Diabetes is currently reaching epidemic proportions in the United States with over 20 million persons affected in this country. The cost of healthcare for a person with diabetes in the U.S. doubled from 1997 to 2002 and now has reached $132 million.
In North Carolina, from 1995-2000, there was a 42% increase of people reported as having diabetes. By 2002, about 600,000 people were reported as having diabetes in the state. The incidence is higher in Eastern North Carolina given the high percentage of minorities, the high prevalence of obesity and substandard health care in much of our rural area.
This is certainly bad news for the health of our nation and our area.
Why Primary Care Physicians...
The good news is that thanks to medical research, we are undergoing an unprecedented explosion in the development of new treatments for patients with diabetes. What is ironic and most unfortunate is that at this very time we are facing a serious shortage of diabetes specialists in the U.S. and in Eastern N.C. in particular.
Most diabetologists are endocrinologists, i.e., physicians who have been formally trained in internal medicine or pediatrics and have completed an additional two or three year fellowship in either adult or pediatric endocrinology to develop an expertise in diabetes. Unfortunately, true diabetes specialists may be considered an “endangered species” with the dwindling ranks of endocrinologists.
Given this situation, it is not surprising that primary care physicians manage over 90% of patients with diabetes. However, modern management of diabetes requires training, including education on the use of a team approach that includes certified diabetes educators (CDE)s, i.e., nurses, dieticians and pharmacists, plus podiatrists and social workers/psychologists.
The One-Year Fellowship
To better prepare physicians to care for this growing and complex patient population The Brody School of Medicine of East Carolina University (BSOM) and Pitt County Memorial Hospital (PCMH) in conjunction with the ECU Diabetes and Obesity Center has sponsored a one-year diabetes fellowship to primary care physicians since 2004. This innovative and successful program is open to physicians who have successfully completed their training in internal medicine, family medicine, or med-peds.
Fellows intensively study diabetes, lipids, obesity and nutrition for one year as a PGY-4 resident. The PCMH office of Graduate Medical Education administers the program. The BSOM adult and pediatric endocrinologists (and other active diabetes providers) will provide state of the art training in both the BSOM Clinics and the inpatient setting at PCMH as well as opportunities at sites within communities in eastern North Carolina.
Optional aspects of the fellowship will include additional concentration in nutrition, obesity, pediatric diabetes, diabetic foot care, inpatient diabetes management, gestational diabetes and high risk pregnancy, type 1 diabetes (and insulin pumps), bariatrics and geriatric diabetes.
Concentration in these areas will depend on the interest of the fellow and the availability and interest of supervising faculty in their areas of expertise.
Candidate selection will be a competitive process and based on prior academic performance and recommendations from the residents’ supervising faculty/attending physicians.