Casey Hein, BSDH, MBA,† and Doreen Small, RN, MA, CDE‡
This article discusses the standard of care-practice gap in diabetes care and makes a compelling case for why dental and medical professionals need to collaborate in integrating oral care in diabetes management. Epidemiologic trends and the etiological rationale for adopting a syndemic orientation to the epidemic of obesity, insulin resistance, diabetes and related inflammatory conditions are presented. The term “syndemic” describes a set of 2 or more linked health problems that interact synergistically to contribute to the excess burden of disease in a population with a specific focus on the forces that bind the problems together. The authors suggest that instead of approaching prevention and treatment of chronic disease states as discrete, individual problems, a syndemic perspective would allow healthcare providers to view chronic inflammatory diseases or conditions such as diabetes, obesity, insulin resistance, hypertension, hyperlipidemia, and infections like periodontal disease as an interrelated cluster of maladies with specific focus on the ties or forces (acquired and environmental risk factors) that bind these conditions together. The article also discusses possibilities for large scale population based intervention strategies and micro-systems of collaboration targeting obesity, diabetes, and periodontal disease through health promotion in childhood and adolescent populations. Also included are aggressive screening and risk reduction strategies targeting patients with risk factors for diabetes and patients who have undetected diabetes.
Citation: Hein C, Small D. Combating diabetes, obesity, periodontal disease and interrelated inflammatory conditions with a syndemic approach. Grand Rounds Oral-Sys Med. 2006;2:36-47. (Digital version Grand Rounds Oral-Sys Med. 2006;2:36-47a.) (A complimentary copy of this article may be downloaded at www.thesystemiclink.com.)
It is staggering to consider the threat that diabetes and obesity pose to our current healthcare system. The growing population of aging Americans with diabetes or unattended risk factors related to diabetes and the growing segment of the youth population that is overweight and already manifesting signs and symptoms of insulin resistance has begun to drain our economy of the resources needed to preventively avert this epidemic in younger generations. More disturbing is the realization that even the best attempts by healthcare providers to follow guidelines for diabetes care have fallen short. We are now at the tipping point where the unrestrained epidemics of obesity and other unattended risk factors for inflammatory conditions such as diabetes have outpaced the intervention strategies currently in practice. This places right at our doorsteps an unprecedented opportunity to change what has clearly become an obsolete model of healthcare delivery. Accordingly, the responsibility to prevent and treat obesity and diabetes can no longer fall solely to an overburdened medical community. The expectation that the medical profession can unilaterally implement wellness-promotion and risk-reduction strategies without enlisting the cooperation of other healthcare profes-
† President, PointPerio, LLC; Arnold, MD
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