In the UK there are 3.2m people with diabetes and it is estimated that a further 630,000 people have the condition but have not been diagnosed. So it’s no surprise that diabetes hits the headlines on an almost weekly basis.
With more than £2m spent on diabetes drugs every day in primary care it is important to understand how your role as a dentist is key, not just in helping diabetic patients manage their condition, but also as a team leader, helping raise awareness within your practice.
As a dentist you are well aware of the impact type 2 diabetes has on periodontal disease, and the risks of sugar to patients’ oral health – as well as its effect on their overall health and wellbeing. As Public Health England’s Delivering Better Oral Health: an evidence-based toolkit for prevention (DBOH) states: “Lowering the amount and frequency of sugars consumed will have wider health benefits, preventing weight gain and obesity which in turn will reducing [sic] the risk of heart disease, type 2 diabetes and some cancers.”
The DBOH document also suggests that clinicians should offer dietary advice and practical help to patients in an attempt to promote good oral and general health. For instance, it suggests dentists invite patients to keep a diet diary to share in future appointments.
Screening
Diabetic patients arrive in the dentist’s chair with their own set of clinical challenges. As health care professionals it is as important to help these patients manage their diets to control any negative impact the disease has on their periodontal status, as it is to help every patient assess their sugar intake.
Along with GPs, dentists are on the frontline for diabetes screening and, by offering a health monitoring service to
patients, you add value.
Some dental practices offer screening opportunities in the form of blood glucose testing (BGT). This is good news since a recent study suggests that most patients attending routine dental appointments would support this, and would be willing to discuss the results afterwards.
Heightened risk
A number of factors have been suggested as increasing an individual’s risk of developing diabetes – some of which are controllable, but others are more difficult to manage. And so, even though the most overwhelming risk factor for type 2 diabetes is family history, there are a variety of everyday risk factors that could increase the chances of developing the condition. These include being overweight, a sedentary lifestyle and a poor diet.
According to Diabetes UK stress has also been proven to instigate changes in blood sugar levels – which can cause problems for people with diabetes. A study found that those under high pressure at work, who felt that they had little control over their activities, were at a 45 per cent higher risk of developing type 2 diabetes than people who were subjected to less work-related stress.
Therefore, as a responsible health practitioner and employer, you could also help your team by raising awareness of the condition and its controllable risk factors. Diabetes UK offers such training and awareness courses including:
- Presentations to raise awareness of diabetes.
- Risk assessments for employees.
- Display stands with information on diabetes, healthy eating and physical activity.
Additionally, Nicola Jeffrey an acute services specialist dietitian at Medway Maritime Hospital, says: “Weight gain has been shown to be associated with insulin resistance. Promoting weight loss to achieve a healthy body mass index (BMI) can, therefore, aid glycaemic control in patients with type 2 diabetes. The ‘Eatwell Plate’, produced by the Department of Health, can be used as a visual guide for patients aiming to follow a healthy, well balanced diet. Following this guide is beneficial both in terms of achieving weight loss and reducing the risk of cardiovascular disease.”
She adds: "Participating in regular physical activity, of at least moderateintensity, benefits glycaemic control and is also advantageous for cardiovascular health.”
Unaware
Pre-diabetes is the state in which some, but not all, of the diagnostic criteria for diabetes are met. By simply losing a bit of weight, quitting smoking, having a healthy diet and increasing their physical exercise, people with prediabetes could reverse the condition and reduce their chances of developing type 2 diabetes by up to 60 per cent.
One way of doing this is by having an NHS Health Check that invites adults in England, aged 40 to 74, without a pre-existing condition, to have a health assessment that aims to identify those at risk of the serious, but potentially avoidable, condition. With the prevalence of diabetes at an all-time high the benefits could be significant.
Health insurance
Diabetes can also affect your ability to obtain health insurance and the terms you may be offered. Dentists’ Provident’s head of underwriting and claims, Bryan Gross, said, "When considering an application for cover from a prospective member who suffers from type 2 diabetes, we pay particular attention to the applicant’s recorded control of their blood sugar, which may be achieved by medication or lifestyle changes. Our decision to offer them terms will depend largely on a demonstration of good long term control. If such control can be demonstrated this will have a favourable impact on our decision."
Dentists’ Provident’s chief medical officer, Dr Robb, supports this stating, “Insurability depends crucially on the control of risk factors such as high blood pressure and cholesterol levels, as well as the diabetes itself. Smoking doubles the risk of heart disease - as does kidney disease when it is due to mismanagement of diabetes. The most common cause of going blind in those of working age is poorly controlled diabetes.”
With us all working together we can commit to improve the nation's awareness of the risks of diabetes and by improving the educational information available, as well as providing screenings, we could work towards preventing the disease and its associated costs.
References available on request.