Understanding What Diabetes Specialists Do
The American Diabetes Association (ADA) estimated that in 2018, 34.2 million Americans had diabetes. Of that 34.2 million, 1.6 million had type 1 diabetes and 7.3 million were undiagnosed.
Diabetes was the seventh leading cause of death in 2017. However, diabetes as a cause of death may be underreported. The ADA states, “Studies have found that only about 35% to 40% of people with diabetes who died had diabetes listed anywhere on the death certificate and about 10% to 15% had it listed as the underlying cause of death.”
Unfortunately, diabetes can lead to acute complications, such as hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, and chronic complications, such as chronic kidney disease and vision issues. Adults aged 20 and older with diabetes had chronic kidney disease (CKD) at a prevalence of 36.5%, but many did not even know they had CKD.
Though preventing acute and chronic complications can be difficult, seeing a diabetes specialist may improve the likelihood of better glucose control.
What is a Diabetes Specialist?
A diabetes specialist is also known as an endocrinologist. An endocrinologist is a doctor who receives specialized training in diagnosing and treating hormone-related diseases.
Examples of diseases that an endocrinologist may treat:
- Diabetes mellitus, including type 1 diabetes and type 2 diabetes
- Thyroid dysfunction
- Obesity
- Osteoporosis
- Adrenal disorders
- Lipid disorders
- Metabolic abnormalities
- Growth disorders
- Sexual function and reproduction
According to the American Academy of Clinical Endocrinology, “Becoming an endocrinologist requires deep knowledge of pathophysiology and biochemistry to understand the processes that may be disrupted in endocrine disorders. Following medical school completion and internal medicine residency training, a two- or three-year fellowship in the field of endocrinology must be undertaken for a physician to become an endocrinologist. Following completion of training, most become board certified.”
An endocrinologist does not replace a primary care physician; they treat only the endocrine disorder, often working with the primary provider to maximize health.
What is diabetic ketoacidosis? It's a serious condition that's linked to type 1 and type 2 diabetes. From symptoms to treatments, here's what to know.
When Should Someone See an Endocrinologist?
Your primary care provider can treat diabetes. You can also work with a certified diabetes care and education specialist (CDCES).
However, you may choose to ask for a referral to an endocrinologist if you would like a higher level of care or if you are wanting care from a specialist.
Your provider may also choose to refer you to a specialist when:
- They do not have a lot of experience treating diabetes
- Your medication regimen becomes complicated
- Your diabetes becomes difficult to manage
- You use an insulin pump to manage your diabetes
- You have complications due to your diabetes
How Does Someone See an Endocrinologist?
The process of seeing an endocrinologist depends on your insurance; some insurance plans require a referral, while others allow for self-referral. If you need a referral to a diabetes specialist, be sure to contact your insurance company, as they can tell you if you need a referral or not.
The cost of seeing an endocrinologist is also dependent on your insurance plan; some insurance plans have a specialty visit copay, while others will bill the visit just like any other office visit copay. If you do not have insurance, many offices while allow you to pay cash or will work with you to pay on a sliding scale.
Pros & Cons to Seeing an Endocrinologist
I would argue that there are many benefits to seeing an endocrinologist, with little in the “con” category.
Visits with an endocrinologist typically are every three months – conveniently, around the same time an A1c is drawn. An A1c is a three-month average of how blood sugar values have been trending. That number can be defeating if it is on the rise. It can also make you feel triumphant if you see a drop. However, the A1c does not show the entire picture. Your healthcare team at the endocrinology office will download any pumps, continuous glucose monitors (CGMs), meters, and review logs – sometimes too many highs or lows can cause A1c readings that are not necessarily false, but do not give a great picture of control.
Visiting with an endocrinologist can also allow you to see other members of a healthcare team who may have a fresh perspective on how you can improve your health, such as CDCES and registered dietitians. You may also learn about new technology that can improve your blood sugar control, such as insulin pumps and CGMs, that you would not know about if you only saw a primary care provider.
Unfortunately, some insurance plans do not cover specialists or have poor coverage, meaning that visits are costly. It can also be frustrating if you have a specialist that you do not “click” with.
The Bottom Line…
If your healthcare provider suggests that you see an endocrinologist, it does not mean you have failed at managing your diabetes. An endocrinologist is a specialist who has advanced training in conditions involving hormones and can help manage your diabetes.
