The good news is you don’t have to go it alone: You can enlist a battery of professionals to show you how to get on track and stay there. Properly controlling diabetes pays off in how you feel today — and in the future. Lower HbA1C, blood pressure, “bad” LDL cholesterol, and BMI may increase the life expectancy of the average U.S. person with diabetes by three years, research, such as an investigation published in April 2022 in JAMA Network Open, has shown. “We know that type 2 diabetes affects most systems of the body. You’ll never find one professional who is an expert in all of those systems,” says Nicole M. Bereolos, PhD, MPH, CDCES, a psychologist and certified daibetes care and education specialist in Dallas. Dr. Bereolos was on the board of directors for the Association of Diabetes Care and Education Specialists from 2018–2021. It may feel frustrating to have five or six providers, she says, but each of these healthcare professionals offers a different resource. “Rather, I want people to reevaluate this thought and, instead, think about optimizing care and doing the best you can with the resources available,” she says. Of course, it’s important to note that who you see, and how often, may come down to your insurance coverage. Costs for copays can add up. And costs to see specialists if they’re only partially covered (or not at all) can quickly become prohibitive. Always check to see what your insurance coverage offers and whether new providers you want to see are in your insurance network. Ultimately, do the best with the resources you have, which includes money, time away from your daily schedule to see these providers, and an ability to get to these appointments via your own car, public transportation, or virtually over a computer with telemedicine. If you have questions about finding specialists in your area, you can tap into a few search tools. A good place to begin is the provider finder through your insurance carrier’s website or app, which can identify those who are accepting new patients. Sesame provides direct-to-patient care through video visits, meaning you pay a flat out-of-pocket fee. And Healthcare Bluebook specializes in accurate information on what your visit will cost, so you can shop around for providers. If time and travel are concerns, video visits can be a great option in certain cases. Because of the pandemic, many providers offer video visits when in-person care is not needed. There are also apps you can use, like Teladoc, MDLive, and Doctor on Demand to facilitate your virtual medical care. These can be used out of pocket, but check to see if your insurance covers the use of a virtual doctor visit app. With all that in mind, here’s a list of the healthcare providers you’ll need on your team as you take up the challenge of managing type 2 diabetes.
1. Primary Care Physician for General Health Concerns
This is the person you’ll see for regular checkups, concerns that are outside the scope of diabetes, and routine care like vaccinations. When it comes to diabetes, however, the PCP plays a critical role as the central coordinator of your care, says Bereolos. That means he or she will recommend that you see a specialist for specific issues that arise, follow up to make sure that you’ve seen that person and understand what treatment you’re being offered, and help you adhere to your care plan. They should also keep a complete list of all the medications (Rx and OTC) and supplements you are taking.
2. Endocrinologist to Help With Blood Glucose Management
This doctor treats diabetes and other diseases of the endocrine system, and they can be especially important if your PCP does not work with many diabetes patients. This doctor will help you manage your blood sugar. They will assess the need for a blood-sugar-lowering medication and determine the right medication and dose for you. As the American Medical Association notes, because many of these diseases, including diabetes, are lifelong, “endocrinologists may have long and close relationships with their patients.” While this is an important doctor to have on your team, know that a June 2020 article in the Journal of Clinical Endocrinology & Metabolism documented a shortage of practicing endocrinologists, and this can make wait times for an appointment long. To find an endocrinologist who specializes in diabetes in your area, use the Endocrine Society’s tool to locate one by zip code and subspecialty.
4. Registered Dietitian-Nutritionist to Build a Diabetes-Friendly Diet
A significant part of diabetes management is good nutrition, according to a consensus report published in April 2019 in Diabetes Care. This involves knowing what to eat and avoid — and how to fit in the foods you love while keeping your blood sugar in check. A registered dietitian-nutritionist (RDN) can help with this, in addition to helping you meet other health goals such as weight loss or improved blood pressure and cholesterol. Importantly, they can assist you in trying specific diet plans, such as the ketogenic diet or intermittent fasting, in a safe way. Ideally, you will work with an RDN who is also a CDCES.
5. Certified Diabetes Care and Education Specialist (CDCES) to Create a Healthy Lifestyle
This certified healthcare professional will help you develop a diabetes management plan, as well as put lifestyle changes into practice. “A CDCES usually has a lot more time to spend with the person with diabetes than a PCP. Appointments with a CDCES are typically up to an hour,” Bereolos explains. “This really allows for more personalized care so that you can succeed in reaching your goals.” Many CDCES professionals are also RDNs, meaning they can work closely with you to develop healthful eating habits to manage diabetes successfully. Some professionals who hold the CDCES credential, like Bereolos, are trained in behavioral psychology, a specialty that offers additional perks for patients. “Working with a psychologist can help to address some of the challenges in living with diabetes,” she explains. They also serve as an accountability partner. “These are professionals who want to be your cheerleader; they want you to succeed,” Bereolos says. Diabetes educators are often employed by hospital systems or in private practice. Find one in your area through a referral from your PCP or via the Certification Board for Diabetes Care and Education locator tool.
6. Dentist to Monitor Gum Health
Care of teeth and gums is vital for everyone, but it’s especially so if you have diabetes, because periodontal (gum) disease is a common complication, per the American Dental Association. In fact, treatment for gum disease may also improve blood sugar control, according to the organization. Talk to your dentist about how diabetes may affect your dental checkups.
7. Podiatrist to Treat Foot-Related Diabetes Complications
This practitioner specializes in problems in the lower legs and feet, and will help you watch for and care for any complications in your lower extremities. Complications from diabetes account for more than 100,000 lower limb amputations each year, according to the American Podiatric Medical Association. Seeing a podiatrist to monitor and treat any foot problems decreases the risk of amputation by as much as 85 percent, the organization says. Bonus: Some podiatrists also have the CDCES credential, says Bereolos.
8. Ophthalmologist to Prevent Eye Diseases Caused by Diabetes
Your eye specialist will help you maintain healthy vision and monitor you for any complications caused by elevated or uncontrolled blood sugar, including diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma, according to the American Academy of Ophthalmology. The Centers for Disease Control and Prevention (CDC) recommends that people who have diabetes get a dilated eye exam annually.
9. Your Inner Circle to Support Good Habits
Let your loved ones know what’s going on with your health (to the degree you feel comfortable) and how they can help you relieve the burden of a diabetes diagnosis. “If they offer a source of positive support, friends and family can buffer some of the stress that comes from managing diabetes,” says Bereolos. In other words: You’re not alone.
10. Support Groups to Share Ideas on Living Well With Diabetes
Support groups, most of which are virtual right now, can connect you with your fellow people with diabetes (PWDs) who understand the struggles and challenges and can offer tips and strategies for a healthy life. Bereolos especially likes DiabetesSisters. The American Diabetes Association has a great community support channel with helpful forums for those living with type 1 or 2 diabetes and their caregivers. Additional reporting by Margaret O’Malley.