Scientific Poster Session III - Case Reports

Case Reports
  Monday, November 13, 2023
  01:00 PM–02:30 PM

Abstract

Introduction: There is a link between periodontal disease and diabetes mellitus (DM), though the impact on glycemic therapy is less clear. This case highlights the significant impact dental disease can have on insulin requirements and adds to data supporting the role of clinical pharmacists (CP) on the care team.

Case: FB is a 64-year-old male followed by a CP for management of Type 2 DM. His hemoglobin A1C has down-trended from 10.1% to 8% over 10 months with subsequent total daily dose (TDD) of U-500 insulin incrementally increased from 265 to 405 units/day. FB reports pain under his lip and has not seen a dentist in 15 years. The CP requests a dental hygienist assessment who finds signs of abscess with multiple fractured teeth. Three teeth are extracted at an emergency dental visit. One week later, FB endorses 9 episodes of hypoglycemia with blood glucoses (BG) ranging from 43 – 63 mg/dL despite eating normally. The CP reduces his TDD of insulin by ~14%. One-week later, FB reports normalized BG with no episodes of hypoglycemia using a TDD of 345 units/day.

Discussion: Few have studied the impact of periodontal treatment on A1c, finding potential to lower A1c slightly; though none have described a need to decrease insulin. Strong teamwork, swift identification and treatment, along with close follow-up led to positive patient outcomes. Even though this is one case-example, it is clear that dental hygienists and clinical pharmacists can and should work collaboratively to provide team-based quality care for persons with diabetes.

Conclusion: Providers should be aware of fluctuating insulin requirements that may occur after periodontal disease treatment. Clinical pharmacists within the integrated care team can provide significant benefits to patients with diabetes complications.

Presenting Author

Morgan Stewart PharmD
University of Colorado

Authors

Kathryn Litten PharmD
University of Texas at Austin College of Pharmacy

Roxanne Powers RDH, PHRDH, MA
Retired