There are two main types of diabetes mellitus (DM) type 1 (T1D, or type 1 DM) - formerly known as insulin dependent or juvenile diabetes- and type 2 (T2D, or type 2 DM - formerly known as non-insulin dependent diabetes. Criteria for the diagnosis of diabetes have been established by the American Diabetic Association.
Individuals with type 1 diabetes (T1D) need insulin for survival. Individuals with type 2 diabetes (T2D) use insulin for glycemic control.
Other types of diabetes include gestational diabetes, which may disappear after the birth of the child but may be a sign of susceptibility to develop diabetes later in life.
Poorly controlled DM may also be associated with increased susceptibility to bacterial infections and poor healing.
Long-term glycemic control can be determined with an A1C assay (also known as the glycated hemoglobin A1C assay). Patients with A1C levels <5.7% are considered well controlled.
For additional information, see glucose testing and interpretation.
Insulin is usually self-injected by patients. It is available in different formulations with different times of onset, peaks of activity, and durations.
There are several oral and other non-insulin hypoglycemic agents and formulations that sometimes may be given with insulin.
Glucocorticosteroids may cause hyperglycemia and should be avoided. Aspirin and aspirin-containing products may enhance the hypoglycemic effect of sulfonylureas.
Individuals with diabetes mellitus will often take medications to lower high blood pressure, to lowering serum lipids, antiplatelet medications, as well as medications that assist with smoking cessation.
Hypoglycemic patients are at an increased risk of intolerance of dental procedures and may even exhibit hypoglycemic signs and symptoms.
Frequent episodes of hypoglycemia may result in “hypoglycemic unawareness” where patients may not exhibit any of the classic signs and symptoms of hypoglycemia.
An extended period of hyperglycemia will make the patient more susceptible to bacterial infections and oral candidiasis and more likely to exhibit poor wound healing and possibly experience intraoral burning and oral dryness.
Diabetes has been associated with severe complications. These are related to damage of the micro- and macrovascular system and nerves. Compared to nondiabetics, diabetics have a higher prevalence and incidence of visual impairment, blindness, renal failure, stroke, heart attacks, hypertension, nerve damage, and amputations.
- Medical Disorders
- Oral Health Care Considerations
- Laboratory Values
- Medical Emergencies
- Classification and Definitions
- Standards of medical care in diabetes - 2021. Diabetes Care. 2021;44(Suppl.1:S1-S232).
- Diabetes. Center for Disease Control and Prevention. May 21, 2021.
- Borgnakke WS. IDF Diabetes Atlas: Diabetes and oral health - A two-way relationship of clinical importance. Diabetes Res Clin Pract. 2019 Nov;157:107839.
- Borgnakke WS, et al. Oral health and diabetes. In: Diabetes in America. 3rd Edition. Cowie CC, et al. Eds. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018:31-1 to 31-51.