In Your Endocrinology Practice, What Has Changed?

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This changes a lot really even in the 20 years or slightly more that I've been a diabetes specialist. First of all when I first was I was certified in endocrinology there were only two drugs that were available for the management of diabetes, or two classes of drugs. One was insulin and the other was the oldest class of oral medications.

Those were medications like glipizide or glyburide that are still in use, but we now have five or six other classes of medications that are available for diabetes management. So that has been a major change there, and frankly there has been enormous effort expanded by drug companies in the development of new drugs for diabetes, and for obesity management.

Because these things are so epidemic in the country at the moment. The other thing is the availability of finger-stick glucose monitors for people to be able to check their sugars. When I was an intern we didn't have such technology. Actually we had one finger-stick glucose monitor but it was such a new device that it was upstairs in the research unit, and that was in the mid 1980s.

And now they're inexpensive and easily used and you can get a finger stick blood sugar reading in five seconds with very, very little blood, and that's been enormously helpful because really people had to go for in most cases months without any real incite into whether their sugars were well controlled until they saw their physician.

And it used to be routine for example to put people on the hospital to initiate diabetes medications because you were so terrified that you were going to make their blood sugar go too low and the only way to get blood sugar reading was to get somebody come up and draw the blood several times a day.

And I never do that, now I haven't done that in 20 years because a person can monitor their blood sugar at home very well.