Diabetes: The ‘silent killer’

Someone is diagnosed with diabetes every three minutes, and dental professionals have an important part to play in that diagnosis and helping people understand the risks and symptoms. Not only are you best placed to note gum problems and periodontal disease that are symptomatic of diabetes, but also because people with diabetes are more likely to have severe symptoms when they contract Coronavirus and an increased risk of in-hospital death.

The facts

More people than ever are at risk of type 2 diabetes in the UK, and if there isn’t a significant change, Diabetes UK (a leading diabetes charity) predict more than five million people could have developed diabetes by 2025. Around 90% of people with diabetes have type 2, the insulin resistant kind that can often be prevented with lifestyle changes, and around 8% of people have type 1, the autoimmune condition.

The costs

Putting it into context, the cost of diabetes to the NHS is over £1.5million an hour or 10% of the total budget for England and Wales. This equates to over £25,000 being spent on diabetes every minute.

The worldwide epidemics of obesity and type 2 diabetes are serious public health issues, and the term ‘diabesity’ is now used to describe the combined adverse health effects. Projections from a paper published in Nature Reviews Cardiology in November 2020 estimate a six-fold increase in adult obesity in the next 40 years and an increase in diabetes to 642 million people by 2040.

There is costly, substantial and constant research being undertaken. For example, Diabetes UK has around 120 research projects across the UK at any one time, but are constantly in need of further funding to do even more.

The risks

A report back in 2010 by Diabetes UK indicated that just over half of those diagnosed with type 2 diabetes the previous year hadn’t even suspected they had it, as they didn’t notice any of the early warning symptoms. Late diagnosis leaves people at an increased risk of developing serious complications such as stroke, heart disease, blindness and kidney disease. They estimate that there are up to half a million people in the UK who have diabetes but aren’t aware of it. This puts dental professionals in a crucial position of responsibility to recognise the symptoms and communicate them to patients.

Diabetes and COVID-19

An article published in The Lancet - Diabetes & Endocrinology in August 2020, shared the results of a study of COVID-19 related hospital deaths of patients in England from March to May, and it showed that patients with type 1 and type 2 diabetes had a significantly increased chance of dying. Another more recent paper published in Nature Reviews Endocrinology in November 2020 found that patients with type 2 diabetes suffered quite severely if they contracted COVID-19 and it could cause hyperglycaemia and increased levels of glucose, that could have a negative effect on their immune system, causing inflammatory responses and death.

It should be noted though that people with diabetes are currently in the ‘clinically vulnerable’ category, not the most severe shielding group, unless they have other conditions or risk factors putting them at further risk.

Dental professionals’ role

As a dental professional, 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. Public Health England’s Delivering Better Oral Health: an evidence-based toolkit for prevention’s section 4 provides healthier eating advice, stating that it should be routinely given to patients.

Screening

A diabetic patient arriving in any dental professionals’ chair has their own set of clinical challenges and, along with GPs, dentists are on the frontline for diabetes screening such as blood glucose testing (BGT) and, by offering a health monitoring service to patients, you’re providing added value to your services. A paper published in the BDJ back in 2014 reviewed patients' attitudes towards screening for diabetes in a dental practice. It indicated that most patients attending routine dental appointments would support this screening, and be willing to discuss the results afterwards.

A research project published in November 2020, conducted in Spain with over 41 dental practices and 1,143 patients over three years, concluded that a simple screening protocol combining a FINDRISC questionnaire and a HbA1c glucose test, identified 96% of patients with undiagnosed diabetes or prediabetes, again, supporting the key role dental practices play in the early detection of diabetes. They also confirmed the view that people with inflammatory gum problems and periodontal disease were more likely to have diabetes.

Heightened risk

A number of factors can, of course, increase an individual’s risk of developing type 2 diabetes, such as being overweight, a sedentary lifestyle and poor diet, however the most overwhelming risk factor appears to be family history, which you keep a record of in practice too. Stress can also contribute to changes in blood sugar levels, and studies have shown that those under high pressure at work have a significantly higher risk of developing type 2 diabetes.

Impact for dental professionals

Being in a highly stressed, often sedentary profession, dental professionals are at risk of developing type 2 diabetes themselves and this can have an impact on health insurance cover including income protection.

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.’

Working together we can improve awareness of the risks of diabetes, and by providing screenings you can play a key role in reducing the incidence and severity of the disease and its associated costs.

References available on request.

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