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