ABSTRACT
Until the 1970s, the care and investigation of childhood diabetes was pursued by internists, pediatricians, nephrologists, and general physicians. In 1971, it was estimated that visits for diabetes by those 0 to 15 years of age were equally divided among internists, general physicians, and general pediatricians (1). At that time, there were few pediatric endocrinologists, virtually none in private practice, and most of them did not consider diabetes to be an endocrine disorder. The third, 1965, edition of what was then the only textbook of pediatric endocrinology devotes a short paragraph to diabetes mellitus as one of half a dozen causes of hyperglycemia (2). By 1993, pediatric endocrinologists accounted for 35% of all visits of 0 to 21-year-old diabetes patients and nearly half of these were to private practicing pediatric endocrinologists; the remainder were 37% to internists (most likely the older adolescents and young adults) and 28% to general pediatricians (3). In pediatric endocrinology practice, diabetes now accounts for 50% to 60% of the workload (3). The movement of diabetology into mainstream pediatric endocrinology has multiple causes beyond the clinical importance and challenge of the problem, including the scientific excitement about diabetes research (and its funding!), the extensive endocrine physiology that diabetes affects, and the inclusion of diabetes in the accreditation requirements of training programs and board certification for pediatric endocrinology.
