The need for more diabetes specialists
(First of two parts)
We have around four million diagnosed diabetics in the country. If we include those with so-called prediabetes—someone with marginal blood sugar values either in a fasting state (fasting blood sugar or FBS) or after eating (post-prandial blood sugar), we’re looking at close to 10 million Filipinos who require medical attention to prevent diabetes and its deadly complications.
Diabetes is really a tricky disease. One who has the problem may remain symptom-free for a long time (15 to 20 years). Slowly but surely though, damage to the heart, brain and leg arteries (macrovascular complications); and to the eyes, kidneys and nerves (microvascular complications) may develop and once it reaches a certain point, the damage to these vital organs may already be irreversible.
That’s the worst part of the story. By the time one is finally diagnosed to have diabetes, serious complications have already developed. Treating the disease can prevent further complications but may no longer reverse the damage to the organs that are already present on diagnosis.
Making the call
Dr. Cecilia A. Jimeno, current president of the Philippine Society of Endocrinology, Diabetes, and Metabolism (PSEDM), and her fellow officers are making the call for more young doctors to train in the field of endocrinology and become specialists in treating diabetes and other hormone-related diseases. A specialist in this field is called an endocrinologist. Dr. Jimeno wrote about the current state of diabetes awareness and prevalence in the country in the April issue of H&L (Health and Lifestyle) magazine.
The PSEDM is aggressively addressing the increasing prevalence of diabetes in the Philippines and sounding the call for interested and committed doctors to fill up the shortage of well-trained and properly certified endocrinologists. If one is a graduate of the specialty of Internal Medicine and has passed the qualifying board exams for it, one may consider applying for a fellowship training in endocrinology. One will likely have a long line of diabetic patients waiting for him/her in the clinic on the first day of private practice.
Like a ‘package deal’
In the Philippines, diabetes ranks eighth as a cause of death. Many with diabetes also have high blood pressure. They cluster together with other metabolic problems like obesity, cholesterol and uric acid abnormalities to comprise what is labeled as the ‘cardiometabolic syndrome’ (CMS). It’s like a ‘package deal’; if one has one of the metabolic problems, there is a high likelihood he has the other metabolic problems as well.
If one includes the heart and brain complications due to diabetes, hypertension and CMS, then this cluster of medical problems is the leading cause of deaths accounting for two out of five deaths in our country.
Looking at the healthcare situation in the country, there is definitely a patient-specialist mismatch. At present, there are only 225 board-certified endocrinologists. This number is definitely not enough to attend to our diabetic population and those with prediabetes. We have to remember that endocrinologists also attend to patients with other hormone-related disorders like thyroid problems, another prevalent medical condition in our country.
So, all our endocrinologists really have their hands full and it’s simply physically impossible for them to treat all diabetes-related problems even if they work 24/7.
Many towns and small cities in the country still have no endocrinologists. This is the reason why even other physicians like family physicians and general internists are treating uncomplicated cases of diabetes.
Master’s program
To fill in the huge gap, the Institute for Studies on Diabetes Foundation (ISDF) has come up with a master’s program in diabetes (Master of Science in Internal Medicine Major in Diabetology), which aims to equip practicing physicians with a more in-depth knowledge about what causes diabetes, its consequences and the various modes to treat it—both as an in-patient (hospitalized) and out-patient (clinic followup). Diabetes-related conditions like obesity and cholesterol abnormalities are also included in the two-year curriculum.
Aside from the ISDF, there are other diabetes organizations including Diabetes Philippines and the newly formed Philippine Society of Diabetologists, all of which aim to train and continually update their members—who are nonendocrinologists—on the latest issues and trends in the management of diabetes-related problems.
Considering the big number of diabetics and the foreseeable doubling of this number in the next 10 to 15 years, it’s mathematically impossible to come up with enough number of certified endocrinologists to meet the increasing demand.
There are currently only seven accredited training institutions in the country for this specialty, namely the University of the Philippines–Philippine General Hospital, Makati Medical Center, University of Santo Tomas Hospital, St. Luke’s Medical Center, The Medical City, Chinese General Hospital, and Chong Hua Hospital.
Together they only produce around 30 new certified endocrinologists yearly. So no matter how you do the math, there’s no way we could address the patient-specialist mismatch in the country if we were to rely only on the seven training institutions plus perhaps several more additions in the next 10 years.
