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By David Mendosa

Last Update: August 1, 1999

Did you ever wonder if your diabetes care is as good as it could be? How would you know?

You can have an endocrinologist to call your own.

Your answer could come from the Web site of the American Association of Clinical Endocrinologists. For people with diabetes one of the most important parts of the association's Web site is its campaign for intensive self-management, according to President-Elect Paul S. Jellinger, M.D.

The key to the association's campaign is a signed contract between the patient and his or her physician.

The patient agrees to eight different points geared to getting blood glucose levels as close to normal as possible. The points include laboratory exams, food diaries, self-monitoring of blood glucose, following an exercise plan, taking prescribed medication, and even wearing identification as a person with diabetes. The physician agrees to lead the diabetes team and to encourage the best possible control.

Did your physician give you this contract to sign? If not, you may be lacking a big incentive to gaining control of your diabetes.

The association's Guidelines for the Management of Diabetes Mellitus are another important part of its site, Dr. Jellinger says. These guidelines for intensive self-management spell out in even more detail what you, your physician, and your diabetes team need to do to maintain good control.

The guidelines say that patients should be given a choice of following them or conventional therapy. That choice, however "may lead to a higher rate of devastating complications." This sounds to me like what's known as a Hobson's choice, which is really no choice at all.

The contract and guidelines assume that the leader of your diabetes team is an endocrinologist. Sadly, that's not true for many of the 10.3 million Americans who have been diagnosed with diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases, a part of the National Institutes of Health.

The problem is that there just aren't enough to go around, particularly outside of the big cities, Dr. Jellinger says. While we have about 7,000 to 8,000 endocrinologists in the United States, only 4,000 to 4,500 of them are clinical endocrinologists.

A clinical endocrinologist is one who takes care of patients. Dr. Jellinger, who has a practice in Hollywood, Florida, is one. And almost all of the 3,300 members of the AACE are practicing, clinical endocrinologists.

But just do the math yourself. Even if there were 4,500 clinical endocrinologists here, if they were to see all Americans who have been diagnosed with diabetes, they would have to see an average of about 2,300 diabetes patients. That's a very heavy patient load, even without considering that many endocrinologists also see family members and others who do not have diabetes.

Dr. Jellinger admits that there aren't enough clinical endocrinologists to go around. "So the next best thing that we can do is educate primary care physicians and internists in the proper way to take care of diabetes," he responds. "We do that in various ways, including the Web site. But we do need more endocrinologists."

Many people get referred to an endocrinologist too late—after complications have set in, Dr. Jellinger says. "Then, there is very little that anyone can do. If endocrinologists could see diabetics earlier, there is little doubt that the patient would be better off."

The site's other strength for people with diabetes is geared to just that, to helping you find an endocrinologist in your area. The AACE's membership directory is online at Physician Search. So, even though not all people with diabetes can have an endocrinologist to call their own, you can. 

The American Diabetes Association originally published this article on its Web site as one of my “About the Internet” columns.

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