Study guide
National Standards for DSMES and the National DPP
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
National Standards for DSMES and the National DPP
Key Takeaways Explain This Topic AI
The 2022 revision of the National Standards for DSMES consolidated the prior 10 standards (2017) into 6 broader standards, jointly maintained by ADA and ADCES.
DSMES accreditation/recognition comes from two CMS-authorized national accrediting organizations: the ADA Education Recognition Program (ERP) and the ADCES Diabetes Education Accreditation Program (DEAP), each on a 4-year cycle.
Medicare's DSMT benefit covers up to 10 hours in the first 12 months after referral, then up to 2 hours per year in subsequent years with a new referral.
The four critical times to assess a person's need for DSMES referral or follow-up are: at diagnosis; annually and/or when not meeting treatment targets; when complicating factors arise; and when transitions in life or care occur.
The National DPP is a CDC-recognized, year-long primary-prevention lifestyle program for adults with prediabetes/at risk (not yet diagnosed with diabetes), targeting 5-7% weight loss and 150 minutes/week of physical activity across a minimum of 22 sessions.
Last updated: July 2026
The National Standards for Diabetes Self-Management Education and Support (NSDSMES)
Domain III of the CBDCE outline tests whether a Certified Diabetes Care and Education Specialist (CDCES) understands the formal frameworks that govern how diabetes education is delivered, recognized, and paid for — not just how to teach a person with diabetes. The National Standards for Diabetes Self-Management Education and Support (NSDSMES) sit at the center of that framework. First issued by the American Diabetes Association (ADA) in 1984, the National Standards are jointly maintained today by ADA and the Association of Diabetes Care & Education Specialists (ADCES, formerly AADE), and are reviewed and revised on a roughly five-year cycle to keep pace with evidence and practice models.
Know the current structure precisely, because it changed in 2022. The 2017 edition of the National Standards organized DSMES around 10 standards. The current (2022) revision consolidated that structure into 6 broader standards — a change tested candidates sometimes miss if they studied an older source. The six current standards are:
- # Standard Core Idea
- 1 Support for DSMES Services Organizational structure, oversight, and resources exist to sustain the service
2 Population and Service Assessment The service identifies and understands the demographics, needs, and social determinants of the population it serves
3 DSMES Team Qualified team member(s) — e.g., CDCES, RD, RN, pharmacist — plan and deliver services, informed by current best practice
4 Delivery and Design of DSMES Services Services are evidence-based, use an approved curriculum, and are structured to meet identified needs
5 Person-Centered DSMES Education and support are individualized to the person's assessed needs, goals, and life circumstances
6 Measuring and Demonstrating Outcomes of DSMES Services The service tracks and reports learning, behavioral, and clinical outcomes to demonstrate value and drive improvement
The National Standards are not just a teaching philosophy — they are the yardstick used to accredit or recognize a DSMES service. Two national accrediting organizations (NAOs), authorized by the Centers for Medicare & Medicaid Services (CMS), assess programs against the National Standards: the ADA Education Recognition Program (ERP) and the ADCES Diabetes Education Accreditation Program (DEAP) . A program that earns accreditation or recognition is approved on a 4-year cycle and becomes eligible for reimbursement, most importantly Medicare's Diabetes Self-Management Training (DSMT) benefit: up to 10 hours of training within the first continuous 12 months following a qualifying referral and diabetes diagnosis (typically 1 hour individual plus 9 hours group), and up to 2 hours per year in follow-up training in subsequent years with a new physician/qualified health care professional referral. Many state Medicaid programs and commercial payers extend similar coverage to accredited/recognized services.
The Four Critical Times to Assess Need for DSMES
DSMES is not a one-time referral made only at diagnosis — it is meant to be revisited across the life of the condition. A joint consensus report from ADA, ADCES, the Academy of Nutrition and Dietetics, and several primary care and pharmacy organizations defines four critical times when a referring clinician (or the CDCES themselves, working across a team) should formally assess whether a person needs DSMES referral or follow-up:
At diagnosis — establishing foundational self-management knowledge and emotional/behavioral support from the start.
Annually, and/or when not meeting treatment targets — for ongoing health maintenance and to catch drift away from goals early.
When complicating factors develop — new diabetes-related complications, comorbid conditions, physical or cognitive limitations, or changes that affect self-management capacity.
When transitions in life or care occur — changes such as a new care team, a move to a different living situation, a change in insurance coverage, or a shift between pediatric and adult care.
These four checkpoints exist because DSMES referral rates and utilization remain far lower than they should be nationally; building assessment for DSMES need into these four specific moments — rather than relying on a single point of referral — is the strategy the consensus report and CBDCE outline both endorse to close that gap.
The National Diabetes Prevention Program (National DPP)
While DSMES serves people already diagnosed with diabetes, the National DPP is the parallel, CDC-recognized structure for primary prevention — reaching adults with prediabetes or who are otherwise at high risk, before a diabetes diagnosis occurs. Eligible participants are adults age 18 or older with a BMI of 25 kg/m² or higher (23 kg/m² or higher if Asian American), no prior diagnosis of type 1 or type 2 diabetes, and evidence of risk (a qualifying blood test result, a validated risk-test score, or a history of gestational diabetes).
The National DPP lifestyle change program runs a minimum of 22 sessions across roughly one year : 16 weekly core sessions delivered over about the first six months, followed by at least 6 monthly core-maintenance sessions over the remaining six months, delivered in person, online, or through a combination, by a trained lifestyle coach using a CDC-approved curriculum. The program's target outcomes are 5-7% body-weight loss and building up to 150 minutes per week of moderate physical activity . Organizations achieve and maintain CDC recognition through the Diabetes Prevention Recognition Program (DPRP) by submitting participant outcome data every six months and meeting benchmarks for retention, weight loss, and physical-activity achievement.
For the CDCES, the practical distinction matters on the exam and in practice: screen for prediabetes and refer eligible, not-yet-diagnosed at-risk individuals to the National DPP ; refer people with a diabetes diagnosis to DSMES . Both pathways are standards-driven, evidence-based, and reimbursable — but they serve different populations at different points on the prevention-to-management continuum.