Key:

NZ:           Nahida Zaman (Optimal Clinical)

BR:           Betsy Rodriguez

NZ:               Ms Betsy Rodriguez, hello and a very warm welcome to Diabetes Radio.

BR:               Thank you very much for having me with you.

NZ:               Ms Rodriguez you are the Deputy Director of the National Diabetes Education Program in the United States, this is a part of the Centres for Disease Control and Prevention.  Can you please give our listeners some information about your professional background and current research focus within the CDC?

BR:               Well I have more than just fifteen years of professional experience providing training of specially diabetes related training, other disease in science of nursing was a primary role of the clinician and a secondary role as an educator and I am also certified diabetes educator.  I have been nationally and internationally providing training and speeches and conferences for organisations such as the American Association of Diabetes Educators, International Diabetes Federation, American Diabetes Association, the Juvenile Diabetes Association of Brazil, Brazil Diabetes Society Association and the Association of Diabetes Educators in Mexico just to mention some of them and to many community healthcare workers associations and networks throughout the nation.  I have been also a strong advocator for the team care approach in diabetes care and education and my area of expertise of course besides nursing is public health, chronic diseases, community health and I am also a specialist in social marketing strategies and in the development of media and educational products for the Hispano Latino population.

NZ:               Ms Rodriguez you participated in an exciting symposium at the 2011 World Diabetes Congress, the lecture was titled Incorporating Oral Health into Team Care for Diabetes Prevention and Lifelong Management, can you tell us about this lecture?

BR:               It will be my pleasure, the symposium focus is on oral health and the importance of oral health as a component of diabetes management in gaining awareness and recognition by the diabetes community for in everything shows that small but significant improvement in glycemic control can be achieved by treating pre-existent periodontal dental diseases in people with type II diabetes.  However, it is also important to understand that the relationship between diabetes and oral health goes beyond this connection.  The symposium is going to emphasise the importance of developing intra-professional collaborative practice model among healthcare professionals in morphing the care of people with diabetes because we know that this approach can improve health outcomes.  It is so well documented, so the objective of integrating oral healthcare into diabetes management is to ensure that ordinary people with diabetes have proper oral health which ultimately has a positive effect on the diabetes management.  The International Diabetes Federation and the National Diabetes Education Program have taken steps to bring oral health into the diabetes management curriculum by creating educational resources and guidelines to assist healthcare professionals in this domain.

NZ:               For the benefit of our listeners, can you please give us some background?  How far away are healthcare professionals in the United States from implementing all the steps for optimal oral health management for diabetes prevention?

BR:               This whole idea of the team management approach is still challenging in the whole nation, however as a federal organisation like the one I am working with under the umbrella of the Department of Health and Human Services, there is a national call to action to promote oral health and this call to action is to address to professional organisations and individuals concerned with the health of their fellow Americans.  It is in a way an invitation to expand plans, facilities and programmes designed to promote oral health and prevent disease especially to reduce health disparities that affect members of the Asian and ethnic groups, poor people, many who are geographically isolated and others who are vulnerable because of the special oral healthcare needs.  The national call to action to promote oral health is first to as a call to action which reflects the work of partnership of public and private organisations who have specific visions and goals and a series of actions to achieve these goals, it is their hope to inspire others to join in their efforts, bring in their expertise and experience to enrich the partnership and to accelerate movement to eNZ:ance the oral and general wellbeing of all Americans.  If this call to action is really to advance the general health and wellbeing by creating typical partnerships at the level of society to engage programmes to promote oral health and prevent diseases, and let me tell you, this call to action has very interesting actions like for instance changing the perception of oral health.  Oral health is in some ways less important that separates from the general health, this is the misconception that is surrounding (oral health).  Another action is to build a science base and to accelerate that transfer of that science into the practice guidelines.  Other action that is really one of my favourite ones in this call to action is to increase oral health workforce diversity, capacity and flexibility and of course the end effort of the actions under this national call to action is to increase the collaboration at all levels. SO as you can see it is the expectation that these call to actions to promote oral health will help increase the access to oral healthcare and reduce healthcare disparities, which is a huge issue in the United States.

NZ:               And what role does oral health play in diabetes prevention?

BR:               Well recent scientific stories suggest that the health of the teeth and the gums may have significant effect on the overall health of the body.  There appears to be a strong relationship between oral diseases and other systemic diseases, like heart diseases, diabetes, strokes and even some forms of cancer and other diseases as the oral systemic connection is more clearly understood, dentists treating or diagnosing periodontal diseases will play the greater role in the overall health of the patients.  In the first signs of systemic health condition in the mouth, dentists can be the first line of defence for early disease detection.  Some of the common signs of periodontal diseases would, for instance the bleeding, swollen gums, pus, loose teeth, chronic bad breath and family history of periodontal diseases, there are many reports that indicate that three out of every four Americans have signs of mild periodontal diseases or gingivitis.  Almost 30% of the population show signs of chronic periodontitis, so people in healthcare professionals truly need to understand how important it is to prevent and treat periodontal diseases.

NZ:               Is it also important that patients who have already developed diabetes pay particular attention to their oral health and why?

BR:               People with diabetes should pay special attention to their oral hygiene because you are more prone to certain problems.  The main oral complications of diabetes are infections and dry mouth.  Together they can lead to tooth decay, gum diseases and delayed healing after surgery and these problems are early diagnosed, it can help decrease most of these symptoms but if the people wait too long, some of these oral complications may be irreversible.  We call this as a directional relationship.  Diabetes can be a risk factor for poor oral health such as gum diseases, periodontitis and gum diseases may trigger a systemic response and then be associated with diabetes so the poor glucose control can contribute to gum diseases and the gum diseases can contribute to poor glucose control, so it can be a very vicious cycle.  This is why it is so important that patients who have already developed diabetes pay particular attention to the oral health.

NZ:               You have been a very vocal advocate of collaborative multidisciplinary team care for adults and children with diabetes.  This approach has been termed “team care”.  How would such an approach work in the clinical setting?

BR:               I definitely have to be an advocate because sometimes oral health problems are over six complications of diabetes.  People with diabetes for instance may develop a dental abscess and any type of infection can interfere with blood sugar control.  So we have been here with a very complex chronic condition, so therefore that is why collaborative teams that provide continual supportive and effective care for people with diabetes throughout the course of the disease are a model for the prevention and management of chronic diseases, especially diabetes.  Well implemented diabetes team care can be cost effective and the preferred method of care delivered particularly when services include health promotion and it is prevention in addition to intensive clinical management.  Team care is a key component of healthcare reform initiative that incorporates an integrated healthcare delivery system especially for those chronic conditions and management.  The evidence shows that early detection and early and aggressive ongoing therapeutic intervention significantly reduced the enormous human economic toll from diabetes. So to achieve health benefits that modern science has made possible and the principal clinical futures of diabetes; for instance hyperglycemia, dyslipidemia and hypertension, need to be treated and managed within a system that provides continued proactive, planned, patient centre and population based care.  Primary care physicians, physician assistants, nurses, practitioners play important role in the delivery of primary care for people with chronic diseases in the United States so to reduce the risk of microvascular complications, this care needs to include regular assessment of the eyes, the kidneys, the teeth, the mouth, lower extremities in people with diabetes.  The system constraints, however, can make it difficult for primary care providers to carry out all these essential elements of a comprehensive diabetes care, so the challenge is to really expand the delivery of care by expanding the healthcare team to include several types of healthcare professionals.

NZ:               What types of benefits would the patient and their healthcare professionals expect to see?

BR:               Well let me tell you, first of all effective care requires the commitment and the support of the organisation leadership.  There has to be an active participation of the patient and healthcare professional team members.  There has to be ways to identify population via information tracking system.  There has to be other kind of resources also from pain mechanism for team care services and a co-ordinated communication system.  Also the recommendation and the evaluation of outcomes is very important to adjust the services as it is necessary.  The inclusion of non-traditional approaches to healthcare such as complimentary health, sure medical appointments, good medication and all expanded access to team care, if those are used effectively can be all the team care practices.

NZ:               Do you have some practical tips for incorporating oral health into team care for diabetes?

BR:               I think that dental providers should participate in the diabetes team care to address oral health and diabetes related issues.  What I am trying to say here is that dental (healthcare professionals) has to be proactive in participating in the diabetes team care.  The primary care team members, whether physician, the nurses, the practitioners, the physician assistant, need to inform patients about diabetes and oral health managing during clinical visits, so in other words it is to empower a patient so they can request the services, because they will realise through education how important it is to include the dental care as part of the comprehensive care for people with diabetes so then when dental care assist team members are in place, I mean then these registered dental hygienists or dental assistants, these are professionals that offers oral health education and that should be done in each dental visit.  Also it is important to collect or get a set of diabetes oral health, education action sheets.  They are ready and available for team members to give to patients and they encourage the patients when they visit the primary care physician, this is what was given to me by my dentist and this is what my dentist said.  So also it is important to establish a process citing and documenting oral health self care education and this process should include providing instructions to help the patient understanding of oral health and daily home care but of the overall treatment plan in diabetes control.  Also to ensure that the patient understands the correlation between poor oral health and the negative effect that it can have in their glycemic control and in diabetes complications.  It is also very crucial to most patients in the healthcare decisions and planning.  Introduce a guide that is called ‘Redesigning the Healthcare Team, Diabetes Prevention and Lifelong Management’ and in this resource we have many other tips that will help others to incorporate oral health into the care for diabetes.

NZ:               You produced a wonderful guide titled ‘Redesigning the Healthcare Team, Diabetes Prevention and Lifelong Management’, can you tell us about this guide and what motivated you to develop this guide and how can a diabetes team make use of it?

BR:               This is the guide that I was telling you about a few minutes ago, this team care (document) was designed to help healthcare professionals and healthcare organisations implement collaborative multidisciplinary team care for adults and children with diabetes in a variety of settings.  If it has input and professional support and for people within pharmacies, the podiatrist, the optometry and the dentistry and it was written by different healthcare professionals about their own specialities to teach other healthcare professionals some basics about the services they provide. We need to promote a team approach, not just with doctors, nurses, community health workers but with their whole team as well.  Oral health professionals can help the primary care provider of the person with diabetes achieved their outcome and this guide precisely designed to help the healthcare professionals and the organisations to implement this team care approach that is so needed when it comes to oral health.

NZ:               Do tell our listeners how they can access this guide.

BR:               Well go to the National Diabetes Education Program website which is www.yourdiabetesinfo.org.  We have a slogan that we say, one call, one click.  One call, 1-888-693-NDEP, one click www.yourdiabetesinfo.org.  We have plenty of resources for healthcare professionals and for people with diabetes or a case for diabetes including the guide and a wonderful checklist has been developed that will help healthcare professionals incorporate the co-ordinated collaborative approach that is needed when it comes to oral health.

NZ:               Ms Betsy Rodriguez, thank you so much for joining us today on Diabetes Radio.