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References

Yeung V, Chandan J. The impact of diabetes on treatment in general dental practice. Dent Update. 2018; 45:120-128
Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus. Abbreviated Report of a WHO Consultation.: World Health Organization; 2011
National Institute of Health and Care Excellence (NICE). Type 1 Diabetes in Adults: Diagnosis and Management. 2016. https://www.nice.org.uk/guidance/ng17/chapter/key-priorities-for-implementation#awareness-and-management-of-hypoglycaemia (Accessed 18 February 2018)
DAFNE. DAFNE: Dose Adjustment For Normal Eating. http://www.dafne.uk.com/ (Accessed 18 February 2018)

The impact of diabetes on treatment in general dental practice

From Volume 45, Issue 4, April 2018 | Page 366

Authors

Katherine McDermott

StR Special Care Dentistry Bridlington Dental Department, Bridlington Hospital

Articles by Katherine McDermott

Article

I am disappointed that a peer-reviewed article within a journal of clinical excellence has, within it, some inaccuracies.1 The article is unclear at times with regards to whether the authors are referring to patients with Type 1 (T1) or Type 2 (T2) Diabetes Mellitus (DM) and, more concerning, is that understanding of DM by the authors is incorrect in the opening statement of the article.

The main presentation of DM is that the undiagnosed or inadequately controlled patient is hyperglycaemic, with a blood glucose elevated over normal physiological range for a period of time, and not hypoglycaemic due to reduced transfer of glucose into muscle cells as the authors state. Indeed, it is hyperglycaemia from which the majority of diabetic complications arise. The name Diabetes Mellitus originates from ancient Greek which literally translates as ‘Sweet/Honey urine’ due to the excessive glucose within the body.

The glycated haemoglobin test (HbA1c) is the most appropriate measure of long term glycaemic control, with a value of over 48 mmol/mol (6.5%) being indicative of DM, although in acute situations a random venous plasma glucose of >11.1 mmol/l would be diagnostic.2

It is important to recognize that the diabetes-related problem of the most acute onset within general dental practice will be hypoglycaemia, a blood glucose of <4 mmol/l, in those patients either on insulin or some categories of oral hypoglycaemic drugs (namely the sulphonylureas), and dentists need to be aware of how to manage such a medical emergency when it occurs.

Other statements are incorrect: patients with T1DM do not need to restrict diet in refined carbohydrate in order to live a full and meaningful life with their condition. Indeed, often they depend on glucose to correct episodes of hypoglycaemia. The current NICE guidelines support structured education on clinically proven programmes such as ‘DAFNE-Dose Adjustment For Normal Eating’, teaching those with T1DM how to adjust their insulin needs for normal carbohydrate consumption, in line with the recommendation for multiple daily injection basal-bolus insulin regimens.3,4