Subspecialist Care Improves Diabetes Outcomes

The ultimate goal of the care of diabetic individuals is to reduce complications and prolong high quality of life. In view of the soaring increase in prevalence of this devastating illness, we as a society are obliged to “pull out all the stops” to identify disease early, prevent its progression, and provide the best care for those in need of treatment. It has become axiomatic that the best way to provide care for patients is the team setting, with substantial emphasis on the role and responsibility of the patient himself. The role of the specialist in caring for people with diabetes is a particularly timely issue in view of the rapidly escalating disease prevalence and the shrinking pool of endocrinologists. The solution may be to train more specialists, distribute their services differently, or use new approaches to assist already overworked primary physicians or other health care providers.

The article by Zgibor et al. (1) in this month’s issue of Diabetes Care supports the contention that specialist physicians and clinics contribute to better outcomes for patients with type 1 diabetes. The study demonstrated that in a large population of 429 childhood-onset type 1 diabetic patients who were followed prospectively over a period of 10 years, a longer duration of time spent in specialist care resulted in a reduction in the development of overt nephropathy, neuropathy, and coronary artery disease. Although the study is limited in that some of the information was obtained by patient questionnaire, the information was validated by medical record review, providing reassurance of the accuracy of responses. After correcting for a number of variables that could influence outcome, including patient demographic characteristics, duration of disease, and comorbidties, significant differences in outcomes persisted.

The current work is vital because it reports the result of clinically important long-term disease outcomes. …