Paediatric diabetes and endocrinology - sub-specialty

Day to day there is great variety in the work, it's diagnostically challenging, there is huge therapeutic potential and with continuity of care we really get to know the children and young people we look after.

Dr Rathi Prasad, Consultant Paediatric Endocrinologist in London

1. What makes a paediatric endocrinologist?

A paediatric endocrinologist is a clinician who has special expertise in looking after children and young people with hormone disorders. These can affect growth or pubertal development and have significant effects on a child’s physical and emotional well-being.

The conditions managed can include normal variations in growth and puberty; over or under-activity of the pituitary, thyroid and adrenal glands; endocrine-related obesity; more complex disorders of sex development; and metabolic bone disease.

Paediatric endocrinologists link closely with other tertiary specialties, including surgeons, gynaecologists, geneticists and adult endocrinologists, to provide coordinated and comprehensive care. Many paediatric endocrinologists are actively involved in clinical research.

They are also involved in managing children and young people with diabetes mellitus. This entails developing expertise in optimising blood glucose control to minimise future complications, intensive insulin regimes, continuous glucose monitoring systems (CGMS), and continuous subcutaneous insulin infusions (CSII).

2. A day in the life of a paediatric endocrinologist

By Dr Rathi Prasad, Consultant Paediatric Endocrinologist in London

"On a typical on-call day, I start with a ward round of children admitted under our team. This may for instance involve meeting a young person with a new diagnosis of Type 1 diabetes or a baby admitted with adrenal insufficiency. We frequently give endocrine consults for children and young people admitted across the hospital under other teams, with our rounds also taking us to the neonatal and paediatric intensive care units, as well as remote consults from across the region.

"After the ward round, I head to outpatients for my clinic. I look after children with a wide array of endocrine problems, diagnostically challenging and ultimately there is huge therapeutic potential. I love the continuity in my clinic work, looking after young people, in some cases from birth through to adulthood. Our diabetes clinics give us the chance to use state-of-the-art technology in our care.  

"My afternoon may include for instance the Difference in Sex Development (DSD) meeting where we carefully plan the best care for our young people with complex conditions with colleagues from different disciplines including for instance urology and psychology.

"I round up the day catching up with my team to ensure the plans for the day have been met and preparing for the next day.

"Within the specialty there is an opportunity to carve out a career that really suits you. At the start of my consultant career, I worked less than full-time (LTFT), giving me the opportunity to spend more time with my young family. I have a deep love of research and my working week is now split between my research team at the university and the clinical teams at the hospital. There is scope to manage your time carefully which importantly affords me time to enjoy my life outside work!"

3. How and where to experience diabetes and endocrinology in your early medical career

Whilst it is great to have the opportunity to have a training placement in the specialty, we appreciate this is not always possible. Try and get a taste of what it is like to work in the subspecialty, whether you are currently based in a district general hospital or tertiary children’s hospital:

• Attend some paediatric endocrinology or diabetes clinics. Get in touch with the clinical lead in your tertiary centre or the consultant with a specialty interest in your district general hospital.
• Get involved in some quality improvement projects relating to the specialty. Again, local leads can signpost you to suitable projects giving you the opportunity to learn about an area in the specialty in greater depth. 
• Attend regional study days in the specialty. All the regional Paediatric Endocrinology Centres hold regular educational meetings/ study days. Get in touch with your local one and see whether you can attend. There is often scope to join in virtually. 
• Attend a national meeting such as the British Society of Paediatric Endocrinology and Diabetes (BSPED). This provides a great opportunity to meet the teams working in the specialty nationally and hear about the work that they are doing around the country. If possible, submit an abstract to present your work! 
• Get involved in endocrine/ diabetes research. If you’re someone who finds research exciting get in touch with your regional centre or take a look on the BSPED website for opportunities to get involved in research as a trainee.

4. Applying to a diabetes and endocrinology programme

We are looking for motivated enthusiastic trainees who have made a clear effort to demonstrate that they have proactively sought to gain some experience in the specialty.

Transferrable skills including evidence of teamwork, and a commitment to service development through audits or quality improvement projects. Where possible show evidence of disseminating the findings of your projects, through presentations at regional or national meetings.

Paediatric endocrinology requires significant attention to detail and an ability to express complex concepts well. Evidencing these skills in your application could include teaching activity or successfully preparing material for presentation or publication.

5. Information for diabetes and endocrinology trainees

For further information about the sub-specialty, you can get in touch with the following:

• Clinical leads and current trainees within the sub-specialty in your local or regional centres
• Trainee representatives in the diabetes and endocrinology CSAC
• Members of the diabetes and endocrinology CSAC
• The BSPED website includes a dedicated section for trainees highlighting useful training opportunities and courses

It’s always a good idea to speak to a number of people training and working in the sub-specialty to get a real sense of what a career in diabetes and endocrinology will involve and signpost you to useful opportunities. It is always pleasing to meet trainees who are interested in your sub-specialty so you are likely to find that people are more than happy to spend a bit of time with you to chat about their experiences or give useful advice.

External links

To find out more about diabetes and endocrinology, the CSAC recommend the following websites as useful resources:

• British Society for Paediatric Endocrinology and Diabetes
• Association of Children's Diabetes Clinicians (ACDC)