Endocrinology and Diabetology | Specialists and Information

Endocrinology and diabetology are one of the nine sub-specialties of internal medicine. The specialty of endocrinology deals with the basics of hormones and metabolism, the interaction of all hormone-producing organs and diseases caused by hormonal disorders. Diabetology in particular covers all aspects from the basics of prevention (prophylaxis) and diagnosis to the treatment and management of diabetes mellitus.

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Endocrinology and diabetology - Further information

Main areas of treatment in endocrinology

Hormones are biochemical substances in the body, the production of which is finely coordinated via complex regulatory cycles and which play a very important role in many of the body's functions. If too many or too few hormones are produced due to an organic disorder or if the hormone-binding cells do not react as they should, this often has far-reaching consequences for the human body.

Hormones that act within the body are produced in so-called endocrine glands. These endocrine glands release the hormones produced directly into the blood, which transports them to other parts of the body where they can then take effect.

Endocrinology is therefore concerned with the hormone balance and its possible disorders, for example in

  • growth,
  • reproduction,
  • development and
  • reactions to stress and strain.

An endocrinologist deals with diseases that affect the hormone balance or hormone-producing organs, such as the

can be traced back. Diseases and disorders in the field of endocrinology include, among others

Diagnostic and treatment procedures in endocrinology

The diagnostic process begins with a medical history, i.e. asking the patient about their symptoms, lifestyle, medication and medical history or that of their direct relatives. This is followed by a physical examination by the doctor. This gives the doctor initial indications of an underlying illness. Depending on the suspected diagnosis, this is followed by laboratory tests and then, under certain circumstances, imaging examinations in order to be able to diagnose a hormonal imbalance with certainty.

Hormonal disorders and metabolic disorders can often be detected by changes in laboratory values, for example if the blood values for certain hormones are either too high or too low or the blood sugar is too high. Laboratory tests are therefore an important part of the diagnosis of endocrinological disorders and should be carried out before imaging procedures are used.

Imaging procedures include, for example

  • Ultrasound examination (sonography), for example of the thyroid gland if thyroid disease is suspected, or of the ovaries if PCOS is suspected
  • Computed tomography (CT) or magnetic resonance imaging (MRI), for example if hormone-producing tumors are suspected
  • Measurement of bone density (examination of the hip and lumbar spine), for example in the case of cortisone therapy or suspected osteoporosis
  • Doppler sonography of blood vessels, for example in the case of lipometabolic disorders

In most cases, irregularities in the hormone balance can be corrected by administering specific hormones or medication. A gradual adjustment to the optimum dosage is often necessary. Sometimes this treatment is necessary for life (for example in the case of thyroid disorders). This requires strict monitoring by the attending physician. Depending on the cause of the hormone disorder, for example in the case of a hormone-producing tumor, surgical intervention may be necessary.

A change in diet and general lifestyle is often necessary (e.g. in the case of diabetes mellitus). In these cases, it is important to advise the patient in detail. Regular exercise can also have a positive influence on the therapy.

If psychological problems have led to hormonal disorders, psychological or psychiatric treatment can be helpful.

Main areas of treatment in diabetology

Diabetology deals with the prevention, diagnosis, treatment and research of diabetes mellitus. The most important types of diabetes are

But also secondary and concomitant diseases, such as

  • Hypoglycemia (low blood sugar)
  • Hyperglycemia (hyperglycemia) diabetic foot syndrome
  • Kidney disease(diabetic nephropathy),
  • nerve damage(diabetic neuropathy or polyneuropathy)

are the responsibility of a diabetologist.

Diabetes-related diseases of the eyes(retinal changes) belong in the hands of an ophthalmologist.

Diagnostic and treatment procedures in diabetology

As part of diabetes diagnostics, if diabetes is suspected, the fasting blood glucose (or plasma glucose value) is measured several times and, if necessary, an oral glucose tolerance test (oGTT, sugar load test) is carried out. The latter is also carried out during prenatal care to rule out gestational diabetes.

Depending on the underlying disorder, various therapies and supportive measures are used in the treatment of diabetes mellitus, such as

  • Insulin therapy, if necessary with the help of an insulin pump
  • Blood glucose-lowering medication
  • Training (e.g. on proper nutrition, self-measurement of blood glucose, use of medication, use of an insulin pump)

Regular blood glucose and long-term blood glucose (HbA1c value) checks are carried out throughout treatment.

Connection between endocrinology and diabetology

The cause of diabetes mellitus is either a lack of insulin or insulin resistance (the target cells of insulin are "less sensitive" to insulin). However, as insulin is a hormone, the discipline that deals with diabetes mellitus, namely diabetology, is considered a sub-discipline of endocrinology.

Disorders in sugar metabolism and thus diabetes mellitus are often discovered by general practitioners during early detection or routine examinations. For this reason, and due to the importance of diabetes for individuals and society as a whole, many general practitioners also complete further training in the field of diabetology.

Further training in endocrinology and diabetology

After completing a medical degree, a doctor licensed in Germany can undertake further training in various specialties and, for example, become a specialist in internal medicine or a specialist in general medicine or directly a specialist in internal medicine and endocrinology and diabetology. This requires five to six years of work, during which a specified number of diagnostic procedures and therapies must be carried out. This gives the endocrinology and diabetology expert in-depth knowledge in all areas of the diagnosis and treatment of hormonal disorders.

In addition to the direct opportunity to train as a specialist in internal medicine and endocrinology and diabetology, other specialists in internal medicine or general medicine can be certified by the German Diabetes Association (DDG) after successfully completing further training to become a DDG diabetologist. This quality award is also proof of comprehensive knowledge in the care of diabetes patients.

As a branch of endocrinology, i.e. the area of medicine that deals with hormones and metabolism, diabetology deals with the prevention (prophylaxis), diagnosis, treatment and also research into diabetes mellitus, also known colloquially as diabetes. Doctors who specialize in this field are called diabetologists.

Areas of activity of a diabetologist

Both adults and children are treated. The specialty includes the following diseases:

  • Type 1 diabetes mellitus is a rare, congenital form of diabetes mellitus in which the insulin-producing cells in the pancreas are destroyed by the patient's own immune system, resulting in a lack of insulin. Those affected are mostly children and adolescents and are dependent on insulin therapy for the rest of their lives.
  • At 90%,type 2 diabetes mellitus is the most common type of diabetes mellitus, which is often associated with obesity and usually only occurs in adulthood. The cause may be that the cells do not respond sufficiently to insulin and therefore absorb too little sugar (so-called insulin resistance) or that the pancreas produces too little insulin. Both causes often occur together.
  • Metabolic syndrome can develop from type 2 diabetes and is a combination of various characteristics (e.g. abdominal obesity, insulin resistance, impaired sugar and fat metabolism, high blood pressure).
  • Gestational diabetes, also known as gestational diabetes, occurs for the first time during pregnancy. Although in most cases it disappears again after pregnancy, the risk of developing type 2 diabetes later on is increased.

Possible secondary and concomitant diseases such as

  • Hypoglycemia (low blood sugar levels) and even hypoglycemic shock,
  • hyperglycemia (high blood sugar levels) and even diabetic coma,
  • Kidney disease(diabetic nephropathy),
  • foot complications such as non-healing wounds and lesions (injuries) through to diabetic foot syndrome and
  • Nerve damage, which can lead to various forms of diabetic neuropathy or polyneuropathy,

are the responsibility of a diabetologist or a general practitioner with appropriate additional training. Diabetes-related eye diseases(retinal changes) are diagnosed and treated by an ophthalmologist.

Diabetologists are not only responsible for diagnosis and treatment, but also for

  • long-term medical advice and care,
  • the provision of training and
  • also provide emergency care for diabetes patients.

The classic tasks in diabetology

Diabetologists treat both patients with already diagnosed diabetes mellitus and patients with suspected diabetes.

In addition to recording the patient's medical history, medication taken and lifestyle habits, the diagnosis also includes measuring the fasting blood glucose in the blood several times, more precisely the plasma glucose value, and, if necessary, carrying out an oral glucose tolerance test (oGTT; also known as a sugar load test).

Measuring the HbA1c value ("long-term blood sugar", the form of hemoglobin to which sugar has accumulated) also provides information about the blood sugar level over the last eight to twelve weeks.

If diabetes mellitus has been diagnosed, the diabetologist may offer various training courses for patients and their relatives in connection with the treatment. In these courses, patients learn

  • how to change their lifestyle,
  • which diet is important,
  • how to measure their blood sugar themselves,
  • how and when to take medication or inject insulin.

If an insulin pump that automatically delivers insulin is required, the doctor will also provide intensive advice.

In order to be able to monitor the progress of the disease regularly, the diabetologist will carry out regular check-ups, during which he or she will take blood samples and determine the HbA1c value as well as the blood glucose level. Based on the HbA1c value, it can be clarified to what extent the medication may need to be adjusted.

As part of the check-ups, the doctor will also check for possible secondary and concomitant diseases and, if necessary, refer the patient to other specialists (e.g. an ophthalmologist).

In emergency care, the diabetologist will also treat patients with hypoglycemia. In this case, an infusion containing sugar is administered to bring the blood sugar level back to normal.

Training and further education to become a diabetologist

After completing their medical studies, a doctor licensed in Germany can continue their training in various specialties and, for example, become a specialist in internal medicine or a specialist in general medicine or a specialist in internal medicine and endocrinology and diabetology. This requires five to six years of work, during which a specified number of diagnostic procedures and therapies must be carried out.

Once the specialist examination has been successfully completed, certification by the German Diabetes Society as a Diabetologist DDG is possible. However, a further prerequisite for being allowed to use the additional title of "diabetologist" is 24 months of further training in a diabetes facility recognized by the German Diabetes Society. A specialist in internal medicine and endocrinology and diabetology does not have to complete this further training again, as special knowledge in the care of patients with diabetes mellitus has already been acquired during specialist training.

Where do specialists in diabetology work?

Diabetologists can work independently in their own practice, where they carry out diagnosis, treatment and emergency care. However, it is also possible to work as an employed diabetologist in a large specialist practice or in a hospital.

Many clinics have now specialized in diabetes patients. The care and treatment in these clinics is provided by diabetologists.

Assistant professions in the field of diabetology

Not only diabetologists are involved in the care of diabetes patients, but they are also supported by members of medical assistant professions for whom the German Diabetes Society offers further training in the field of diabetology. These include, for example

  • Diabetes consultant
  • Diabetes assistant

Diabetes consultants care for and advise patients with type 1 and type 2 diabetes mellitus as well as pregnant women with gestational diabetes. Diabetes assistants are mainly responsible for the care, counseling and training of patients with type 2 diabetes mellitus, but they also provide support in the care of type I diabetes patients.

While diabetes consultants can either be employed or work independently, the work of a diabetes assistant is under the direction of the responsible doctor, meaning that a diabetes assistant is always employed as part of a team.

A completed training in a healthcare profession (e.g. medical assistant, healthcare/nursing assistant, geriatric nurse) is a prerequisite for both further training courses; prospective diabetes consultants must also provide proof of practical work in diabetology under the supervision of a diabetologist as part of their further training. Diabetes assistants can therefore also train to become diabetes consultants.

References

  • Bundesärztekammer (2013) (Muster-)Weiterbildungsordnung 2003 in der Fassung vom 28.06.2013. https://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/20130628-MWBO_V6.pdf
  • Bundesärztekammer et al. (2014) Therapie des Typ-2-Diabetes. Nationale VersorgungsLeitlinie. AWMF-Register-Nr.: nvl-001g. http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Leitlinien/Evidenzbasierte_Leitlinien/dm-therapie-1aufl-vers4-kurz.pdf
  • Deutsche Diabetes Gesellschaft (DGG) (2019). Richtlinien zur Anerkennung als Diabetologin DDG / Diabetologe DDG. http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Weiterbildung/Diabetologe_DDG/2019_Richtlinien_zur_Anerkennung_als_Diabetologe_DDG.pdf
  • Feldkamp J et al. (2016) Klug entscheiden: ... in der Endokrinologie. Dtsch Arztebl 113(17): A-821 / B-696 / C-687. https://www.aerzteblatt.de/archiv/177837/Klug-entscheiden-in-der-Endokrinologie
  • WHO (2016) International Statistical Classification of Diseases and Related Health Problems 10th Revision. https://icd.who.int/browse10/2016/en
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