As an optometric physician, you will see many patients every single day. You will find that a lot of your patients do not have a primary care physician that they see on a regular basis, or have not been to their primary care doctor for a physical examination in several years.
You may actually be the only doctor that your patient sees regularly or has been to in quite some time. Therefore, we have a responsibility to our patients to ensure that their overall general health needs and concerns are being met.
Take a few extra minutes during your exam to do a thorough case history and identify any risk factors for health conditions that may be undiagnosed or poorly managed.
Diabetes mellitus should be one of the conditions that we feel comfortable talking to our patients about.
Here, we will review the most important risk factors that we should be on the lookout for:
Risk Factors for Diabetes Mellitus
- Type 1 Diabetes Mellitus
- Positive family history of diabetes: patients with a first-degree relative (parent or sibling) with diabetes puts them at higher risk for developing diabetes themselves
- Viral exposure: exposure to certain viruses such as Epstein-Barr, Coxsackie, mumps, or cytomegalovirus has been shown to trigger the autoimmune destruction of islet cells (or directly infect the islet cells) in some patients, leading to diabetes
- Autoimmune conditions: Hashimoto’s disease, Grave’s disease, Addison’s disease, celiac disease, Crohn's disease, and rheumatoid arthritis has all been linking to diabetes
- Type 2 Diabetes Mellitus
- Family history of diabetes: patients with first-degree relatives with diabetes are three times more likely to develop the disease
- Overweight/obese: patients with a body mass index (BMI) of 25 or greater are at greater risk of developing diabetes (this “at-risk BMI” may be lower in certain ethnic groups)
- Age: those 45 years of age or older are at higher risk
- Ethnic background: certain ethnicities have a higher risk for diabetes; these include African Americans, Hispanic/Latinos, American Indians, Alaska Natives, Asian Americans, and Pacific Islanders
- Gestational diabetes: women who were diagnosed with gestational diabetes are more likely to develop type 2 diabetes
- Prediabetes: persons with impaired fasting glucose or impaired glucose tolerance (but not diagnosed diabetic) have a higher risk of converting to diabetes
- Hypertension: elevated blood pressure is a significant risk factor for diabetes
- Abnormal lipid levels: patients with high-density lipoprotein (HDL) level of 35 or less and/or triglyceride level of 250 or greater are at higher risk
- Physical inactivity: less than 10 minutes a week in activity in each of the physical activity areas of work, leisure time, and transportation elevates a person’s risk for diabetes
We challenge you all to take a global look at your patient’s health status and identify these risk factors for the development of diabetes and have a discussion with your patient regarding your assessment.
Guide them in obtaining a physical examination if they have not had one recently, and make other recommendations for them as you see appropriate. You’ll be surprised at how many patients just need a little push to help get their health in check!