-based professional practice standards
• Population health strategies
• Team-based care
• Advocacy for access to medications, supplies, and services
• Primary and secondary diabetes prevention
• Evidence-based care and education
• Health disparities
• Diversity, equity, and inclusion

How to study: Understand how standards guide program quality, prevention, collaboration, advocacy, and equitable access to diabetes care.

How to Study for the CDCES Exam

Use the Current Content Outline

Build your study plan around the three current domains. Older materials using different domain structures may not reflect the exam administered since July 1, 2024. Download the CDCES Examination Content Outline effective July 1, 2024.

Give Care and Education Interventions the Most Time

This domain accounts for 105 of the 150 scored questions. It requires broad knowledge of medications, nutrition, activity, technology, monitoring, complications, education, psychosocial care, and follow-up.

Study Across Professional Disciplines

The CDCES exam is multidisciplinary. Regardless of your professional background, you are responsible for knowledge across the complete examination content outline.

Nurses may need additional work in nutrition, while dietitians may need more medication and technology review. Pharmacists may need to spend more time on learning assessment, behavioral support, and nutrition.

Use Person-Centered Reasoning

When answering a scenario, ask:

• What is the immediate safety concern?
• What information must be assessed before changing the plan?
• What matters most to the person receiving care?
• What barrier is interfering with self-management?
• Is the recommendation realistic and affordable?
• Does the person understand and agree with the plan?
• Which response best fits the individual’s readiness to change?
• How will the specialist evaluate whether the intervention worked?

Practice Interpreting Data

Practice using glucose patterns, continuous glucose monitoring metrics, laboratory results, medication information, diet and activity histories, and psychosocial findings to make appropriate recommendations.

Review Every Answer Explanation

After answering a practice question, review why the correct response is appropriate and why each alternative is less suitable. This develops the judgment needed for questions in which several options appear clinically reasonable.

How Long Is CDCES Certification Valid?

The CDCES credential is valid for five years.

Renewal pathways require continued eligibility and a combination of professional practice, continuing education, or examination. Depending on the pathway, a CDCES may renew by:

• Completing at least 1,000 hours of qualifying professional practice and 75 hours of diabetes-related continuing education
• Completing at least 1,000 hours of qualifying professional practice and passing the exam
• Completing 75 hours of diabetes-related continuing education and passing the exam

Credential holders should review the current CBDCE renewal handbook because requirements and accepted activities may change during a five-year certification cycle.

Start Preparing for the CDCES Exam

Pocket Prep’s CDCES exam prep is part of the Nursing Pocket Prep collection. It includes 700 practice questions across all three exam domains, detailed explanations for correct and incorrect answers, and performance insights to help candidates focus on the areas that need the most review.