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October 3, 2003

Other

Question from Tampa, Florida, USA:

I am 18 years old, I have type 1 diabetes diagnosed almost five months ago, and I currently have an endocrinologist who I believe hasn't been informative or helpful at all so would like to find a new doctor. Should I go to a regular endocrinologist? Can I go to a pediatric endocrinologist? Which would be more beneficial? Is there any real difference?

Answer:

I am biased. I am a pediatric endocrinologist, and I can imagine that my adult endocrinology colleagues have their own biases.

That said, I think that most (hopefully) pediatric endocrinologists and their respective diabetes team players (nurse specialist, nutritionist, social worker, psychologist) are more in tune than the adults endocrinologists regarding the unique circumstances that newly diagnosed patients have as well as the stresses placed upon the family and the nuances to coordinate the care with school nurses, coaches, etc. Frankly, I think pediatric endocrinologists can be more skilled in managing type 1 diabetes. Adult endocrinologists often can have more experience in type 2 diabetes.

The training is a bit different given that pediatric endocrinologists generally first trained for three years as pediatricians before seeking out additional training (typically three more years) of only pediatric endocrinology. Adult endocrinologists generally are adult internists first, followed by two to three years of adult general endocrinology.

However, all this might be unhelpful to you. In this day and age, it is possible that your insurance company influences where you seek your care. I know that some pediatric endocrinologists do not take “new” patients at age 18 years. Some some centers don’t accept such patients over 16 years, but allow they to stay until college if they are already established patients in a practice. You might ask your primary care doctor (pediatrician, family physician, etc.) for a referrall to a specialist.

DS

[Editor’s comment: And I am an adult endocrinologist — with the opposite opinion! Adult endocrinologists are very used to self-referrals of young adults with type 1 diabetes — frequently because these people have moved into a new community to attend college or because of marriage or new employment. Or because the patient is extremely uncomfortable with continuing in a pediatric-oriented diabetes program, frequently at a very cute, but very child-oriented building.

Of course, sooner or later, you’ll have to make the transition to an adult endocrinologist. When you do is pretty much your decision (with the caveats that Dr. Schwartz mentions). Finding a doctor (and diabetes team) that you are comfortable with is more important then whether their practice is mostly pediatric or mostly adult.

WWQ]