From Detroit, Michigan, USA:
I was recently diagnosed with diabetes and am trying to determine what type of physicians I should see. I am currently going to a Family Practice program that is affiliated with a teaching hospital. Currently, I am scheduled to see a resident under supervision of a full-fledged [full-time] physician for my ongoing care.
I am also scheduled to see a Nurse Practitioner for my diabetes education. Is this sufficient? Also, I requested an antibody test and was told that it is very new and that they didn't have the knowledge yet to perform the test. Is this an appropriate response or red flag about using this particular family practice program?
If you are already fairly sure of your ability to manage your diabetes and especially if you can have telephone access to the Resident Physician outside of clinic visits then the present arrangement may work well for you. You should remember though that the Resident is probably going to change next July and that a Family Practice clinic is less likely to be familiar with some of the refinements of achieving meticulous control (e.g., the use of the new substituted insulins, intensive insulin therapy and the use of pumps.)
Recognising that you may have insurance constraints on where you go, you might prefer to be looked after by an endocrinologist in private practice; the Department of Endocrinology in the associated teaching hospital should be able to suggest names and you should ask the resident to help you with this.
Finally, teaching hospitals often have diabetes teams consisting of one or more diabetologists working with nurse educators and a nutritionist, a social worker and sometimes a clinical psychologist. Such a team approach may be particularly supportive in the first year or so of having to deal with diabetes.
Some patients find it helpful to go just once a year to a special center, depending on less elaborate arrangements for the rest of the time.
If you are using insulin therapy, it is much more important at this stage to concentrate on being in really good control than it is to know if you are Type 1 or 2. (If you are under 30 and on insulin you are probably Type 1 [and antibody-positive] and if you are on oral medication you are probably Type 2 [and antibody-negative].)
[Editor's comments: Measurement of antibody levels is still largely at a research level of development; many university-based pediatric endocrinology centers are now doing them routinely (mainly to gather research data, although to some extent to help answer patients and families concerns). Private-practice endocrinology offices will occasionally obtain these antibody tests, sometimes through contacts at research labs, and sometimes from commercial laboratories. I would guess that most general physicians don't have adequate information to decide when/whether to do such testing.
Original posting 27 Jan 97
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