You might assume that you will get better care when you spend extra time and extra money to see a medical specialist. But is that really true?
Not always. Generalists-such as internists, general practitioners and family physicians-have a broader, more holistic view of the patient's condition and provide integrated care, but they lack the in-depth knowledge that specialists have in their area of medicine. Specialists may provide more fragmented care and order unnecessary tests and more procedures that are risky, studies show.
So when does the benefit of a specialist's added expertise outweigh the problem of sometimes disjointed medical care and excessive testing, especially when you have a chronic condition such as diabetes?
Rule of thumb: Specialists are generally preferable when a single medical condition that requires expert knowledge dominates all other medical concerns, such as a cardiologist treating an acute heart attack or an oncologist prescribing chemotherapy. Generalists, however, are usually more suitable when multiple chronic conditions, such as hypertension, diabetes and high cholesterol, are present.
How to get the best care for Diabetes
Where to start: A primary care physician. Type 2 diabetes is largely a lifestyle disease caused by obesity and inactivity. It is initially managed with diet, exercise and oral medications, although insulin may be required as the disease progresses. Cardiovascular risk factors, such as high blood pressure, as well as lifestyle factors and blood sugar levels need to be monitored. Because of the comprehensive care that they require, people with type 2 diabetes should optimally be cared for by a generalist.
Diabetes specialists, or diabetologists, endocrinologists who specialize in diabetes, often take a narrow view. For example, they emphasize the importance of lowering blood sugar, frequently with insulin or oral medications.
Overall blood glucose control is monitored by the AlC blood test, which measures average blood sugar levels over the past two to three months. The major health risks for type 2 diabetics are heart disease and stroke, but lowering blood sugar too much (more than a full point in those at high risk) can actually increase risk for heart attack.
See a specialist when: Your AlC level is consistently above 8. (A normal level is below 6.3.) Elevated AlC increases the risk for some diabetes complications, including kidney disease. A specialist might be better able to lower consistently elevated AlC to healthier levels.
For type 1 diabetes: These patients should almost always see a diabetologist. Type 1 diabetes occurs more commonly in young adults and requires insulin shots from the onset. Also, the use of insulin and insulin pumps, which is recommended for type 1 diabetes patients, requires specialized knowledge.
