Today's program is going to be about dentists should they provide prediabetes preventive care
if there's one thing recurring rant that I have it's that we think we've got a COVID
pandemic but we're clueless because we've had long before the COVID epidemic and during the
COVID epidemic we've got a prediabetes epidemic and everybody seems to be okay with it we seem to
be ignoring it including the folks that should be leading the charge against this problem
are doctors and quite often the rant sounds like it's turning into a criticism of docs
again you know here's the thing I've spent a lifetime recruiting
and managing doctors they're just like everybody else most of them are really good people and they
continue to respond to their environment docs tend to blame some of the problems in detecting
and managing prediabetes on insurance companies and patients and the reality is
insurance companies and patients both as groups they need to level up as well as the doctors
so here we go we're going to talk about prediabetes and participation of another
healthcare group a healthcare group that tends to see patients more often than primary care doctors
better access dentists so despite strong evidence in national policy supporting type 2 diabetes
prevention a little is known about type 2 diabetes prevention in the primary care setting
I would add editorially that we do know that it's not good this article is the National
Survey of Primary Care Physicians knowledge practices and perceptions about prediabetes
so you'll see the term PCP primary care physician PCPs had limited knowledge
of risk factors for prediabetes screening laboratory diagnostic criteria for prediabetes
and management recommendations for patients with prediabetes only 36 percent of PCPs refer
patients to a diabetes prevention lifestyle change program as their initial management approach
43% discuss metformin immediately so in other words you know as is typical
they go straight to the prescription pad sure medications are very appropriate lifestyle is
three times more important I mean we've covered those that research that science multiple times
PCPs believe that barriers to type 2 diabetes prevention are both at the individual level
in other words well I tell the patient to lose weight and he didn't well it's not that simple
and at the system level as well lack of weight loss resources PCPs blame the problem on
patients and insurance companies so if you look at this infographic here from Helio 8 percent
of primary care docs in a survey knew that the ADA recommended a minimum weight loss of 7 percent
25 percent may be identifying patients as having prediabetes when they actually have diabetes and
we see that a lot and it wasn't covered in that survey but as you know we see it time and time
again each month on this YouTube channel and with the practice that quite often docs tell patients
you're fine I checked your A1c and you don't have a problem or more often much more often they say
you're fine I checked your fasting glucose and the patient had full-blown diabetes back to the Helios
survey 42% identified the correct range of fasting glucose to indicate prediabetes less than half
and again this is the doctors so should dentists be providing care in this space you know you say well
if the doctors don't know it maybe the dentists are going to know worse there's a major component
and we didn't cover this yet well let's talk about it let's talk about some of the issues yes the CDC
has recommended that dentists provide prediabetes and diabetes prevention care which should include
at a minimum awareness education and screening and let me read through this this came out of this was
a study done using NHANES NHANES is the National Health and Nutrition Examination Survey
it's become part of the census and what they do is you know just like the census to find out who's in
the country what our trends are in terms of a population they take a subsample of the census
and do full-blown health and nutrition surveys as well as examination because then they can
start understanding a little bit more about the health of our country now let me read this quote
out of that study screening for prediabetes at dental visits has the potential to alert
an estimated 22.36 million adults of their risk for prediabetes or diabetes screening for
prediabetes and diabetes during dental visits has the potential to raise patients awareness
of diabetes risk and prevent prediabetes from progressing to diabetes
for some patients the dental visit may be the only point of contact with the health care system
which heightens the importance of including diabetes risk assessment for patient well-being
dentists are in a unique position in terms of public health they see patients gums all day and
again what do gums have to do with it I mentioned that in the teaser in the beginning gum diseases
associated with heart attack and stroke why is that guess what the major cause of gum disease is
prediabetes it may not be a widely known fact but inflamed reddish and bleeding gums are early
warning signs of prediabetes prediabetes metabolic syndrome insulin resistance are
all parts of the same disease process as type 2 diabetes it's just that a bunch of officials
got together one day and decided we're not going to call it full-blown diabetes until it reaches
a certain level but it's the same disease process this disease process leads to over 75 percent of
cardiovascular inflammation arterial plaque heart attack stroke by far this is the leading cause of
heart attacks which are the number one cause of death and strokes the number one cause of
permanent disability blindness kidney damage and among other things if you're sitting on
the other side of the camera saying wow this doc's pushing it too hard no you're not going to get
real damage until you get diabetes well go back I mean we've covered this in several other videos
go back and look at the research google prevalence of retinopathy eye damage at the time of type
2 diabetes diagnosis in other words and you'll find it it's between one and two-thirds of people
already have retinal disease retinopathy before they have their diagnosis of full-blown diabetes
indicating as you might think if you're thinking rationally prediabetes causes this kind of damage
too it's not something that waits until you get a formal diagnosis of type 2 diabetes well that's
for other people right it's not for me I don't have that problem my dentist never told me that
most dentists don't tell you that they do what my dentist friends call drill fill and bill in other
words they drill they fill cavity and they bill the patient they get so used to seeing bleeding
gums that it just goes right over their head but it's very common as you see here half of American
adults suffer from gum disease so you know you want to connect some dots half of Americans adults
suffer from gum disease half of American adults have prediabetes prediabetes the number one
cause of gum disease if you just look at some of the more subtle information out there things start
to become much clearer in the US the CDC and NIH said yes dentists should become more involved
in prediabetes awareness and care in the UK the Royal College of Surgeons has recommended this
as well other groups support it as well American Academy of Periodontology and the
European Federation of Periodontology have given specific recommendations and they are
practitioners should make patients aware of the evidence that periodontitis or disease around the
tooth gum disease is a risk factor for developing cardiovascular disease periodontitis patients with
comorbidities high blood pressure increased body fat tobacco use etc should see their doctor at
a minimum yearly or be referred to other doctors practitioners should address risk factors in the
dental setting in context of periodontal disease for example diet smoking cessation exercise blood
pressure glucose checks you know as I mentioned before and this came out of another article you
see over here on the right as I mentioned before I understood it when I heard some docs that really
didn't think prevention wise didn't think public health didn't think population-based but I heard
a recent just a couple of years ago a doc who does prevention for a living and they were talking
about dentists getting involved in this space and this quote was what are they doing do they
want to play doctor what can I say to that oh in fact that's a good point for this next slide
so I haven't seen this movie it's not really my taste but it's a great example and I found a blog
recently by a dentist who's talking about that the comment was do you mind if I take a look I'm
actually a doctor yeah well you're just a dentist you're a dentist don't try and get fancy you're
only a dentist unfortunately these quotes are very way too common it implies the dentists are
going outside of their professional practice roles if they provide prediabetes prevention services
this is a negative impression and this negative impression on dentists and their profession
is only the tip of the iceberg this physician elitist approach results in the loss of valuable
prediabetes prevention services as I mentioned on the last slide as in 22 million American adults
not finding out that they have prediabetes you know there's just so many chunks and this
is one of the biggest ones where adults are not finding out about this problem
continue to get great feedback regarding the webinars and here's why you know on the
Internet when you hear a webinar you expect for somebody to try to sell you something we're not
doing that we're trying to tell you something people are coming in with their labs from Quest
inflammation panel OGTT insulin survey response and then they're finding out do
I have inflammation do I have insulin resistance and where does that fit in terms of other folks
we're getting ready to start one for CIMT as well so again people are really
excited about finding out their own status looking forward to seeing you there thanks