Experts from the Spanish Society of Periodontics (Know) and the Spanish Diabetes Society (SED) request the health authorities that assume scientific evidence and address the management of periodontal diseases in people with diabetes as a public health issue. Specifically, they demand expand coverage of oral care for people with diabetes. The requirement is supported by a report on the association between diabetes and gum disease (such as gingivitis or periodontitis).
The Sepa-SED working group understands the need and importance of expanding the coverage of oral services in at-risk patients, as are people with diabetes. It is a work in which they have been immersed for years and that now crystallizes in a document that represents a call to action for health authorities. “We cannot continue leaving aside public system coverage for gum healthsince there is firm and conclusive evidence on the impact that some periodontal diseases have on the quality of life of patients and on multiple other diseases. You cannot have good general health without optimal oral health”states the Dr. Eduardo Monteroperiodontist and member of the Sepa-SED working group.
For her part, the vice president of Sepa, the Dr. Paula Matesanzensures that “evaluating the condition of the gums of people with diabetes could help prevent or early detect a large number of cases of periodontitis and reduce the morbidity associated with this pathology”.
The Spanish Diabetes Federation (FEDE) welcomes this request made by scientific societies. “This is a very positive step forward.”says its president, Juan Francisco Perán, who remembers that “Oral health is closely related to diabetes, and can have repercussions on overall health if the necessary measures are not taken in time”. In fact, as he continues to defend, “Oral health is very important for the quality of life of people with diabetessomething that FEDE has been influencing for years and that now has the support of important scientific societies”.
People with diabetes are much more likely to suffer from any disease; in the case of the oral diseasesthe The most common in this population are caries and periodontal diseases: gingivitis and periodontitis.. “Hence, having adequate oral care and coverage is a key aspect, which we support and will continue to support for the benefit of all the agents involved: patients, professionals and Public Administration”concludes the president of FEDE.
Expected benefits
Working for the oral health of people with greater risk or greater susceptibility is one of the commitments of the current government of Spain for this legislature, which has announced to expand oral care coverage to children and young people, pregnant women and people with intellectual disabilities or mobility-limiting disabilities, as well as promising to begin work to incorporate the population over 65 years of age. Initiatives that are being ambitiously deployed by some Health Departments of the Autonomous Communities.
Along these lines, and taking into account the two-way relationship existing between diabetes and periodontitis, added to their enormous prevalence, the risk of complications and the health costs associated with both, “There is no doubt that working on its detection and prevention acquires a strategic dimension both at the individual level and at the community level, which can be as important as working with the population groups previously listed”says the vice president of Sepa, Paula Matesanz.
“It’s necessary that public health systems guarantee an evaluation of the health status of the gums of people with diabetes”as defended by the Dr. Matesanzwho remembers that “There is solid evidence to support the usefulness of periodontal treatment to improve glycemic control in people with diabetes, reducing the risk of complications”. The implications of this, in terms of reducing economic costs for health services associated with diabetes management, have been confirmed in different studies.
From the SEDas highlighted by its president, the Dr. Francisco Javier Ampudia Blascowho is head of the Section of the Endocrinology and Nutrition Service of the University Clinical Hospital of Valencia and professor at the Faculty of Medicine of the University of Valencia, “We recommend a thorough control of oral health in people with diabetesand that they attend their dental consultation regularly, since good control of the health of their gums not only ensures healthy teeth and avoid diseases such as periodontitis, but also reduces the negative impact that all this has on diabetes and “its complications”.
Expanding periodontal care coverage for people with diabetes offers, according to the signatories of this report, multiple benefits that impact different areas. On the one hand, as Dr. Montero indicates, “will result in an improvement in the periodontal health of patients with diabetes and will facilitate their glycemic control.reducing the incidence of complications associated with diabetes (nephropathies, retinopathies, neuropathies, cardiovascular pathologies…)”. But, furthermore, according to this expert, “All this will also mean a significant reduction in costs for public coffers. intended for the management of complications of diabetes”.
In a study carried out in 2013 by the American medical and dental health insurance company Cigna, the annual savings estimate In those people with diabetes who were adequately treated for their periodontal problems it was $1,292 (a 27.6% savings). On the other hand, another study that evaluated information from a large database evaluated whether periodontal treatment during the first two years after being diagnosed with type 2 diabetes had an impact on the costs and utilization of health services in the third and fourth years. after diagnosis. They observed that the total healthcare cost in the two years evaluated was 1,799 dollars lower in each patient who had been treated compared to those who had not (the average reduction in healthcare expenditure associated with diabetes was 408 dollars in each patient that period).
Much more than a two-way relationship
The Diabetes mellitus and periodontal diseases They are among the most important chronic non-communicable diseases. As stated in the [email protected] study, Approximately 1,000 cases of type 2 diabetes are diagnosed every day in Spain (about 365,000/year); For its part, a disease like advanced periodontitis is situated as the sixth most prevalent pathology in the worldThey are, therefore, very relevant pathologies due to their high prevalence, risk of complications and associated health costs.
Its relevance is even greater if we take into account its two-way relationship, a tremendously solid connection, as has been established for decades. But, in addition, recent consensus documents from the International Diabetes Federation (IDF) and the European Federation of Periodontology (EFP) highlight this. People with diabetes more frequently have periodontitis (risk increases approximately three times compared to subjects without diabetes, especially in those with poor glycemic control) and more advanced forms of the disease; On the other hand, patients with periodontitis and diabetes have more difficulties in having adequate glycemic control and more and greater complications. There is even evidence that periodontitis is a risk factor for developing diabetes. Fortunately, as Dr. Montero emphasizes, “It’s not all bad news, since periodontal treatment can even facilitate diabetes control”.
Intervention studies carried out in different countries, including Spain, have examined the effect of periodontal treatment on diabetes, highlighting the reduction in glycosylated hemoglobin levels (HbA1c), one of the most important indicators of metabolic control in diabetes. This decrease in HbA1c ranges around 0.4-0.5%. “The magnitude of this effect is not negligible in the context of the management of people with diabetes, since each 1% reduction in HbA1c levels is associated with a 35% decrease in microvascular complications associated with diabetes, and A 0.5% reduction in HbA1c may be comparable to what is obtainedne sometimes adding a second hypoglycemic drug”highlights the endocrinologist Virginia Bellidowhich is part of the Sepa-SED group and who considers that “count on this “The report is very positive and necessary, it already represents an opportunity for early detection of periodontitis in people with diabetes and appropriate management.”.