Diabetes burnout
Featured Products Promotional FeaturesPosted by: Dental Design 3rd May 2024
Much has been said about the importance of patients living with diabetes to practice effective oral healthcare routines to prevent the development of periodontitis.[i] However, those with the condition – especially emerging adults – can find it difficult to keep up with the numerous demands of managing their diabetes, and can suffer with burnout. Feelings of stress associated with burnout can even have a negative impact on blood sugar levels. Exhaustion and frustration interconnected to the inflexible daily demands of managing the illness, can result in negative associations with self-care.[ii]
Diabetes mellitus is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces to manage glucose levels.[iii] Diabetes UK reports that there are at least 5 million people in the UK with the condition, and numbers are increasing rapidly, with 90% of those with diabetes experiencing type 2. More than 2.4 million people are at risk of developing type 2 diabetes, and a further 850,000 are likely to be living with the condition undiagnosed.[iv]
More than half of all new cases of type 1 diabetes occur in adults, and the condition means the body is unable to produce insulin.[v] Type 2 diabetes, is slightly different, in that it is characterised by insulin resistance, where the muscle, liver and fat cells do not use the hormone well. Insulin resistance can be affected by excessive adipose tissue, lifestyle, genetic factors, hormonal diseases, damage to the pancreas, pregnancy and certain medicines.[vi] Effective management of the condition is vital to avoid potentially devastating consequences.
It’s demanding. A daily regime of exercise, managing medication, and monitoring blood glucose are the therapeutic obligations of patients with diabetes. The condition itself can cause fatigue, and the stress of managing the condition can exacerbate this.[vii]
Patients can be under the care of multiple healthcare professionals, including doctors, dentists, nurses, ophthalmologists, endocrinologists, and mental healthcare professionals. Managing diabetes may put additional pressure on all aspects of their lives, and may require support from family members, carers or social workers. It’s common for diabetic patients to feel guilty about the impact of their condition on loved ones, or to feel bad that they cannot fulfil certain tasks or obligations.[viii]
The impact of so many factors outside their control can affect emerging self-efficacy levels, and burned-out individuals can become apathetic or non-compliant with managing their therapy.[ix]
Nonadherence is rife. Studies have shown that diabetes has the second lowest adherence rate of 17 chronic conditions.[x] This especially affects young adults, for whom the constant regime of treatment can be associated with perceived obedience to authority, and a desire for autonomy and freedom can make developing self-governed care emotionally complex. Knowing the additional risks for diabetic patients, dental clinicians may also feel frustrated by an inability to impress upon them the vital importance of oral hygiene.[xi]
Diabetes and additional oral care needs
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.[xii] Periodontitis has been called the ‘sixth complication of diabetes’,[xiii] and a two-way relationship exists; periodontitis could have a negative effect on glycaemic control.[xiv] This knowledge has had dental professionals doubling down on advice to practice good oral hygiene, including regular interdental cleaning.[xv]
Diabetes, as well as some associated medications, can affect the production of saliva,[xvi] which is vital for cleansing the oral cavity. The antimicrobial properties of lysozyme in saliva also assists in managing biofilm build-up, and it contains minerals to help protect teeth. Saliva has an important role to play in the digestive process of starch,[xvii] and impaired saliva-production increases the risk of periodontal disease, dental caries and tooth-loss.[xviii]
Fat metabolism in diabetics influences collagen production, adversely affecting repair and replacement of soft tissue in the mouth, further risking periodontal disease and tooth loss.[xix]
How to approach diabetic burnout as a clinician
Recommending optimal oral hygiene is the job of all dental professionals. It’s important to be honest about the consequences of not taking the extra care needed to maintain a healthy mouth. However, patients experiencing diabetic burnout report that they wish healthcare professionals could be more aware of the many pressures and frustrations of managing their condition when communicating, and adopt a more collaborative rather than authoritarian approach to recommendations around their care.[xx]
Products like PREVENT GEL from TANDEX, used with their range of FLEXI interdental brushes are a great combination to recommend to patients with additional oral care needs due to diabetes. Interdental cleaning is easy with FLEXI, and PREVENT GEL can support mineralisation and management of bacteria where saliva-production is impaired. TANDEX also has a helpful FLEXI Educator tool, which enables a more collaborative approach to understanding patients’ unique oral hygiene needs.
Dental professionals want the best outcomes for all patients. Where patients are overwhelmed by the demands of managing their diabetes, it’s helpful to develop an awareness, and an empathetic approach to challenges they might be experiencing.
For more information on Tandex’s range of products,
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Author Kimberley Lloyd- Rees on behalf of Tandex
Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.
[i] National Institute of Dental and Craniofacial Research. Periodontal (Gum) Disease. Available at: https://www.nidcr.nih.gov/health-info/gum-disease. Oct 2023. Accessed Feb 2024
[ii] Kontoangelos K, Raptis A, Lambadiari V, Economou M, Tsiori S, Katsi V, Papageorgiou C, Martinaki S, Dimitriadis G, Papageorgiou C. Burnout Related to Diabetes Mellitus: A Critical Analysis. Clin Pract Epidemiol Ment Health. 2022 Oct 21;18:e174501792209010. doi: 10.2174/17450179-v18-e2209010. PMID: 37274843; PMCID: PMC10156041.
[iii] World Health Organisation. Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=Overview,hormone%20that%20regulates%20blood%20glucose. April 2023. Accessed Feb 2024
[iv] Diabetes UK. how many people in the UK have diabetes? Available at: https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/statistics#:~:text=Our%20data%20shows%20that%20more,by%20148%2C591%20from%202020%2D2021. Accessed Feb 2023
[v] Leslie RD, Evans-Molina C, Freund-Brown J, Buzzetti R, Dabelea D, Gillespie KM, Goland R, Jones AG, Kacher M, Phillips LS, Rolandsson O, Wardian JL, Dunne JL. Adult-Onset Type 1 Diabetes: Current Understanding and Challenges. Diabetes Care. 2021 Nov;44(11):2449-2456. doi: 10.2337/dc21-0770. PMID: 34670785; PMCID: PMC8546280.
[vi] National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Diabetes. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes#type November 2016. Accessed Feb 2024
[vii] Kontoangelos K, Raptis A, Lambadiari V, Economou M, Tsiori S, Katsi V, Papageorgiou C, Martinaki S, Dimitriadis G, Papageorgiou C. Burnout Related to Diabetes Mellitus: A Critical Analysis. Clin Pract Epidemiol Ment Health. 2022 Oct 21;18:e174501792209010. doi: 10.2174/17450179-v18-e2209010. PMID: 37274843; PMCID: PMC10156041.
[viii] Diabetes UK. Supporting Someone with Diabetes. Available at: https://www.diabetes.org.uk/guide-to-diabetes/supporting-someone-with-diabetes. Accessed Feb 2024
[ix] Kontoangelos K, Raptis A, Lambadiari V, Economou M, Tsiori S, Katsi V, Papageorgiou C, Martinaki S, Dimitriadis G, Papageorgiou C. Burnout Related to Diabetes Mellitus: A Critical Analysis. Clin Pract Epidemiol Ment Health. 2022 Oct 21;18:e174501792209010. doi: 10.2174/17450179-v18-e2209010. PMID: 37274843; PMCID: PMC10156041.
[x] Rezaei M, Valiee S, Tahan M, Ebtekar F, Ghanei Gheshlagh R. Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study. Diabetes Metab Syndr Obes. 2019 May 1;12:589-599. doi: 10.2147/DMSO.S197159. PMID: 31118722; PMCID: PMC6507070.
[xi] Pyatak EA, Florindez D, Weigensberg MJ. Adherence decision making in the everyday lives of emerging adults with type 1 diabetes. Patient Prefer Adherence. 2013 Jul 29;7:709-18. doi: 10.2147/PPA.S47577. PMID: 23935361; PMCID: PMC3735338.
[xii] World Health Organisation. Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=Overview,hormone%20that%20regulates%20blood%20glucose. April 2023. Accessed Feb 2024
[xiii] Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012 Jan;55(1):21-31. doi: 10.1007/s00125-011-2342-y. Epub 2011 Nov 6. PMID: 22057194; PMCID: PMC3228943.
[xiv] Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012 Jan;55(1):21-31. doi: 10.1007/s00125-011-2342-y. Epub 2011 Nov 6. PMID: 22057194; PMCID: PMC3228943.
[xv] Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012 Jan;55(1):21-31. doi: 10.1007/s00125-011-2342-y. Epub 2011 Nov 6. PMID: 22057194; PMCID: PMC3228943.
[xvi] National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, Gum Disease, & Other Dental Problems. Available at:https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/gum-disease-dental-problems January 2022. Accessed Feb 2024
[xvii] Tiwari M. Science behind human saliva. J Nat Sci Biol Med. 2011 Jan;2(1):53-8. doi: 10.4103/0976-9668.82322. PMID: 22470235; PMCID: PMC3312700.
[xviii] Ahmadinia AR, Rahebi D, Mohammadi M, Ghelichi-Ghojogh M, Jafari A, Esmaielzadeh F, Rajabi A. Association between type 2 diabetes (T2D) and tooth loss: a systematic review and meta-analysis. BMC Endocr Disord. 2022 Apr 13;22(1):100. doi: 10.1186/s12902-022-01012-8. PMID: 35418054; PMCID: PMC9006550.
[xix] Ahmadinia AR, Rahebi D, Mohammadi M, Ghelichi-Ghojogh M, Jafari A, Esmaielzadeh F, Rajabi A. Association between type 2 diabetes (T2D) and tooth loss: a systematic review and meta-analysis. BMC Endocr Disord. 2022 Apr 13;22(1):100. doi: 10.1186/s12902-022-01012-8. PMID: 35418054; PMCID: PMC9006550.
[xx] Pyatak EA, Florindez D, Weigensberg MJ. Adherence decision making in the everyday lives of emerging adults with type 1 diabetes. Patient Prefer Adherence. 2013 Jul 29;7:709-18. doi: 10.2147/PPA.S47577. PMID: 23935361; PMCID: PMC3735338.
