We can make a significant contribution to the fight against diabetes mellitus. As health care professionals, this is not our choice to make; it is our responsibility.
It is not possible today to prevent the development of type 1 diabetes mellitus (DM), a disease that affects 1 to 2 million Americans. The lives of these autoimmune or genetically and/or environmentally susceptible people are greatly shortened and are made difficult by severe complications, such as cardiovascular disease, renal disease, blindness and other comorbid disorders.
Eighteen to 19 million Americans suffer from type 2 DM. This type of diabetes, in contrast to type 1 DM, is in many cases a preventable disease. If diagnosed early and treated appropriately, most affected people can lead a "normal" and healthy life. A most alarming development is the emergence of an additional 41 million Americans who are "prediabetic"—defined as having impaired fasting glucose and impaired glucose tolerance.1 These conditions eventually may result in DM unless preventive measures are implemented.
This latest information on the prevalence and incidence of DM in the United States is both grim and staggering.1 In the past couple of years, a 14 percent increase in the number of Americans with DM—an increase in absolute numbers of 2.6 million, from 18.2 to 20.8 million people—has been documented. This means that 7 percent of the entire U.S. population has diabetes.
The past decade has seen a 78 percent increase in the number of people diagnosed with DM. Yet, 6.2 million people with diabetes remain undiagnosed. More than one in every five people older than 65 years has DM, and more than 40 percent of all people aged 40 to 74 years are prediabetic. The lifetime risk of developing DM for all U.S. children born in the year 2000 is one in three.
For specific populations, the risk is even higher—two in five for African-Americans, for example, and one in two for Hispanic females. The global picture is not looking much better. As an example, it is estimated that 60 to 70 percent of all children in China and Japan may be at risk of developing DM.
Diabetes mellitus is the sixth leading cause of death in the United States. Affected people have approximately twice the risk of dying prematurely as do their unaffected counterparts, and their risk of developing stroke or heart disease is two to four times that of nondiabetic people. Stroke and heart disease account for about 65 percent of all deaths among diabetic people. Furthermore, nearly three-quarters of all people with DM have elevated blood pressure. Other serious complications include kidney disease, nervous system disease, blindness, amputations, complications during pregnancies and more advanced periodontal disease.
How to prevent diabetes and reduce the complications associated with this menace is a great challenge, but a challenge worth addressing. With improved blood cholesterol levels, blood glucose levels and controlled blood pressure, the mortality rate attributed to cardiovascular disease can be reduced by 30 percent and the decline in kidney function by up to 70 percent. Routine eye care and foot examinations and timely monitoring of blood glucose levels can reduce blindness and amputations by more than 80 percent. More specifically, every percentage drop in glycosylated hemoglobin A1C can reduce the risk of microvascular complications by almost 40 percent.
Oral infections such as periodontal disease may complicate glycemic control, and, conversely, poor glycemic control can exacerbate periodontal disease. This association highlights the importance of oral health care among patients with diabetes. The U.S. Department of Health and Human Services aims to achieve a goal of 71 percent of all people with diabetes having annual dental examinations by 2010.2 In 2004, 67 percent of dentate adults with diabetes had visited a dentist’s office within the preceding 12 months.3 Use of oral health services varied greatly depending on state and territory, race/ethnicity, education and income level, smoking and health insurance status, and having accessed a course in diabetes management.
Beyond providing direct care, oral health care professionals can play an important role in the life and overall health of patients with DM. We can be part of the diabetic patient’s support network by getting involved in monitoring blood glucose levels and blood pressure, by reminding patients of the importance of having their eyes and feet examined in a timely manner, and by encouraging patients to see their primary care providers on a regular basis and to follow proper nutrition.
Screening patients for diabetes may be in our future. A dental practice with an average of 1,000 different patients per year can be expected to treat annually at least 70 diabetic patients and an additional 140 patients who are prediabetic. The vast majority of these patients will not be aware of their diabetic status. With an older patient population, the number of diabetic and prediabetic patients may be even higher.
Finding patients who are predisposed to developing diabetes and identifying undiagnosed diabetic patients will greatly reduce the complications of this insidious disease. For as long as measuring patients’ blood glucose levels is for the purpose of screening and monitoring—and not for diagnosing or treating—we are not practicing medicine but performing an important task in prevention.
It is incumbent on us as health care professionals to help reduce the incidence of diabetes. We need to establish partnerships with physicians, health care organizations and insurance providers to facilitate referrals, treatment and reimbursement. Given the opportunity, we can make a significant contribution to the fight against diabetes mellitus. As health care professionals, this is not our choice to make; it is our responsibility.
REVISIONS AND REVISIONS
We’re always searching for ways to make JADA more inviting and useful to its readers. This issue of The Journal is a prime—if subtle—example of that continuing quest.
The discerning reader will note a number of changes in JADA’s organization and design, all of them adopted in direct response to feedback from readers, authors and our Editorial Board.
Certain sections have been renamed, reconfigured or consolidated. All personal columns, for example, have been grouped together under the banner heading "Perspectives." And in our Table of Contents, each article is introduced with a key word meant to capture its essence and, we hope, catch the reader’s interest.
Perhaps most obvious, the multiple colors we’d been using in tables and text boxes have been reduced to a single hue—this in response to readers and authors who said the multicolored look of the past made the boxes and tables hard to read.
Beyond mere appearances, the year ahead will bring improvements in content as well. Watch for more about that in a future issue.
—MG
