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Overview

The U.S. Preventive Services Task Force (USPSTF) has released updated recommendations for screening type 2 diabetes mellitus in adults,1 which reaffirm that asymptomatic adult patients with sustained high blood pressure (greater than 135/80 mm Hg) should be tested for diabetes. The primary recommendation is that hypertensive adults should be screened for type 2 diabetes, even individuals who have no symptoms of the disease (e.g., polyuria, polydipsia and polyphagia). The recommendations are an evidence-based resource that can be considered when measuring patients’ blood pressure, evaluating health histories, and identifying hypertensive adults who may require referral for additional tests to confirm diagnosis of type 2 diabetes. The USPSTF recommendations and an accompanying evidence review are published in the June 3 issue of Annals of Internal Medicine, and received online news coverage from MedPageToday,2 Physician’s First Watch3 and others.

The U.S. Preventive Services Task Force is a panel of health experts sponsored by the Agency of Healthcare Research and Quality, which periodically reviews the available research literature and develops recommendations on the provision of preventive health services in the general population. The Task Force concluded that “for adults with sustained blood pressure greater than 135/80 mm Hg, there is moderate certainty that the net benefit of screening for diabetes is substantial.” The recommendations emphasize the importance of early recognition of hypertension, which is often referred to as the “silent killer” because it commonly occurs without symptoms and, like type 2 diabetes, remains undiagnosed during its earliest stages.

Over 50 million Americans have hypertension, and many do not have adequate control of their blood pressure to prevent complications. According to the National Center for Health Statistics, at least 30 percent of American adults aged 20 years and older have hypertension or are taking blood pressure control medications. These statistics are important because high blood pressure is a major cause of cardiovascular disease, and many hypertensive patients have not sufficiently controlled their condition to reduce cardiovascular risks.4

Published in 2003, the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure presents the following recommendations for the prevention and management of high blood pressure: 

  • Cardiovascular disease risks begin at 115/75 mm Hg, and double for each increment of 20/10 mm Hg. 
  • For adults over 50 years of age, systolic pressure above 140 mm Hg is a more important risk factor for cardiovascular disease than diastolic pressure. 
  • Pre-hypertensive individuals, with systolic pressure of 120 to 139 mm Hg (or diastolic pressure of 80-89 mm Hg), should make health-promoting lifestyle modifications (e.g., weight reduction, healthy diet, physical activity) to reduce the risks of cardiovascular disease.

Dentists can provide a valuable public health service by regularly checking their patients’ blood pressure and informing them when measurements are suggestive of hypertension. As health care providers, dentists should be active in monitoring hypertension, assessing patients’ cardiovascular status and their ability to withstand potentially stressful procedures, and promoting behavioral changes that can improve overall health. Also, as noted in an ADA policy on blood pressure screening,5 dentists and allied dental personnel should explain to patients that their measurement of blood pressure does not constitute a diagnosis, and that it is a screening procedure to assist in identifying unsuspected cases of high blood pressure.

Both dentists and patients should be aware that type 2 diabetes is a national health problem and is more prevalent in adults with hypertension. Dentists may want to advise patients referred for medical evaluation based on high blood pressure that they may also wish to ask their physician about screening for type 2 diabetes. Practitioners are also encouraged to educate patients that the incidence of type 2 diabetes increases with age, obesity and lack of physical activity, and that regular exercise, eating a proper diet, and maintaining a healthy weight can help prevent or delay the development of type 2 diabetes. In addition, diabetic individuals are at least two to three times more likely to develop periodontal disease than non-diabetics, and should visit their dentists regularly for full evaluation of their dental and periodontal condition. For more information on the relationship between diabetes and periodontal disease, visit the diabetes oral health topic page at ADA.org and JADA online for an October 2003 supplement on diabetes and oral health.

Footnotes

1. U.S. Preventive Serves Task Force. Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Serves Task Force Recommendation Statement. Ann Intern Med 2008;148:846-854.

2. Neale T. Hypertensive adults should be tested for type 2 diabetes. MedPageToday, June 3, 2008. Available at: http://www.medpagetoday.com/Cardiology/Diabetes/tb/9694. Accessed June 5, 2008.

3. Screen hypertensive patients for diabetes, USPSTF advises. Physician’s First Watch, June 3, 2008. Available at: http://firstwatch.jwatch.org/cgi/content/full/2008/603/1. Accessed June 6, 2008.

4. Centers for Disease Control and Prevention. Racial/ethnic disparities in prevalence, treatment, and control of hypertension--United States, 1999-2002. MMWR Morb Mortal Wkly Rep. 2005 Jan 14;54(1):7-9. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a3.htm. Accessed June 10, 2008.

5. Suggestions for Dentists on Participating in the National High Blood Pressure Education and Screening Program (policy statement). 1995 Transactions. Oct 7-11, 1995. Las Vegas: American Dental Association Annual Session. Chicago: American Dental Association; 1995:610-3.

Additional Resources

Science in the News is a service by the American Dental Association (ADA) to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.

Document Posted June 2008