Description of specialty
Diabetes and endocrinology is a broad-ranging specialty encompassing the diagnosis and treatment of patients with conditions caused by abnormalities of hormone production or action, and the endocrine glands that produce them. This requires an understanding of the basic mechanisms of physiology and pharmacology, coupled with the ability to improve long-term outcomes for patients through effective disease control, and in some conditions offer cure. Endocrine diseases and diabetes affect every physiological system of the body so specialists need a wide range of skills and expertise.
Endocrine and metabolic diseases, in particular diabetes, are some of the most commonly encountered in the UK population and are increasing in prevalence and impact emphasising the need to continue to improve healthcare delivery in the specialty. This is especially true for diabetes, a chronic long-term condition that requires lifelong management. There is a strong evidence base for the management of disorders encountered within the specialty. Delayed, inadequate or inappropriate treatment leads to poor health, reduced lifespan and increased burden on the health service. Conversely, many of the endocrine diseases encountered within the specialty are uncommon and present special diagnostic and therapeutic challenges.
Diabetes and endocrinology physicians treat patients holistically, with many patients requiring lifelong follow-up. Patient education and self-management are vital to the specialty and there are a number of groups that support this, for example DAFNE (Dose Adjustment for Normal Eating), Pituitary Foundation, Addison’s Diseases Self Help Group. The specialty is primarily outpatient based, however the skills of endocrinology and diabetes physicians are called upon for patients admitted as emergencies as part of the acute take, particularly those with coexisting diabetes or presenting with hyponatraemia, or requiring pre- or post-operative management. Nearly 17% of all hospital inpatients have diabetes (Source: National Diabetes Inpatient Audit).
Diabetes and endocrinology physicians work in teams, including career-grade doctors, doctors in training, ward-based and outpatient nurses, diabetes and endocrine nurse specialists, psychologists, secretaries and managers. For diabetes, the multidisciplinary team (MDT) also includes dietetics and podiatry supported by microbiology and radiology, and with close links to ophthalmology, nephrology, vascular surgery, obstetrics and orthopaedics for the assessment and management of complications of diabetes. For endocrinology, physicians work closely with colleagues in biochemistry, radiology, histopathology and genetics as well as surgical specialties, oncology, nuclear medicine and palliative care. Both diabetes and endocrinology physicians work alongside colleagues in obstetrics and gynaecology and paediatrics. MDT working is key to patient care, and teams are often led by endocrinology and diabetes physicians (see below for more detail on the members of an MDT).
Nearly all physicians practising endocrinology and diabetes are also trained in general internal medicine (GIM), and are members of at least one of the three main specialist UK professional societies: Association of British Clinical Diabetologists (ABCD), Diabetes UK, and the Society for Endocrinology.