systemic risk factors part 2 Flashcards
what is the definition of diabetes
common group of metabolic disorders characterised by chronic hyperglycaemia resulting from insulin deficiency or impaired utilisation of insulin
what is diabetes characterised by
chronic hyperglycaemia
what does chronic hyperglycaemia result from
insulin deficiency or impaired utilisation of insulin
what is the full name of diabetes
diabetes mellitus
what can the medication of diabetes result in
hypOglycaemia
in 2017 what did the international’s federation of diabetes find out to be the number of people suffering worldwide
451 million ( aged 18-99 years)
what is the expected number of people suffering from diabetes in 2045
693 million
how many people were diagnosed with diabetes in 2018 in the uK
3.7 million
how many people are at an increased risk of type 2 diabetes
12.3 million
what percentage of people have type 1 diabetes in the uk
10%
what percentage of people have type 2 diabetes in the uk
90%
what is the % of gestational diabetes
3.5%
what type of diabetes can we get in young adults
1-2%
MATURITY ONSET DIABETES
how many people are estimated to be undiagnosed with mainly type 2
1 million
describe type 1 diabetes
destruction of b cells in the islets of Langerhans in the pancreas
autoimmune disease
generic disposition
abrupt onset, most often in children or teens
describe type 2 diabetes
defect in b cells and is insulin resistant
usually manifests mid life and less children affected
genetic influence
increased risk if sedentary lifestyle, obese, asian/afro Caribbean
complications possible
what is the typical age group for type 1 diabetes
abrupt onset, most often in children or teens
what is the typical age group for type 2 diabetes
mid life but now can be seen in younger ages
what are the risk factors for type 2 diabetes
Sedentary lifestyle, obese, asian/afro carribean
how can we test for diabetes
venous plasma glucose levels
HbA1c- OVER A PERIOD OF TIME
glucometer can be done at home
what does the random venous plasma glucose levels have to be
greater than or equal to 11.1 mmol per litre
what does the fasted venous plasma glucose levels have to be
greater than 7 mmol per litre AND
unexplained weight loss
polyuria
polydipsia
what is polyuria
a condition usually defined as excessive or abnormally large production or passage of urine (greater than 2.5 or 3 L over 24 hours in adults)
what is polydipsia
abnormally great thirst as a symptom of disease (such as diabetes) or psychological disturbance.abnormally great thirst as a symptom of disease (such as diabetes) or psychological disturbance.
what should normal blood glucose levels be
4-5.5 mmol per litre before meals
OR
less than 8 mmol per litre 2 hours after meal
How do we use HbA1c To test for diabetes
glucose binds to haemoglobin within erythrocytes for the life of the RBC( 8-12 wks)
we measure how much haemoglobin is glycated
what is the cut off point for HbA1C
48 mmol per mol (6.5%)
what should we try to keep diabetes in the range of in regards to HbA1C according to the new system
6.5-7.5%
AKA 48-58mmol/mol
what should we try to keep non diabetic people in the range of according to the new system
4-6%
20-42 mmol/mol
what are the implications of poorly controlled diabetes
diabetes complication
risk factor for perio diseases
how can we treat type 1 diabetes
insulin injections/pump
balance carb intake and insulin
new technology includes transplantation of islets of langerhans cells in the pancreas
how do we treat type 2 diabetes
treat by diet or oral hypoglycaemia drugs and exercise
25% may need insulin injections
balancing act
how do we carry out a home glucose monitor
simple finger prick
drop of blood on a strip
inserted into a glucometer
what do we aim for on a home glucose strip
4-7 mmol per litre
under the renal threshold of 10 mmol per litre
what is the new technology for home glucose monitoring
flash glucose sensor
what are the complications of diabetes
macrovascular
microvascular
what are the macrovascular complications of diabetes
CVD( major cause of death) and peripheral vascular disease- amputations
cerebrovascular disease and stroke
what are the microvascular complications of diabetes
retinopathy- blindness
neuropathy- painful nerve damage
nephropathy- kidney failure
what was the percentage of type 1 diabetics who achieved the target percentage in 2016-2017
30.2%
what was the percentage of type 2 diabetics who achieved the target percentage in 2016-2017
66.8%
what is the target percentage for diabetics
less than 7.5%
what does diabetics cost the nHS
23.7 BILLION in uk
how much do diabetic patients take of the NHS budget
10%
what percentage of hospital beds to diabetics take up
19%
what level will people start expiring hyocylcaemic effects
under 4mmol per litre
what is the projected cost for diabetes in 2035/2036
39.8 billion
what do studies show
that people with poorly controlled diabetes had more attachment bone loss and bone
what is there an increase risk of in the study
of perio disease with age
increased severity with the duration of diabetes
what do Pima indians have a higher prevalence of
type 2 diabetes
what is the increased risk of Loss of attachment in pima indians
2.8 x
what is the increased risk of bone loss n pima indians
3.4 x
what is the risk of mortality in pima indians
3.2 x
due to ischaemic heart disease and nephropathy
what is the central feature of pathogenesis of DM and periodontitis
inflammation
what can cause systemic inflammatory response
perio infections
what is there an increase of in systemic inflammation
acute phase proteins such as C reactive protein
and pro inflammatory cytokines
give an example of acute phase protein
C reactive protein
what is stimulated in obesity
IL-6 stimulates TNF-alpha
what molecule stimulatied TNF- alpha
IL-6
what does an increase in TNF- alpha and IL-6 may cause
insulin resistance- in type 2 diabetes
what might an increase in IL-B cause
pancreatic ß cell destruction- in type 1 diabetes
what is AGE
advanced glycation end products
how do we get AGE
from hyperglycaemia which leads to collagen undergoing non enzymatic glycation
what changes occur which leads to AGE forms
increased crosslinking- negative cross links
increased cytokine production
what occurs after increased cytokine production
microvascular complications
atherosclerosis
decreased production of bone matrix
what is RAGE
RECEPTOR FOR AGES
What activates the RAGES
ages
what happens when RAGES and AGES interact
Microvascular & macrovascular diabetes complications
Accelerated periodontal tissue destruction
what is linked to LOA
BMI which is related to obesity
what happens to PMN in diabetes mellitus
reduced PNM—> increased perio
enhanced resp burst
and delayed apoptosis and increased tissue destruction
what do systematic reviews currently tell us about perio diseases and diabetes control
periodontal diseases adversely affect diabetes outcomes:
with less HbA1C there is a reduced risk of
Deaths related to diabetes, 21%
Myocardial infarction, 14%
Microvascular complications,
what is the reduced % of deaths related to diabetes when less Hb1AC
21%
what is the reduced % of myocardial infarction when less Hb1AC
14%
what is the reduced % of microvascular complications when less Hb1AC
37%
what do we advise for perio care in diabetics
1.Check HbA1c with Diabetes Care Team
Follow principles of 3 stages of therapy
2.Initial therapy: GDP can undertake; if poor response, consider specialist referral
3.Corrective therapy: Consider adjunctive systemic antibiotics (but more research needed)
4.Supportive therapy: GDP can undertake
how do we manage hypoglycaemia
Give 3-6 glucose tablets (3g each) ie 10-20g
give glucose drink eg Lucozade 150-200ml
buccal glucose- less cooperative patient
what are the clinical symptoms of hypoglycaemia
Pale, shaky, clammy, may be aggressive/confused; blood glucose <4 mmol/l
how do we manage severe hypoglycaemia
Give glucagon IM, SC or IV injection (
Advice: get doctor/dial 999 if no recovery in 10 minutes
If still unconscious, will need glucose IV
what mgram of glucagon do we give if they are adult or over 8 years
1mg
what amount of glucagon do we give if the child is under 8
0.5mg
what does IM stand for
intra muscularly
what does SC stand for
sub cutaneous
when is familial aggregation shown in periodontitis
early onset and progresses fast
what do genetic factors may increase the susceptibility to other associated chronic conditions
Cancer
Heart disease
Diabetes
what are other risk factors
Osteoporosis
Dietary Calcium
Vitamin D
Obesity
what is osteoporosis
reduced bone mineral density
who is osteoporosis most common in
post menopausal women but does occur in men
what does osteoporosis lead to
an increase risk of fracture
what leads to increased bone resorption
reduced oestrogen production
what is systemic bone resorption associated with
MANDIBULAR BONE RESOPTION
what should patients with diabetes mellitus be told
At increased risk of periodontitis
Glycaemic control may be more difficult
At higher risk of other complications eg cardiovascular disease
And should:
Receive thorough oral/perio exam (adults and children)
if the patient doesn’t have periodontitis and no DM what should we do
Prevention, monitor
If risk for Type 2 DM, inform patient, do chairside HbA1c or refer to GP
if the patient has periodontitis and diabetes what do we do
and three stages of therapy Manage acute infections, oral complications; dental rehabilitation if tooth loss
