Diabetes Clinic:

Trainees learn skills related to history taking, examination, assessment and  planning for the ambulatory patients with diabetes and its various presentations of referrals to the subspecialty diabetes mellitus clinic.  Patients seen in this venue include difficult to manage Type 1 and Type 2 diabetes mellitus patients and newly diagnosed patients.  Interaction occurs with the staff available in this clinic (endocrinology, ophthalmology, and psychiatry attendings along with diabetes teaching nurses, diabetic foot nurses and dietitians). The format of the diabetes clinic is a multidisciplinary one and consists of several teaching faculty from the disciplines of Internal Medicine, Pediatrics, Nutrition, Podiatry, Ophthalmology, and Psychiatry.  Patients are seen initially by the trainee.  Patient-based mentored assessment of historical findings, examination and therapeutic plan is conducted with aid of the faculty. Pragmatic and theoretical issues along with diagnostic and therapeutic strategies are discussed. Frequently ethical issues along with economic issues related to patient’s compliance and ability to cope with the disease are discussed in this format. 

The trainee is exposed to the multidisciplinary management of the disease in the following areas:
1) Patient monitoring and treatment objectives in children and adults

2) Acute and chronic complications including

   a) Diabetic ketoacidosis

   b) Hyperosmolar coma

   c) Hypoglycemia

   d) Microvascular and macrovascular disease including

             1)       Diabetic retinopathy

             2)       Diabetic nephropathy

             3)       Diabetic neuropathy

             4)       Diabetic dermopathy

             5)       Coronary heart disease

             6)       Peripheral vascular disease

             7)       Cerebral vascular disease

   e) Infections

3) Gestational diabetes mellitus and diabetes mellitus complicated by pregnancy

4) Patient education

5) Psychosocial effects of diabetes mellitus on patients and their families

6) Genetics counseling

7) Hypoglycemic syndromes

8) Rationale for and calculation of diabetic diets

9) The rationale, indications, performance and interpretation of glucose tolerance tests

10) The utilization and interpretation of glycosylated hemoglobin levels, islet cell and insulin antibody levels in patient management and counseling

11) Prescription of exercise programs

12) Use of insulin in its various forms

13) Glucose monitoring devices

14) Foot care

15) Patient and community education