Learning Considerations & Barriers

CDCES Certified Diabetes Care and Education Specialist

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1 Introduction & the CDCES Exam

About the CDCES Credential & Current Exam Facts The July 2024 Exam Content Outline & Domain Weights The ADCES7 Self-Care Behaviors Framework

2 Pathophysiology, Classification & Diagnosis

Normal Glucose Regulation and the Pathophysiology of T1DM and T2DM Classification and Diagnostic Criteria Risk Factors and Primary Prevention Treatment Goals and Glycemic Targets

3 Assessment: History, Physical & Data

Health History & Diabetes-Specific Physical Assessment Interpreting Diabetes Measures & Laboratory Data Social Determinants of Health & Psychosocial Wellbeing

4 Assessing Self-Management & Learning

Assessing Self-Management Behaviors & Knowledge Assessing Technology Use, Problem-Solving & Risk-Reduction Behaviors Assessing Learning: Goals, Readiness to Change & Literacy Learning Considerations & Barriers

5 Developing the Education & Care Plan

Developing the Individualized Education/Care Plan Instructional Methods & Person-Centered Teaching Strategies SMART Goals, Behavior-Change Theory & Motivational Interviewing

6 Nutrition Therapy

Nutrition Recommendations & Eating Patterns Carbohydrate Counting & Insulin-Food Timing Fats, Protein, Alcohol & Dietary Supplements Food Labels, Weight Management & Special Nutrition Considerations

7 Physical Activity

Physical Activity Recommendations, Benefits, Challenges & Safety Activity Planning with FITT and Adjusting for Planned & Unplanned Activity

8 Pharmacologic Therapy

Insulin — Types, Pharmacokinetics & Delivery Systems Non-Insulin Glucose-Lowering Agents Guideline-Based Medication Selection Medication Titration & Immunizations for People with Diabetes

9 Monitoring

Glucose Monitoring: SMBG, CGM & Time in Range A1C and Ketone Monitoring Cardiometabolic and Organ System Monitoring

10 Acute Complications

Hypoglycemia Hyperglycemia, DKA, and HHS

11 Chronic Complications

Screening Schedules and Microvascular Disease Macrovascular Disease and Lower-Extremity Foot Care Infections, Dental Disease, Sexual Dysfunction, and Other Comorbidities

12 Special Situations & Populations

Sick-Day Management, Surgery, Travel & Emergency Preparedness Special Populations Across the Lifespan Preconception, Pregnancy, Postpartum & Gestational Diabetes Daily Living, Psychosocial Wellbeing & Safety

13 Evaluation & Documentation

Evaluating Intervention Effectiveness & Outcomes Documentation, Plan Revision & Referral

14 Standards, Guidelines & Professional Practice

National Standards for DSMES and the National DPP Applying Evidence-Based Practice Guidelines Population Health, Health Equity & Advocacy

Learning Considerations & Barriers

Key Takeaways Explain This Topic AI

Domain I.C.5 requires assessing learning considerations across developmental stage, physical abilities, language, culture, psychosocial status, economic status, caregiver dynamics, and learning disabilities.

Developmental-stage assessment differs sharply across pediatric, adolescent, adult, and older-adult learners, and education must be adapted rather than simply scaled down or up.

When a language barrier is present, a qualified medical interpreter is the standard of care; relying on a family member, especially a minor, risks inaccurate translation and privacy or role conflicts.

Caregiver dynamics assessment identifies who actually performs diabetes tasks day to day, since the caregiver — not always the person with diabetes — may be the primary or co-primary education target.

Sensory, cognitive, and physical disabilities require adapted teaching formats (large print, tactile devices, simplified sequencing, adaptive equipment) rather than a reduced curriculum.

Last updated: July 2026

Why Barrier Assessment Is Its Own Step

Sections 4.1 through 4.3 assessed what a person does, wants, and is ready to learn. This final learning-assessment component, I.C.5, asks a different question: what individual factors will shape how education must be delivered so it actually lands? The blueprint lists eight considerations: developmental stage, physical abilities, language, cultural background, psychosocial factors, economic status, caregiver dynamics, and learning disabilities. Missing any one of these can cause an otherwise well-designed plan to fail in delivery, not in content.

Developmental Stage

Developmental-stage assessment recognizes that a pediatric learner, an adolescent, a working-age adult, and an older adult require fundamentally different approaches, not just a scaled-down or scaled-up version of the same content.

• Stage Key Consideration
• Pediatric Concrete, play-based teaching; caregiver is often the primary learner
• Adolescent Autonomy and peer-normalcy concerns; risk of disengagement or rebellion against management
• Adult Integration with work, family, and life-stage transitions
• Older adult Cognitive changes, sensory decline, polypharmacy, potential need for simplified regimens

A single education handout is rarely appropriate across this full range; content depth, format, and who receives the teaching all shift with developmental stage. Reassessment matters here too — a child's developmental needs at age six differ from the same child at age fourteen, so developmental-stage assessment should be repeated at intervals rather than performed once at diagnosis.

Physical Abilities and Learning Disabilities

Physical assessment identifies limitations — vision loss, dexterity loss (arthritis, neuropathy), hearing loss, mobility limitation — that affect a person's ability to perform tasks like drawing up insulin, reading a meter display, or hearing a CGM alarm. These require adapted tools (large-display meters, audible glucose readouts, adaptive injection devices) rather than a reduced curriculum; the person still needs the same information, delivered through an accessible format. Learning disabilities (e.g., dyslexia, processing disorders) similarly require format adaptation — simplified sequencing, more repetition, multisensory reinforcement — not lowered expectations about what the person can ultimately learn and do.

Language and Cultural Considerations

When a language barrier is present, the standard of care is a qualified medical interpreter , in person or via a certified interpretation service. Using an untrained family member — and especially a minor — as an interpreter risks inaccurate medical translation, omitted or softened information, and inappropriate role burden on that family member, particularly for sensitive topics. Cultural assessment goes beyond language to include food traditions, family decision-making structure, health beliefs (including beliefs about the cause or meaning of diabetes), and trust in the healthcare system, all of which shape how education should be framed and who should be present for it.

Psychosocial and Economic Factors

Psychosocial barriers — untreated depression, diabetes distress, cognitive impairment, active substance use — can prevent even well-motivated learners from absorbing or acting on education, and often need to be addressed concurrently rather than treated as separate from the diabetes plan. Economic barriers — inability to afford supplies, unstable housing, lack of reliable transportation to appointments, or lack of refrigeration for insulin — can make a technically correct plan physically impossible to execute; assessment should surface these constraints before, not after, a plan is finalized. A plan that assumes reliable refrigeration, daily internet access, or discretionary income for premium supplies can quietly fail for reasons the person never voices unless directly asked.

Caregiver Dynamics

Caregiver-dynamics assessment identifies who actually performs day-to-day diabetes tasks. For a young child, an older adult with cognitive impairment, or a person with significant physical limitation, a caregiver may be the primary or co-primary learner, and education must be directed at whoever performs the task, not only at the person carrying the diagnosis. This also requires assessing caregiver burden, competing responsibilities, and whether the caregiving arrangement is likely to be stable over time, since a plan built around a caregiver who is unavailable or overwhelmed will not hold. Multiple caregivers — for example, a parent and a school nurse, or a spouse and a home health aide — may each need separate, role-appropriate education rather than a single shared session.

Integrating Barrier Assessment Into the Plan

Every barrier identified in this section becomes a design constraint for Chapter 5's individualized education plan: it shapes format (visual, tactile, interpreter-mediated), pacing (more repetition, shorter sessions), audience (person, caregiver, or both), and setting (home visit, telehealth, in-person). Barrier assessment is not a separate checklist completed once — it should be revisited whenever life circumstances change, since a barrier that was absent at diagnosis, such as new cognitive decline or a new caregiver arrangement, can emerge years into ongoing care and quietly undermine a plan that once worked well.

Avoiding Assumption-Based Planning

The common thread across all eight considerations is that assumptions substitute poorly for direct assessment. A DCES should not assume an older adult cannot use a smartphone app, that a person from a particular cultural background will refuse a certain food group, or that a family will automatically absorb caregiving duties without strain. Each of these assumptions, even when well-intentioned, can lead to an education plan that underestimates the person's actual capability or overestimates support that does not reliably exist. Directly asking about each consideration, and documenting the specific answer rather than a general impression, keeps the barrier assessment accurate and keeps the resulting plan realistic.