05/25/2015    Robert Creighton, DPM

Dentists, Podiatrists, and Diabetic Screening

There was an interesting presentation at the
recent American Association of Clinical
Endocrinologist's 24th Annual Scientific and
Clinical Conference. During this conference,
findings were presented from a prospective
study of 500 consecutive patients who completed
a 14-question diabetes risk survey in their
dentist's office. The dental patients also
agreed to have a finger stick blood draw to
measure HbA1c levels. None of the patients had
a prior diagnosis of diabetes or pre-diabetes,
and the screening revealed that 19.2% were pre-
diabetic and 1.2% had diabetes.
(http://www.medpagetoday.com/MeetingCoverage/AA
CE/51554).

The rationale for the dental office as a
screening site is based on many dental patients
visiting a dentist more often than their
primary care physician. The study author put it
this way, "60% to 70% of the population visits
a dentist once or twice a year, and many of
these people don't have a family doctor."

The dentist who developed the screening survey
and conducted the screenings at her private
dental practice said, "I can tell you that only
1% to 2% of dental practices in the United
States are doing anything right now regarding
general health, but it is our future...The
bidirectional relationship between diabetes and
periodontal disease makes a strong case for
dental office screening."

I get it, the percentage of the general
population that visits a podiatrist annually
pales in comparison to the dental statistics,
but what role should podiatrists be playing in
this important public health mission, if any?

The NHANES results entitled the "Prevalence of
the Metabolic Syndrome in the United States,
2003-2012" were just published
(http://jama.jamanetwork.com/article.aspx?
articleid=2293286). The overall prevalence of
metabolic syndrome was 33% with a significantly
higher incidence in women (35.6% women vs.
30.3% men). As readers know, insulin resistance
("pre-diabetes") is one of the hallmarks of
metabolic syndrome.

If one uses the prevalence of metabolic
syndrome among patients presenting to a
podiatric office as a measure of the public
health value of pre-diabetes screening by
podiatrists, I would be willing to bet the
screenings would be regarded as a positive
endeavor.

In addition, of these two medical specialties,
which one can speak more compellingly to pre-
diabetics about the complications of diabetes?
Diabetic foot complications are often visible
and striking; and therefore, more personally
motivating. We all know public health messages
regarding tobacco use show the laryngectomy
patient speaking their anti-smoking message via
an electrolarynx for a reason.

Podiatry is great at speaking to diabetics once
they have been diagnosed with the disease. We
also need to formally speak a public health
message to pre-diabetics in an effort to impact
the one in three members of the U.S. population
who are heading toward a diabetes diagnosis.

Robert Creighton, DPM, St. Petersburg, FL

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