Diabetes Specialists & Information on Diabetology

Both adults and children receive treatment.

The specialty covers the following conditions:

• Type 1 diabetes mellitus: This is the rare, congenital form of diabetes mellitus. In this condition, the immune system destroys the insulin-producing cells in the pancreas, resulting in insulin deficiency. Those affected are mostly children and adolescents, who require lifelong insulin therapy.
• Type 2 diabetes mellitus: Accounting for 90% of cases, this is the most common form of diabetes mellitus. It is often associated with obesity and typically does not develop until adulthood. It can be caused by cells not responding adequately to insulin, resulting in insufficient glucose uptake (insulin resistance). It is also possible that the pancreas produces too little insulin. Often, both causes occur together.
• Metabolic syndrome: This condition can develop from type 2 diabetes and is characterized by a combination of various factors, such as:
• Abdominal obesity
• Insulin resistance
• Impaired glucose and lipid metabolism
• High blood pressure
• Gestational diabetes: First appears during pregnancy. In most cases, it resolves after pregnancy. However, the risk of developing type 2 diabetes later in life is increased.

Gestational diabetes occurs in up to 20% of all pregnancies @ geargodz /AdobeStock

Possible complications and comorbidities also fall within the scope of practice of a diabetologist or a primary care physician with appropriate additional training, such as:

• hypoglycemia (low blood sugar, blood sugar levels that are too low) up to hypoglycemic shock
• Hyperglycemia (high blood sugar, blood sugar levels that are too high) up to diabetic coma
• Kidney disease (diabetic nephropathy)
• Foot complications such as non-healing wounds and lesions (injuries), ranging up to diabetic foot syndrome, and
• nerve damage, which can lead to various forms of diabetic neuropathy or polyneuropathy

Diabetes-related eye diseases (retinal changes) are diagnosed and treated by an ophthalmologist.

In this context, diabetologists are responsible not only for diagnosis and treatment, but also for:

• long-term medical counseling and care
• conducting educational sessions and
• emergency care for patients with diabetes

Diabetologists treat both patients who have already been diagnosed with diabetes mellitus and patients suspected of having diabetes.

The diagnosis includes:

• Taking a medical history, including medications taken and lifestyle habits
• Repeated measurement of fasting blood glucose levels (plasma glucose levels)
• Conducting an oral glucose tolerance test (oGTT; also known as a glucose challenge test)
• Measuring the HbA1c level (long-term blood sugar) over the past eight to twelve weeks

If diabetes mellitus is diagnosed, the endocrinologist offers various educational programs for patients and their families. 

In these sessions, patients learn:

• How to make lifestyle changes
• What kind of diet is important
• How to monitor their blood sugar on their own
• How and when to take medication or administer insulin

If the patient needs an insulin pump that automatically delivers insulin, the doctor also provides in-depth counseling.

To monitor the progression of the disease on a regular basis, the endocrinologist conducts regular checkups.

These include:

• Blood draw
• Measurement of blood glucose and HbA1c levels

Based on the HbA1c level, the doctor can determine to what extent medication may need to be adjusted.

During these checkups, the doctor also monitors for potential complications and comorbidities. If necessary, the doctor refers the patient to other specialists (such as an ophthalmologist).

In emergency care, the diabetologist also treats patients with hypoglycemia. In this case, they administer a glucose infusion to restore blood sugar levels to normal.

After completing medical school, a licensed physician in Germany can pursue further training in various specialties.

For example, they can become a specialist in internal medicine or a specialist in internal medicine, endocrinology, and diabetology. 

This requires five to six years of clinical experience. During this time, they perform a specified number of diagnostic procedures and treatments.

After successfully passing the specialist examination, certification as a DDG-certified diabetologist by the German Diabetes Society is possible. 

An additional requirement for the title of “diabetologist” is a 24-month advanced training program at a diabetes facility recognized by the German Diabetes Society. 

A specialist in internal medicine, endocrinology, and diabetology is not required to complete this additional training, as they have already acquired specialized knowledge during their residency.

Diabetologists may work in their own private practices, where they provide diagnosis, treatment, and emergency care. However, it is also possible to work as a salaried diabetologist in a large specialty practice or in a hospital.

Many clinics have now specialized in treating diabetes patients. Care and treatment are provided by diabetologists.

Diabetologists are not the only professionals involved in the care of diabetes patients. Members of allied health professions can also complete continuing education in the field of diabetology. 

These include, for example:

• Diabetes counselor
• Diabetes assistants

Diabetes counselors provide care and counseling to patients with type 1 and type 2 diabetes mellitus, as well as to pregnant women with gestational diabetes. 

The duties of diabetes assistants include:

• Care
• Counseling and 
• training of patients with type 2 diabetes mellitus

They also provide support in the care of patients with type 1 diabetes.

While diabetes counselors may be employed or self-employed, diabetes assistants work under the supervision of a responsible physician. This means that a diabetes assistant always works as part of a team.

For both advanced training programs, a completed education in a healthcare profession (such as medical assistant, healthcare/nursing professional, or geriatric care worker) is a prerequisite. 

Prospective diabetes counselors must also provide proof of practical experience in diabetology under the supervision of a diabetologist. Therefore, diabetes assistants can also undergo further training to become diabetes counselors.