How does Diabetic specialist clinic work?

Question

I am from IT domain and would like to seek some help on certain medicine related questions

I would like to know how does Diabetic specialist hospital/clinic work for Diabetic patients when compared to any other non-specialist hospitals (for treating diabetic patients)

1) Why do people visit specialist clinic? What is special here? Isn't it because primary care physician is not experienced enough in treating diabetes?

2) It's not necessary/mandatory for a patient to visit diabetes specialist clinic when he could get the treatment from any primary care physician. Am I right?

3) Let's say we have patient A who has been diagnosed for diabetes and been referred to a diabetes specialist clinic by his primary care physician. So Am I right to understand that patient A will keep visiting diabetes specialist clinic only for complications related to Diabetes like blindness, cataract, nephropathy etc. or can he visit for anything (medical condition or whatever) unrelated to diabetes?

4) Let's say we have a database of patients from diabetes specialist clinic. This database will only contain info about their visits to diabetes specialist clinic, complications diagnosed for diabetic patients,Drugs prescribed for diabetes complications etc.

5) For example, if I look at the database for T2DM and T1DM drugs (drugs for T2/t1 + associated complications), does it mean all patients (100%) who visited the diabetes specialist clinic will have this info? Because they all are diabetic patients? They ought to have these drugs. Can a patient be treated without prescribing drugs?

6) Is it possible that patients visit diabetes specialist clinic but may not have the T1/T2 drugs? But they are prescribed other drugs unrelated to T1DM and T2DM?

If yes, for what sort of conditions do they get prescribed for? Is it possible that diabetic patients contain more than 80% of NOT T1 and T2 drugs.

Can you help me with this?

Answer 1

You pretty much answered your questions, except for 5 and 6.

1) Diabetes is a serious disease, so it needs to be diagnosed accurately and complications detected early (some people will already have complications at the time of first diagnosis). All this requires investigations for which a primary doctor doesn't have equipment/experience and time. Also, from all available drugs, a specialist (endocrinologist) needs to figure out an exact type and dose of a drug appropriate for a given patient, which may involve a stay in a clinic.

2) The exact diagnosis should be given by an endocrinologist when possible. When appropriate treatment is prescribed by a specialist it can be then monitored by a primary doctor - which is the usual practice.

3) Yes, a patient will visit a clinic for complications, but because a patient may not be able to detect some complications early enough, a specialist may ask a patient to have a control once a year, for example, even if a patient doesn't have any complications. A common reason to visit a clinic is also to ask for a change in treatment regime (for other types of drugs/insulin).

4) A specialist of any kind should have access to a complete medical record of any patient visiting him/her. Some diabetic complications need exact diagnosis by other specialists (cardiologist, neurologist...) and they are these specialist who can prescribe appropriate drugs.

5) and 6) A patient with diabetes type 2 (but not likely type 1) visiting a diabetic clinic may have no drugs prescribed at any time and can be treated solely by a diet and other lifestyle measures. Some patients may initially get some drugs, which can be later discontinued, because they don't need them any more. And some patients will have no drugs for diabetes, but for other conditions, like high blood pressure, prescribed by an endocrinologist or other specialists and all those drugs should be in a database accessible to an endocrinologist. It is also possible for an endocrinologist to prescribe non-diabetic drugs, for example:

• for high blood pressure
• for diabetic neuropathy
• for bowel issues (common in diabetes): prokinetics
• antibiotics

If you say that diabetic drugs include only oral glucose-lowering drugs and insulin, then, yes, it's possible that, in the database, you see 80% of drugs that are not strictly for diabetes.