Tag Archives: Plaque

Common Test Could Help Predict Early Death In Diabetes

High levels of calcified ‘plaque’, a strong indicator of coronary heart disease, can be measured by a special ‘gated’ CT scan that costs just over $200

WHILE vascular disease is common in the general population, it is twice as common in people with diabetes. At least 60 percent of diabetes patients – even those on dialysis for kidney failure – ultimately die of a vascular event, such as heart attack or stroke. However, questions about why so many diabetes patients die early have remained unanswered in the medical community’s understanding of the disease.

Diabetes is associated with many other medical problems so identifying a way to determine who is at highest risk and who needs the most intensive medical monitoring and care is especially important. Now new findings reveal that a common test may be useful in predicting early death in individuals with diabetes. The study appears in the May issue of Diabetes Care.

Dr. Donald W. Bowden

“People with diabetes are already at high risk of developing heart disease and experiencing an early death,” said Donald W. Bowden, Ph.D., the director of the Center for Diabetes Research at Wake Forest Baptist Medical Center and lead investigator in a press statement. “With this study, we’ve discovered that we can identify a subset of individuals within this high risk group who are at even higher risk, and the means to do this is already widely available in the form of a computed tomography (CT) scan – a relatively inexpensive and non-invasive test.”

For the Diabetes Heart Study, Bowden and colleagues have been following nearly 1,500 patients with diabetes in North Carolina for about 13 years, gathering data on various aspects of the disease and how it affects individual health. As original study participants began to die, the researchers sought to understand why.

“When we reviewed the data last year, we were shocked by the number of participants who had already died during this study,” Bowden said. “We wanted to find out if there were any predictors of who would succumb versus those who are still living. In a group of people who are already at high risk, we were looking for a way to identify which individuals were at even higher risk for early death, with the goal of finding interventions or ways to focus medical care and attention toward those individuals at highest risk.”

A high coronary artery calcium (CAC) score is known to be a strong indicator of coronary heart disease. The score provides a measure of how much coronary artery disease, or calcified ‘plaque’ is present in the blood vessels of the heart. Plaque plays a major role in heart attacks and other vascular events and can be measured by taking a special ‘gated’ CT scan which, in comparison to typical CT scans, uses very few X-rays, does not require any injections and generally takes less than 10 minutes to perform. (At Wake Forest Baptist, the test costs just over $200 and some insurance companies will cover the exam in appropriate situations, informs the press statement.).

Within the diabetes-affected population, there is a very wide range of calcified plaque buildup in the arteries and the heart, from individuals with none at all, to people whose entire vessels are nearly completely calcified. The researchers separated more than 1,000 study participants into five groups, according to the amount of calcified plaque they had in their blood vessels at the beginning of the study. The health of those participants was then followed for an average of 7.4 years before researchers compared the data from those who died during the study to those who are still living.

“We saw a dramatic risk of dying earlier in the people with highest levels of calcified plaque in their blood vessels,” Bowden said. “When comparing the group with the highest amount of plaque to the group that had the lowest amount of calcified plaque, the risk of dying was more than six times greater in the group with high levels of calcified plaque. The difference in risk that we revealed is striking. It’s in a group of people who are already at risk, but the CAC level really rather dramatically differentiates risk between people within this high risk group. This finding could have novel clinical implications.”

“The striking magnitude of the risk suggests very strongly that other research samples should be evaluated, especially in individuals with diabetes,” he said.

Source: Wake Forest Baptist Medical Center

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Dental Health Key to Diabetes Control

Did you know there is a “closed loop” between your dental health, gum disease/health, and dental care and the worsening or improvement of your ability to successfully control your blood sugar levels? And did you know: all dentists are not equally prepared to assist diabetics with their dental health, periodontal care, implant dentistry or restoration after years of inadequate care, if needed?

Along with eyes, feet, skin, hearing and heart complications that can arise when someone has diabetes, the American Diabetes Association also lists oral health factors into the equation as well. Indeed, having poor gum health, under the gum line low-level infections, loose teeth or other dental problems can be a secret enemy fighting your efforts to manage your diabetes.

“Research shows that there is an increased prevalence of gum disease among those with diabetes,” warns the American Diabetes Association, which includes the dentist as a key member of the healthcare team when someone is living with diabetes.

Connections Between Treatment of Diabetes and Gum Disease

It’s very important for people who have diabetes symptoms to work closely with their dental treatment team to keep their teeth and gums in great shape. Unfortunately, however, not all dentists understand the connections between treatment of diabetes and gum disease, let alone knowing how to lower blood sugar.

Putting the problem in perspective, Mayo clinic experts list how oral health ties into a person’s overall health. Like all infections, serious gum disease may be a factor in causing blood sugar to rise and may make diabetes harder to control.

“Diabetes reduces the body’s resistance to infection – putting the gums at risk. In addition, people who have inadequate blood sugar control may develop more frequent and severe infections of the gums and the bone that holds teeth in place, and they may lose more teeth than do people who have good blood sugar control,” experts warn.

Research also suggests that the relationship between serious gum disease and diabetes is two-way.  Not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes.

People with diabetes are at higher risk for oral health problems, such as gingivitis (an early stage of gum disease) and periodontitis (serious gum disease) because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums.

Gum Disease (Periodontitis)

The American Dental Association lists systemic diseases, including diabetes, as a factor that can increase the risk of periodontal disease. Periodontitis involves the inflammation and infection of bones and ligaments that support the teeth.

Dentists should encourage diabetics to make sure they have periodontal charting or probing done. That process measures the space of the gums around a tooth. Two to 3 millimeters of space is in the normal range. The space deepens to 5-10 mm in someone with gum disease, and by 8-9 mm, teeth are getting mobile.

Many people have a misconception a tooth can just be replaced, but nothing functions as well as your own teeth. When someone has gum disease, it’s important to have cleanings more often. The process can include deep cleaning or surgery to treat gum disease.

According to the American Dental Association, plaque, a sticky film of bacteria, covers the teeth. After someone eats or drinks something that contains starch or sugar, the bacteria release acids that attack tooth enamel, and over time, the attacks can cause enamel to break down, which can lead to cavities.

Dry Mouth & Thrush

In addition to gum disease and tooth decay, other health conditions have connections to diabetes. For example, someone with diabetes might be prone to xerostomia (dry mouth), which also is a side effect with many medications, and candidiasis (thrush), an oral infection. Burning mouth syndrome is another condition that might affect someone who has diabetes.

When diabetes isn’t properly controlled, high glucose levels in saliva can create an environment favorable to these bacteria. The ADA recommends brushing twice a day and flossing daily to help remove plaque that could cause tooth decay.

Saliva contains enzymes and proteins that help control the bacteria in the mouth to help prevent oral infections, dental decay and gum disease. Yet for those with diabetes, higher sugar levels in the blood and saliva encourage bacterial growth.

Dental researchers say there also may be a link between xerostomia and the medications prescribed to treat diabetics. According to recent studies, three-fourths of those who suffer from diabetes also have high blood pressure, and most drugs used to treat hypertension can cause the salivary glands to produce less saliva. Dryness can also be intensified by the use of other drugs, such as antidepressants and antihistamines. For diabetics it is a vicious cycle, so it is important to use products specially formulated to treat gum disease and dry mouth.

Plaque & Tartar

Plaque that isn’t removed can harden into tartar. When tartar builds above the gum line, it becomes more difficult to brush well and to clean between the teeth. This can ultimately lead to chronic inflammation and infection. Diabetes isn’t caused by gum disease, but gum disease can make it worse and vice versa, say dental hygienists.

If members of the dental team don’t achieve the progress they expect with a patient, they might send him to have a full workup done to see what might be affecting how the dental treatment is going. When someone is having trouble controlling blood sugars, taking care of their dental situation results in improvements a lot of times.

Indeed, just removing plaque every six months can help a lot. Bacteria in the mouth is a concern because if it gets into you bloodstream through your mouth, it can go systemic. It’s important to let your dentist know if you have been diagnosed with diabetes.

Nutritional Status

Good oral health also plays a role in a person’s nutritional status, which has a significant impact on overall health. A diet high in carbohydrates, which break down into sugar, could affect a person’s likelihood of developing cavities. Tooth loss can also affect a person’s ability to eat.

Giving up cigarettes is equally important because tobacco smoke dries out the mouth, besides being linked to a number of other health risks, including cancers. Use of other tobacco products also tightens the blood vessels. You need blood flow into your mouth.

To prevent dental problems associated with diabetes, first and foremost, control your blood glucose level. Then, take good care of your teeth and gums, along with regular checkups every six months. To control thrush, a fungal infection, maintain good diabetic control, avoid smoking and, if you wear them, remove and clean dentures daily. Good blood glucose control can also help prevent or relieve dry mouth caused by diabetes.

Remember, whatever has kept you from getting the optimum, complete dental care you need in the past should not concern you now. Today’s methods can actually be virtually pain free; you can be assured of respectful, compassionate care in a relaxed environment, never any criticism for having put off treatment. And every dental problem has a solution.

Bottom line: Managing diabetes includes everything from nutrition to exercise to medication to dental health.

Sources: American Diabetes Association, American Dental Association, Mayo Clinic, Colgate

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