Learning the Landscape: Early Challenges in Diabetes Care and Education
May 12, 2026, 08:53 AM
By Nichole Lewis, RN, CDCES
As a career, the work of a diabetes care and education specialist (DCES) is multifaceted and broad, and the work of a newer DCES can feel overwhelming at times considering the amount of new information there is to keep up with in the realm of high quality diabetes care. But the work is always rewarding.
Healthcare in general can be a complicated system where entities are stretched thin, profits are put before people, and systems are not always designed with the patient at the center of the focus. Diabetes care and education navigates these entities and systems while always centering the patient, their social realities, and their needs, first and foremost.
One of the most immediate challenges is the sheer volume and complexity of patients. Many individuals are not just managing diabetes; they are balancing multiple chronic conditions, mental health concerns, food insecurity, and inconsistent access to care. Appointments are rarely straightforward. What might look like a medication adjustment on paper often becomes a layered conversation about affordability, transportation, or competing life priorities. For a newer DCES, learning how to triage these needs while still delivering effective education can feel overwhelming.
Staffing shortages only add to this pressure. At the rural FQHC I work at, primary care is already limited, diabetes care and education professionals often become one of the most consistent touchpoints in a patient’s healthcare experience for diabetes care.
This creates both an opportunity and a burden. Patients rely heavily on these interactions, sometimes for guidance that extends well beyond diabetes. Meanwhile, the healthcare system continues to struggle with recruitment and retention, leaving fewer providers to meet the growing demand.
A lack of community resources adds another layer of difficulty. Housing instability, in particular, can undermine even the most well-designed care plans. When patients are concerned about housing or food, they cannot also plan and execute healthy living strategies. It is not uncommon to see patients work hard in structured treatment programs, only to return to homelessness or unsupported environments that make sustained progress nearly impossible. When individuals lose stable housing, managing medications, nutrition, and daily routines all become secondary to survival. Watching patients cycle through progress and relapse due to systemic gaps, not lack of effort, is one of the more frustrating realities of the job.
At the same time, misinformation remains a constant obstacle. Patients often come in with strong beliefs shaped by social media, anecdotal advice, or outdated guidance. Correcting misinformation requires more than simply presenting facts; it requires trust, patience, and the ability to meet people where they are without dismissing their concerns. For newer professionals, developing this communication style takes time and intentional effort.
Another unique challenge is the number of roles a CCES is often expected to fill. We are educators first and foremost, but also counselors, case managers, and at times, emotional support systems. Many patients, especially those who have struggled with healthcare access or negative experiences, may begin to see their DCES as their primary source of guidance once trust is established. While this trust is meaningful, it also creates a delicate balance. Maintaining professional boundaries while still providing compassionate care can feel like walking a tightrope.
Boundaries, in general, are an ongoing consideration. Expressions of gratitude from patients, through gifts, food, or invitations to connect outside of clinical settings, are genuine and often heartfelt. However, consistently reinforcing professional limits is paramount to maintaining ethical practice and protecting both the patient and provider relationship. For newer professionals, learning to navigate these moments with kindness and clarity is an important part of professional growth.
Finally, the landscape of diabetes care itself is constantly changing. New medications, evolving technologies, and shifting insurance coverage policies require flexibility and continuous learning. It is not enough to understand how a device or medication works; DCES professionals must also understand who can realistically access it. Insurance barriers often dictate treatment options as much as clinical need, adding another layer of complexity to patient care.
Despite these challenges, the role remains deeply meaningful. Being a DCES means showing up each day ready to problem-solve, adapt, and advocate in these imperfect circumstances. For those newer to the field, the learning curve is steep, but so is the impact and the role fulfillment. Behind every challenge is an opportunity to make care more accessible, more human, and more responsive to the realities patients face every day.