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Dentist highlights dentistry's key role in identifying diabetes

August 20, 2015

By Michelle Manchir


Dr. Brown
Dr. Jerry Brown, now a retired clinical dentist, was 21 when the unexpected Type 1 diabetes diagnosis came.

He had been making frequent trips to the restroom and felt excessively thirsty. A swimming test required for his graduation from Brooklyn College proved difficult, despite his above average skills in the water.

"My self-diagnosis was a kidney infection, so I went to a primary care physician, who told me that I wasn't taking very good care of my diabetes. I asked him, 'What is diabetes?'" Dr. Brown recalled.

Forty-five years later, Dr. Brown is working to help others manage the chronic disease. He volunteered as a diabetes educator at the University of South Florida Diabetes Center until his recent hiring as a diabetes educator by the university's department of internal medicine. In that role, he helps patients with diabetes learn to identify and manage blood glucose patterns and trends; assist in behavior modification strategies; and set up and train patients in the use of devices such as insulin pumps and continuous glucose monitors. He also travels and delivers presentations about the relationship between oral health and diabetes management and how it relates to the dental profession.

Dr. Brown is the first health professional with a dental degree to earn board certification as a Certified Diabetes Educator from the National Certification Board for Diabetes Educators.

CDEs are health professionals who have comprehensive knowledge of and experience in prediabetes and diabetes prevention and management. Diabetes education, also known as diabetes self-management training or diabetes self-management education, "is a collaborative process through which people with or at risk for diabetes gain the knowledge and skills needed to modify their behavior and successfully self-manage the disease and its related conditions," according to the NCBDE.

Getting the certification that legitimized his position as a diabetes educator and proved his competency was important to Dr. Brown.

"Having practiced dentistry for 30 years and been a diabetic patient for 45 years – and having direct contact with other people living with this chronic disease – I am passionate about helping others successfully manage the daily challenges associated with it," Dr. Brown said.

From 1980 through 2012, the number of adults diagnosed with diabetes in the U.S. nearly quadrupled from 5.5 million to 29.1 million, according to the Centers for Disease Control and Prevention.  

Dentists can play a role in reversing this trend, according to the ADA Council on Access, Prevention and Interprofessional Relations.

Dentists are on the frontline of being able to refer for appropriate care, said Dr. Jane Grover, CAPIR director, in a letter to NCBDE earlier this year.

The NCBDE agrees.

"Dentists have the unique opportunity to be an initial 'touch point' in patient care that enables diabetes prevention and an early diagnosis of diabetes," said Sue McLaughlin, NCBDE board chair. "A timely referral from the dental professional to a person's medical team may result in earlier treatment for diabetes, thereby reducing the risk for diabetes complications in the future."
    
Dentists are not included in the standard pathway to certification, which requires successful passage of a rigorous exam to demonstrate specialized knowledge. To qualify for the exam, most health professionals, including physicians, registered nurses and registered dietitians, must accrue 1,000 hours of direct patient contact hours in which diabetes self-management education is provided, plus a minimum of 15 hours of continuing education credits.

But Dr. Brown had to accrue 2,000 hours of contact hours and 30 CE hours, using a unique qualifications pathway.

The intensive work didn't deter Dr. Brown. After 30 months of volunteering, he was able to achieve enough training to sit for the NCBDE exam. He passed, and hopes other dentists will be moved to undertake the effort, or at least start to understand their role in diabetes detection.

The ADA, including Dr. Grover, assisted Dr. Brown by providing the NCBDE information on why dentists might be considered for the standard pathway. Dr. Grover wrote a letter to the NCBDE board including facts about why inclusion of dentists in the standard pathway may be appropriate.

ADA CAPIR supports dentists pursuing this certification, said CAPIR vice chair Dr. Cesar Sabates.

"CAPIR is committed to serving our members' needs; we want all members to succeed. We congratulate Dr. Brown on achieving this certification and will work to facilitate the process by which our members who are providing diabetes education to their patients can do so," Dr. Sabates said. "Dentists are often on the front lines in the early diagnosis of diabetes. The future of our profession will involve more medical/dental integration. I can envision the dentist as an integral part of our patients' health care system. By providing education and counseling to our patients we have an opportunity to improve the overall health of the patients we serve."

The NCBDE's CEO, Sheryl Traficano, said the NCBDE board will keep track of how many dentists pursue certification. If it sees a consistent pattern in the growth and total number of CDEs who are dentists, "we will certainly reach out to the ADA regarding the possibility of adding dentists to the standard pathway for certification and to establish a collaboration between the two organizations to encourage dentists who are providing DSME to pursue certification."

"The NCBDE looks forward to the possibility of more dentists becoming CDEs – and to the possibility of adding dentists to the standard pathway for certification," she said.

For more information about becoming a CDE, visit NCBDE.org.