Nutrition and Oral Medicine (Nutrition and Health)

Chapter 11 / Diabetes Mellitus 193of hyper- and hypoglycemia, and other medications and over-the-counter products shouldbe routinely asked of patients on initial and periodic follow-up exams. Prior diet prescriptionsshould be compared to current dietary habits based on the diet history taken; this willprovide some level of assessment of patient compliance and health attitude. In additionto the oral exam, an overall physical exam including height and weight, blood pressure,skin, and cranial nerves should be conducted. Subsequent referrals to appropriate healthprofessionals should be provided on the basis of the exam findings and patient needs.Tables 1 and 3 (from the National Diabetes Education Program) summarize currentrecommended diabetes surveillance and management strategies; important roles areclearly stated for dentist and RD.4.2. Team Approach to Diabetes ManagementAll health professionals must be cognizant of the medical, dental, and nutrition goalsfor management of diabetes, be aware of the resources available and refer the patient tothe appropriate health care provider. No discipline functions within a vacuum; in particular,in regard to dentistry and nutrition, there is sufficient evidence to support the need forawareness of diabetes management goals, screening, and referral mechanisms.It is incumbent on dietetic and dental professionals to screen individuals with diabetesfor nutrition and oral health risk, provide appropriate education, and refer to other healthprofessionals as needed. The relationship between oral manifestations of diabetes anddiet/nutrition is a complex two-way street. Oral manifestations of diabetes challenge andcompromise eating ability and consequently diet quality and nutrient intake, ultimatelyimpacting nutrition status. Clearly, the role of each discipline is different in this process;both roles are outlined below. A detailed review of oral nutrition risk assessment may befound in Chapter 17.5. CO-MORBIDITIES AND DIABETESThe term “diabesity” has been coined to refer to the strong relationship betweendiabetes and obesity. Diabetes and obesity incidence are increasing at escalating proportionsacross the life span; T2DM in children, once considered rare, is becoming increasinglycommon with the increased incidence of obesity in children. Obesity remains adominant modifiable risk factor for diabetes for adults and children.Metabolic syndrome refers to the combination of the following risk factors: abdominalobesity, T2DM, insulin resistance, dyslipidemia, and hypertension (68). Obesity andcentral abdominal adiposity (waist circumference of 40 in for men, 35 in for women) aretwo independent predictors of metabolic syndrome that have an additive effect on riskfactors for metabolic syndrome (68).5.1. Screening5.1.1. THE ROLE OF THE RDMedical nutrition therapy (MNT) for individuals with all types of DM is a recognizedessential component of care. The American Diabetes Association Clinical Practice Recommendationsfocus on treatment and prevention of diabetes and the related complications(69) and are described in the subsequent section of this chapter. Qualified dieteticsprofessionals need to incorporate questions and guidelines on dental sequellae of diabe-