Diabetes Mellitus: Strategies for Providing Comprehensive Care

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Definition:

By: Joann R. Gurenlian, RDH, PHD

Diabetes mellitus is a chronic metabolic disorder that has reached epidemic proportions in the United States. The disease affects 18.2 million Americans, yet approximately one-third of these individuals remains undiagnosed. An additional 41 million individuals have prediabetes. It is estimated that one in three that were born in the year 2000 will have diabetes, and that diabetes will increase by 225% between 2000 and 2050. 1,2

Diabetes is the sixth leading cause of death in the U.S. Among middleaged people with diabetes, life expectancy is reduced by 5–10 years. For the entire population with diabetes, an estimated 13 years is lost by both men and women.1

There are multiple complications associated with diabetes mellitus. In 2000, 37.2% of individuals with diabetes age 35 years and older reported receiving a diagnosis of cardiovascular disease.1 Heart disease and stroke are the leading cause of diabetes-related deaths in individuals with diabetes mellitus. Diabetes is the leading cause of new cases of blindness among adults, and the leading cause of treated endstage renal disease. Severe forms of diabetic nerve disease are a major contributing cause of lower extremity amputations. Aggressive periodontitis is recognized as the sixth complication of diabetes.3 Diabetes can cause risks of birth defects and spontaneous abortions during pregnancy. Further, individuals with diabetes are more susceptible to pneumonia and influenza.

Given these statistics and complicating factors, it is incumbent upon all health care providers, including dental professionals, to be knowledgeable of the signs and symptoms of diabetes, and to participate in programs related to diabetes prevention and control. The purposes of this paper are to provide an overview of diabetes and to present strategies for providing comprehensive oral health care.

Types of Diabetes

There are five types of diabetes mellitus. The most recognized types of diabetes include Type 1 and Type 2. The other types of diabetes include gestational diabetes,secondary diabetes, and maturity-onset diabetes of the young.

Type 1 diabetes was formerly referred to as insulindependent diabetes mellitus or juvenile diabetes. It comprises 5%–10% of all cases of diabetes mellitus and affects young children and adolescents. It is characterized by the marked inability of the pancreas to secrete insulin caused by an immunologically mediated destruction of Β cells.5 Individuals are insulin-dependent and produce no exogenous insulin. If insulin is withdrawn, ketosis and eventually ketoacidosis develops. Ketoacidosis can occur rapidly and can lead to coma and death. The male to female ratio for this disease is 1:1. Caucasians are more affected with Type 1 diabetes than other racial groups.1

Approximately 90%–95% of individuals with diabetes mellitus have Type 2 diabetes. This typically occurs in older individuals with a family history of diabetes; however, it is being seen more frequently in younger individuals due to the rising prevalence of childhood obesity. It reflects peripheral insulin resistance associated with insulin secretory defect, which varies in severity, and is caused by a failure of the beta cells to meet an increased demand for insulin. Individuals with Type 2 diabetes are considered to be insulin-requiring, not insulin-dependent. Type 2 diabetes is more prevalent among Hispanic, African-American, Native American and Asian-American racial groups.1

Gestational diabetes refers to any degree of glucose intolerance with onset or first recognition during pregnancy. Secondary diabetes is caused by other illnesses or medications that lead to destruction of pancreatic beta cells or the development of peripheral resistance. Maturity-onset diabetes of the young (MODY), is a form of Type 2 diabetes that affects many generations in the same family. The onset of this type of diabetes occurs before the age of 25.4

Risk Factors

There are multiple risk factors associated with Type 2 diabetes. Age greater than 45 years is the primary risk factor. This risk is increased when associated with the following risk factors:

  • Obesity
  • Family history of type 2 diabetes mellitus
  • Racial descent
  • History of gestational diabetes or history of delivering a baby weighing greater than 9 pounds
  • History of prediabetes, that is impaired glucose tolerance or impaired fasting glucose
  • Hypertension (>140/90 mm Hg)
  • Dyslipidemia (HDL cholesterol <35 mgdL or triglyceride level >250 mgdL)5

Signs and Symptoms

Classic signs and symptoms of diabetes include polydipsia (insatiable thirst), polyuria (frequent urination), nocturia (urination at night), and polyphagia (extreme hunger). Other signs and symptoms that may appear to be subtler include unexplained weight loss, general fatigue, increased infections, leg cramps, pins and needle sensations in the fingers and toes, impotence, and blurred visions. These symptoms may be overlooked for an extended period of time and contribute to the high number of cases of diabetes that are undiagnosed.5


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