Easing the burden of diabetes

Maria Perno Goldie, RDH, MS, discusses the findings of a recent Diabetes Coalition of California meeting, and how dental and oral health professionals can apply these insights in any state.

Insulin syringes
Insulin syringes
Diabetes Coalition Of California

Last month, I attended the Diabetes Coalition of California (DCC) Annual Meeting and 2015 Call to Action. We all look forward to taking new steps and moving forward on plans for reducing the burden of diabetes in California’s diverse communities. The DCC is fortunate to have a coalition with enthusiasm and the expertise of a variety of individuals and groups. While the DCC hopes to change the impact of diabetes in California, the strategies can be applied to other states.

ADDITIONAL READING | What's new in diabetes research, care, and prevention?

Treating diabetes in the community
One of the presentations was from La Roux Pendleton, MPH, California Department of Public Health, and Chronic Disease Control Branch. She discussed the Burden of Diabetes in California, a report of the Chronic Disease Control Branch. We learned that more male than female patients have been diagnosed with Type 2 diabetes, and that higher rates are found in Hispanics, African Americans, and American Indians/Alaska Natives. Education also plays a role—the higher the level of education, the lower the incidence of diabetes. Obesity and smoking were also positively related to diabetes incidence. Hypertension was twice as common in individuals with diabetes as those without diabetes (56.5% vs. 24.5%). (1)

Complications of unmanaged diabetes include end stage renal disease, lower extremity amputations, and increased risk of heart disease. Type 2 diabetes prevention and management is vital in order to prevent morbidity and mortality. The California Department of Public Health California Wellness Plan 2014 goals include healthy communities, optimal health systems linked with community prevention, accessible and usable health information, and prevention sustainability and capacity.

The central goal is equity in health and wellness. A five-year (2013–2018), $2.4 million project funded by the Centers for Disease Control and Prevention addresses obesity, physical activity, nutrition, school health, diabetes and cardiovascular disease in a coordinated manner. The project allows for implementation of evidence-based strategies to reduce chronic disease in California.

Other prevention and self-management programs abound:Stanford Patient Education Research Center

The National Diabetes Prevention Program (NDPP)
Diabetes Self-Management Education (DSME) Programs
The Chronic Disease Self-Management Programs (CDSMP) from Stanford University

These programs work! For example, a National Institutes of Health (NIH) Study of the NDPP showed a 58% reduction in risk for developing type 2 diabetes. Individuals took a 16-week curriculum with a monthly follow-up for the rest of the year, including 150 min/week of physical activity. It resulted in a 5-7% loss of total body weight. (2)

The DSME’s programs are designed to support informed decision-making, self-care behaviors, problem-solving and active collaboration with the health care team, and to improve clinical outcomes, health status, and quality of life.

The CDSMP are designed for individuals with chronic health conditions (e.g., diabetes, arthritis). Workshops are led by trained individuals from the community who may share the experience of living with a chronic condition. Leaders help participants develop problem-solving skills and confidence to achieve short and long term goals.

Community health workers (CHWs) are one strategy to address the growing shortage of health workers, particularly in low-income countries. (3) According to the CDC, CHWs “facilitate access to services, and improve the quality and cultural competence of service delivery. They are trusted members of the community or have an unusually intimate understanding of the community in which they serve. CHWs build individual and community capacity by increasing health knowledge and self-sufficiency.” (4)

Prevention in the dental office
What can we do as oral health care professionals in the realm of prevention and early detection of diabetes? A strategy we might employ is to implement systems that facilitate identification of patients with undiagnosed hypertension and prediabetes. A Clinical Diabetes article states that “in the United States, there is a shortage and maldistribution of primary care medical providers, and the increasing number of urgent care clinics that are often operated by mid-level providers adds further evidence to the growing problem of disparities in health care.” (5) Changing demographics will most likely increase the toll of this problem. The article suggests that an effective way “to ease the primary care shortage is to efficiently use the available paramedical labor force that includes nurses, dental hygienists, dentists, and other supplementary personnel as points of entry to primary medical care.” (5) Two recent studies confirmed the suitability and viability of measuring A1C in dental offices and successfully identifying previously undiagnosed diabetes. (6, 7) The screening was shown to be well-received by the dental health care team and patients.

ADDITIONAL READING | The first piece of the systemic puzzle

Dental hygienists and dentists attempt to modify lifestyle habits in patients, such as smoking cessation, and improving poor oral hygiene, which both risk factors for chronic periodontitis. We could certainly partner with the medical workforce in guiding patients and working with them to set goals to assist them in attaining glycemic control. We can also help patients modify their dietary and lifestyle habits to improve their overall well-being.

Are you willing to help lessen the burden of diabetes? I am! Free fact sheets are available to help you here!

References
1. California Health Interview Survey (CHIS) 2011–2012 Adult Survey. UCLA Center for Health Policy Research. http://healthpolicy.ucla.edu/chis/Pages/default.aspx.
2. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403
3. Lehmann U, Sanders D. Community health workers: What do we know about them? The state of the evidence on programs, activities, costs and impact on health outcomes of using community health workers. World Health Organization. http://www.who.int/hrh/documents/community_health_workers.pdf. Published 2007. Accessed February 12, 2015.
4. How the Centers for Disease Control and Prevention (CDC) supports community health workers in chronic disease prevention and health promotion. The Centers for Disease Control. http://www.cdc.gov/dhdsp/programs/spha/docs/chw_summary.pdf. Published March 2014. Accessed February 12, 2015.
5. Elangovan S, Hertzman-Miller R, Karimbux N, and Giddon D. A framework for physician-dentist collaboration in diabetes and periodontitis. Clin Diabetes. 2008;32(4):188-92. doi: 10.2337/diaclin.32.4.188.
6. Genco RJ, Schifferle RE, Dunford RG, Falkner KL, Hsu WC, Balukjian J. Screening for diabetes mellitus in dental practices: A field trial. J Am Dent Assoc. 2014;145:57-64.
7. Franck SD, Stolberg RL, Bilich LA, Payne LE. Point-of-care HbA1c screening predicts diabetic status of dental patients. J Dent Hyg. 2014;88:42–52


Maria Perno Goldie 2014e FoMaria Perno Goldie, RDH, MS, is the editorial director of RDH eVillage FOCUS.

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