"While patients with diabetes traditionally seek care from endocrinologists and/or primary care physicians, these national data suggest that a broader network of clinicians, including cardiologists and nephrologists, may provide additional avenues for care delivery," said corresponding author Muthiah Vaduganathan, MD, MPH, a cardiologist at the Brigham. "This is especially important as the cardiovascular and renal risks associated with diabetes are becoming increasingly recognized, and as new strategies become available to modify disease course."

Vaduganathan and colleagues used 2016 data from the U.S. Centers for Disease Control and Prevention U.S. Diabetes Surveillance System to find the number of new diabetes cases in each state. They also gathered data on the number of practicing endocrinologists, cardiologists, and nephrologists in each U.S. state using 2016 Centers for Medicare and Medicaid Services physician and other supplier public files.

In 2016, 1.9 million U.S. adults were newly diagnosed with diabetes. Colorado had the lowest density of cases (6.2 percent) and Puerto Rico had the highest (13.7 percent). The density of specialists varied widely, but overall, cardiologists were the highest represented specialists and there was a lower ratio of patients with diabetes to cardiologists than to nephrologists or endocrinologists.

"For any patient seeing a specialist, it's important to ask how your diabetes may put you at risk and if there's anything that can be done to reduce risk," said lead author Ravi B. Patel, MD, a former internal medicine resident at the Brigham. Patel is now a clinical fellow in cardiovascular medicine at Northwestern University. "Diabetes is a systemic disease and should be treated as such, with many specialists as part of a team providing optimal care."