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Diabetologist: the diabetes healthcare professional
The diabetologist is an endocrinologist who specializes in the treatment of diabetes and its complications. When, why and how often to consult a diabetologist? What is his role ? What to expect in consultation?
What is a diabetologist?
The diabetologist is an endocrinologist who specializes in the study, diagnosis, monitoring and treatment of diabetes and its complications. The diabetologist works in close collaboration with the patient’s general practitioner. This practitioner works in hospital or in private practice. Consultations are fully reimbursed by social security when its fees are agreed.
Highly informed, the diabetologist provides the patient with all the medical innovations in terms of self-monitoring of blood glucose, treatments or even insulin injector equipment. It also puts the patient in touch with the diabetes health networks and directs them to various specialists in the event of complications.
What is diabetes ?Diabetes is a chronic disease that affects 1 French on 10. This condition results in an increased concentration of glucose in the blood or hyperglycemia : we talk about diabetes when the fasting blood sugar exceeds 1,26 g / L of blood (with at least two blood sugar checks). Diabetes occurs when the pancreas does not make enough insulins (type 1 diabetes also called insulin-dependent diabetes) or when the body uses insulin inadequately (type 2 diabetes or non-insulin-dependent diabetes). Gestational diabetes is characterized by hyperglycemia during pregnancy. Type 1 diabetes is an autoimmune disease while type 2 diabetes is generally associated with being overweight and being excessively sedentary. Gestational diabetes results from hormonal changes associated with pregnancy which increase the insulin requirements of pregnant women. For some, the pancreas then fails to keep pace by not producing enough insulin to moderate blood sugar. |
Close collaboration with the general practitioner
Diabetes is a serious chronic disease that requires specific management. If you have blood tests that suggest insulin resistance, prediabetes or declared diabetes, the general practitioner may recommend that you consult an endocrinologist who specializes in diabetology: the diabetologist.
Generally, the general practitioner and the diabetologist maintain exchanges in order to ensure the quality and consistency of the therapeutic follow-up.
The general practitioner knows the history, the lifestyle of the patient as well as the context of the onset of the disease. He is the conductor of the medical follow-up and directs the patient to the diabetologist or to other specialists when more in-depth questions come into play. The general practitioner is also the one who prescribes regular examinations (cholesterol, triglycerides, glycated hemoglobin …) In order to monitor the patient’s progress. The general practitioner is available to the patient for any guidance or quick advice.
On the other hand, any complications or need for modification of treatment must be the subject of a consultation with the diabetologist who notifies his decisions to the general practitioner. Complications are generally cutaneous, renal, ocular or even cardiovascular. The diabetologist can call on another specialist when the question goes beyond his field of expertise.
Why consult a diabetologist?
In case of type 1 diabetes
In case of type 1 diabetes (or insulin-dependent diabetes): monitoring by a diabetologist is essential. Indeed, this specialist teaches the patient to acquire his autonomy. The patient gets down to knowing the type of insulin needed, the evaluation of its dosage as well as the frequency and the realization of the injections.
In case of type 2 diabetes
Consulting a diabetologist is not imperative. The general practitioner and the endocrinologist are often competent. The purpose of the consultations is to collect healthy lifestyle precautions to adopt (balanced diet with a low glycemic index, regular physical activity, etc.).
When the control of these parameters is insufficient, the doctor may prescribe an oral treatment: metformin (biguanides), sulfonylureas, glinides, gliptins (or dipeptidyl-peptinase 4 inhibitors), GLP 1 analogues, intestinal alpha-glucosidase inhibitors, glifozins (inhibitors of an enzyme present in the kidney: SGLT2), insulins.
It is recommended to start treatment with metformin (or in case of intolerance or contraindication to it, with a sulphonylurea). In the event of resistance to these molecules, the doctor adds two associated complementary antidiabetics. It is sometimes necessary to give a third oral diabetes medication, or insulin.
How often to consult your diabetologist?
In case of type 1 diabetes
Patients should see their diabetologist at least once a year. Ideally, the patient visits his specialist 4 times a year (frequency corresponding to the number of glycated hemoglobin (HbA1c) tests to be performed annually) in order to closely monitor the follow-up of his injectable treatment.
In case of type 2 diabetes
The consultation of a diabetologist is not imperative but it remains strongly recommended at the rate of at least once a year (and ideally 4) in order to adjust the dietary instructions and the administration of oral treatments.
How is the consultation with the diabetologist?
During the first consultation, the diabetologist performs a clinical examination, an interview and reads the documents which it is recommended to bring with you:
- the referral letter from your general practitioner;
- medical examinations and documents enabling the history of the disease to be traced;
- the latest blood tests.
At the end of a consultation, the diabetologist may readjust your treatment, prescribe new examinations to be performed or refer you to another specialist in the event of complications.