Many people have symptoms of type 2 diabetes when they are diagnosed, but diabetes screening and identification procedures are oftentimes inadequate.9 Less than half complain of diabetes symptoms like polyuria, lethargy, or polydipsia. Because classic symptoms do not always appear, it is imperative that healthcare providers, including dentists and dental hygienists, participate in more aggressive recognition of symptoms of patients with type 2 diabetes or pre-diabetes. The updated medical history and oral exam offer excellent opportunities to assess each patient. In reviewing a patient’s medical history, here are some practical questions that you can ask, keeping in mind that questions should be individualized to help determine the patient’s glycemic control and overall approach to diabetes care management:
* A1C level refers to the hemoglobin A1c test. Table 1 provides the accepted value. This is a simple lab test that shows the average amount of glucose in a patient’s blood over the last three to four months. Glucose binds to hemoglobin in the red blood cells, which has a life span of 120 days. It’s the best way to find out if the patient’s blood glucose is under control. Monitoring blood glucose values via a glucometer can be equated to taking pictures with a camera. Each value is a snapshot of that moment. Blood glucose levels vary throughout the day. Having and A1c is similar to a video. This value gives a longer running value, an average over 3-4 months. All people with diabetes should have a hemoglobin A1c test two to four times a year depending on their glycemic control and changes to therapy.6
Since many undiagnosed patients may be asymptomatic, probing questions related to the chronic complications during the medical history and a thorough oral examination can lead the dental professional to be the first to recognize the possibility of undiagnosed diabetes. The oral exam in an individual with undiagnosed diabetes might reveal:
The American Diabetes Association recommends testing for high-risk patients for early diagnosis of diabetes and to prevent the associated chronic complications (Tables 4A and 4B). Testing is to be done within a health care setting in which appropriate follow-up is available.
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