A Practical Approach to Special Care in Dentistry. Группа авторов

conditions associated with increased red blood cell turnover, such as sickle cell disease, pregnancy (second and third trimesters), haemodialysis, recent blood loss or transfusion, or erythropoietin therapy, only plasma blood glucose criteria should be used to diagnose diabetes

       Haemoglobin variants can also interfere with the measurement of HbA1c (e.g. sickle cell trait).

       Serum fructosamine levels may be considered as an appropriate laboratory measurement when monitoring long‐term glycaemic control in patients with underlying haemoglobinopathies

      Management

       Diet and regular physical exercise

        Oral hypoglycaemic agentsSulfonylureas (e.g. glipizide, glyburide, glimepiride and tolazamide)Meglitinides (e.g. repaglinide and nateglinide)DDP‐4 inhibitors (e.g. sitagliptin)Biguanides (e.g. metformin)Alpha‐glucosidase inhibitors (e.g. acarbose and miglitol)Thiazolidinediones (e.g. pioglitazone and rosiglitazone)

       InsulinSeveral types of human insulin according to the speed and duration of their effects (Table 5.1.4)Generally, individuals with diabetes are controlled with 2 administrations of subcutaneous fast‐acting or intermediate insulin (first hour of the morning and middle of the afternoon)Insulin can also be administered with a continuous release pump (especially indicated for patients with considerable blood glucose variability)

       Classically, glycaemic control has been performed with home (electronic glucometers) and professional monitoring (blood glucose and HbA1c levels)

       Continuous glucose monitoring systems consist of a subcutaneous sensor and a transmitter that sends the signal to a receiver by which the reading can be taken (Figure 5.1.4); this process can even be controlled with a smart phone; these devices are also the basis of the so‐called ‘artificial pancreas’, which injects the required insulin doses in real time

       Other treatments under development include the transplantation of pancreatic islets and pluripotent stem cell‐derived insulin‐producing cellsTable 5.1.4 Types of insulin and their action profiles.Main types of insulinInjection timingStart of actionMaximum effectDuration of effectFast‐acting insulin30 minutes before meals30 minutes1–3 hours6–8 hoursUltrafast‐acting insulin analogues10 minutes before meals10–20 minutes1–2 hours3–5 hoursIntermediate‐acting insulin30 minutes before meals60–120 minutes4–6 hours10–12 hoursLong‐acting insulin analoguesAt the same time every day60–90 minutes12 hours17–24 hours

      Prognosis

       Life expectancy of a person with type 2 diabetes mellitus is likely to be reduced, by up to 10 years

       People with type 1 diabetes mellitus traditionally have a life expectancy reduced by over 20 years, although improvements in diabetes care in recent decades have meant that people are now living significantly longer

       The prognosis is better for patients who respond adequately to drug treatment and appropriate dietary and general health measures

       Multiorgan complications (renal failure, heart disease, stroke, blindness, limb amputation and peripheral neuropathy) can affect life expectancy and quality

       Approximately 3% of all deaths worldwide are attributable to diabetes. This percentage increases to 8.5% if we include deaths caused by the cardiovascular disease and renal failure directly related to diabetes, which represent 5 million adult deaths annually

      A World/Transcultural View

       The prevalence of diabetes is related to the community's socio‐economic conditions, given that 75% of individuals with diabetes live in low‐ or middle‐income countries

       The adoption by some indigenous communities (e.g. in South Africa and Australia) of a Western diet has resulted in a considerable increase in cases of non‐insulin‐dependent diabetes mellitus

       Countries as heterogeneous as India, the US and Saudi Arabia have shown that dental clinics can be important centres for detecting previously undiagnosed diabetes and prediabetesFigure 5.1.4 Continuous glucose monitoring system.

Recommended Reading

      1 Borgnakke, W.S. (2019). IDF diabetes atlas: diabetes and oral health – a two‐way relationship of clinical importance. Diabetes Res. Clin. Pract. 157: 107839.

      2 Diabetes Canada Clinical Practice Guidelines Expert Committee, Lipscombe, L., Butalia, S. et al. (2020). Pharmacologic glycemic management of type 2 diabetes in adults: 2020 update. Can. J. Diabetes 44: 575–591.

      3 Johnson, E., Warren, F., Skolnik, N., and Shubrook, J.H. (2016). Diabetes update: your guide to the latest ADA standards. J. Fam. Pract. 65: 310–318.

      4 Lalla, E. and Papapanou, P.N. (2011). Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat. Rev. Endocrinol. 7: 738–748.

      5 McKenna, S.J. (2006). Dental management of patients with diabetes. Dent. Clin. North Am. 50: 591–606.

      6 Miller, A. and Ouanounou, A. (2020). Diagnosis, management, and dental considerations for the diabetic patient. J. Can. Dent. Assoc. 86: k8.

      7 Wilson, M.H., Fitzpatrick, J.J., McArdle, N.S., and Stassen, L.F. (2010). Diabetes mellitus and its relevance to the practice of dentistry. J. Ir. Dent. Assoc. 56: 128–133.

      8 Wray, L. (2011). The diabetic patient and dental treatment: an update. Br. Dent. J. 211: 209–215.

5.2 Hypothyroidism

      Section I: Clinical Scenario and Dental Considerations

      Clinical Scenario

      A 22‐year‐old female presents for an emergency dental appointment complaining of unbearable pain in the region of the left angle of the mandible. The patient initially experienced discomfort 3 days ago, but this intensified overnight leading to disturbed sleep and a persistent throbbing ache.

      Medical History

       Autoimmune hypothyroidism (Hashimoto' disease) diagnosed 2 years ago

       Autoimmune hepatitis diagnosed 4 years ago

       Poor compliance with the treatment of her autoimmune disease; fails to attend review appointments with her physician, takes medication irregularly

       Obstructive sleep apnoea‐hypopnoea syndrome

       Depression/anxiety

      Medications (intermittently taken)

       Azathioprine

       Levothyroxine

      Dental History

       Brushes her teeth irregularly

       Irregular dental attender (only attends when in pain)

       Emergency dental treatment last provided in a dental clinic 5 years ago

      Social History

       Single; lives with her mother; no contact with father since the age of 5