World Diabetes Day—A dental perspective
LEIPZIG, Germany: Although most of the world’s population continues to focus its attention on the COVID-19 pandemic, it is now more important than ever to raise awareness of other diseases that may significantly affect health. This Saturday, 14 November, marks World Diabetes Day—the birthday of Sir Frederick Banting. Almost a century ago, Banting and Charles Best co-discovered insulin, a peptide hormone that helps control blood glucose in people with diabetes. The International Diabetes Federation (IDF) and the World Health Organization (WHO) chose the date in order to shed light on issues that are relevant to diabetes prevention and to bring public and political attention to the disease.
According to IDF, 463 million adults were living with diabetes in 2019, and the number is expected to rise to 578 million by 2030. Unfortunately, one in two adults with diabetes remain undiagnosed, the majority of whom have Type 2 diabetes, which is characterised by the body’s inability to produce and use insulin. Just in 2019 alone, 4.2 million people died from the disease. That is why it is of paramount importance to spot its early warning signs and promote testing.
This year’s theme
Each year, the World Diabetes Day campaign focuses on a dedicated theme that runs for one or more years. This year’s theme is “The Nurse and Diabetes”. The IDF believes that nurses play a crucial role in supporting people living with diabetes and that they should be provided with better education and receive adequate funding from governments.
According to WHO, there are currently 27.9 million nurses worldwide, and nurses account for 59% of all health professionals. Despite the high numbers, there is a rising nursing shortage, and WHO reported that the global shortage of nurses in 2018 was staggering—approximately 5.9 million. To overcome the shortfall in the profession by 2030, the number of trained and employed nurses ought to grow by 8% a year, WHO noted.
“As the number of people with diabetes continues to rise across the world, the role of nurses and other health professional support staff is becoming increasingly important in managing the impact of the condition,” a statement on the campaign’s website reads. “Nurses are often the first and sometimes only health professional that a person interacts with and so the quality of their initial assessment, care and treatment is vital.”
Dentistry and diabetes
There is a well-established link between diabetes and periodontal disease. In the first quarter of 2020, Dental Tribune International reported on a study that associated frequent toothbrushing with a lower risk of developing diabetes. The same study also found that people with a higher number of missing teeth have increased chances of developing new-onset diabetes.
Dentists often unknowingly treat people who have a high risk of prediabetes. In two recent studies, researchers examined how close collaboration between dental professionals and other health professionals could help effectively identify the disease in a dental setting. The first study was conducted in Australia and involved 801 patients from 51 dental practices across the country. The researchers concluded that screening patients for Type 2 diabetes in the oral healthcare setting could be highly effective and that it could, indeed, play a significant role in improving an individual’s systemic health. However, they noted that, in order to function properly, the screening of patients should include effective referral pathways to and from general practitioners as well as follow-ups.
In a similar study, researchers aimed to synthesise the existing literature that supports identifying people with an increased risk of or suffering from undiagnosed non-diabetic hyperglycaemia or Type 2 diabetes in a dental setting. The researchers noted that, besides severe periodontitis, glycaemic status also has a direct correlation with oral health and explained that poor glycaemic control affects periodontal health and could lead to tooth loss and associated psychosocial sequelae.
“It is in the interests of dental teams to know whether their patients have NDH [non-diabetic hyperglycaemia] or undiagnosed T2DM [Type 2 diabetes mellitus] due to the impact of both upon periodontal stability and treatment outcomes,” the researchers wrote. “Given the interrelationship between these two chronic, non-communicable diseases, raising awareness of the NDH/T2DM status of patients in the dental environment will enable dental teams to better target their prevention and management strategies in order to improve oral health. Moreover, earlier detection of both conditions will facilitate improved systemic health outcomes for these individuals by facilitating appropriate prevention and interventions, further demonstrating the role that dental teams can play in assisting with management of the growing health and economic burden of T2DM.”
The findings showed that dental professionals and their teams, including dental hygienists and dental students, had a positive attitude towards assessing the risk of patients for non-diabetic hyperglycaemia or Type 2 diabetes and were thus willing to conduct the necessary screening. Additionally, patients were found to strongly support tests that yield immediate results. The researchers concluded that the main barriers to undertaking diabetes screening in a dental setting were “time, adequate training, support of the dentist or dental practice owner and patient willingness”.
Link between diabetes and SARS-CoV-2
According to Diabetes UK, the fact that a person has diabetes does not make him or her more prone to contracting SARS-CoV-2. However, if such a person does become infected, he or she could be more at risk of developing complications, which, in turn, make the diabetes harder to manage.
Additionally, it is stated on the website that the risk of death from SARS-CoV-2 is higher for those from Black, Asian or minority ethnic groups, for older people, for those whose body mass index is over 30 and for those who have a history of high haemoglobin A1c or have health complications.
The overall risk of dying from COVID-19 is very low. However, recent data from NHS England showed that diabetes patients who are hospitalised owing to the virus have an increased risk of dying compared with people who do not have diabetes. According to the data, the majority of COVID-19-related deaths in patients living with diabetes have been in the elderly. Very few deaths have been recorded in those under the age of 40 and none in children.
Editorial note: The second study, titled “The role of the oral healthcare team in identification of Type 2 diabetes mellitus: A systematic review”, was published in the March 2020 issue of Current Oral Health Reports.