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Discuss systemic diabetes control with patients, speaker advises
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ATLANTA – “We need to engage the patient with diabetes, making appropriate recommendations regarding foot exams and glucose and hypertension measurement – and not only educating the patient, but the family and community as well,” Tony Cavallerano, OD, FAAO, said here at SECO during a presentation cosponsored by Primary Care Optometry News.
Cavallerano said interprofessional education and practice are becoming more common, where all practitioners managing a patient with diabetes share resources.
“At New England College of Optometry we partner with the Boston University School of Dental Medicine,” said the PCON Editorial Board member.
It is easy to ask a patient with diabetes if he or she has had a dental or foot exam, Cavallerano said.
“Also ask how often they measure their blood glucose level and if they check their blood pressure on a regular basis,” he said.
Patient self management is becoming more popular, with at-home technologies monitoring blood pressure, weight and dietary habits and the information being transferred to a virtual health care provider, he said.
“Patients with diabetes are not only at risk of developing diabetic retinopathy, they’re also likely to develop periodontal disease,” Cavallerano said, “just like your diabetic patient is likely to develop cataracts 10 years earlier than a nondiabetic patient.”
Those with diabetes are slow healers, he said, and do not respond well to treatment when they develop gum disease.
“In type 1 diabetes, kids are more likely to develop periodontal disease as they near puberty,” Cavallerano added. “This is a microvascular problem that diabetic people have, leading to gum disease and retinopathy. The progression is faster.
“Optimal glycemic control is the ultimate goal,” he said. “They all know what they’re supposed to do, but it’s not that easy.
Cavallerano says he recommends that these patients see their dentist more regularly and, if they have diabetic neuropathy, to examine their feet.
He offered a pearl for managing a patient experiencing hypoglycemia in your office who cannot remember taking his or her insulin.
“One of the easiest things to administer is a tube of frosting,” he said. “It has a long shelf life, comes in a toothpaste-like tube and is almost 100% sugar. You don’t have to worry about them swallowing a pill or taking a drink. It dissolves quickly and the effects are immediate.
“We don’t cure diabetes, we manage it,” he concluded. “I’m always mindful of what a lifelong diagnosis of diabetes means for these patients.”