A qualitative study exploring strategies to improve the inter-professional management of diabetes and periodontitis

Exploring the Feasibility and Acceptance of Delivering Oral Health Interventions in a Primary Care Diabetes Context in North East England: A Qualitative Two-Case Study

The evidence base supporting a bidirectional relationship between diabetes and periodontitis is well-established and published guidance recommends inter-professional management. This two-case study describes the development and implementation of an evidence-based oral health intervention delivered in diabetes review consultations in NHS primary medical care in Northeast England.

AIM

The intervention aim was to inform people with diabetes about the links between diabetes and periodontitis, and signpost them to a dental professional for assessment.

METHODS

The study utilised focus groups in the design phase and a mixture of focus groups and interviews in the evaluation phase.

RESULTS

Two research active primary care medical practices were recruited. The interventions were informed by their diabetes management protocols to reduce disruption. The interventions were piloted for 2 months, and staff and patient perceptions were evaluated. The findings from this study suggested that the oral health interventions were feasible and acceptable particularly for nurses and health care assistants when delivering diabetes education, but they caused disruption to the GPs review, which included complex medication reviews and referrals. The patients (n = 2) found the intervention to be acceptable and appropriate in the context of their diabetes review.

CONCLUSION

Medical staff and patient evaluation data appear to suggest acceptance of the introduction of an oral health intervention into the diabetes review, but it is difficult to assess the impact of the intervention. Further research, such as a realist review, is needed to evaluate the outcomes and utility of an oral health intervention in the context of the medical management of diabetes in primary care.

Screening for type 2 diabetes and periodontitis patients (CODAPT-My©): a multidisciplinary care approach

BACKGROUND

The practice of referring diabetic patients for dental intervention has been poor despite awareness and knowledge of the oral health effects of diabetes. Likewise, dentists treating patients receiving diabetes treatment are rarely updated on the glycaemic status and as a result, the opportunity for shared management of these patients is missed. This study aimed to provide a standardised care pathway which will initiate screening for diabetes from dental clinics and link patients with primary care for them to receive optimised care for glycaemic control.

METHOD

A Modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices to screen for diabetes among patients attending dental clinics for periodontitis. Expert panel members were recruited using snowball technique where the experts comprised Family Medicine Specialists (5), Periodontists (6), Endocrinologists (3) and Clinical Pharmacists (4) who are involved in management of patients with diabetes at public and private healthcare facilities. Care algorithms were designed based on existing public healthcare services.

RESULTS

The CODAPT^© panel recommends referral to primary care for further evaluation of glycaemic status if patients diagnosed with periodontitis record fasting capillary blood glucose levels ≥ 5.6 mmol/L. Intervention treatment options for prediabetes are listed, and emphasis on feedback to the dental healthcare team is outlined specifically.

CONCLUSION

The CODAPT^© care pathway has the potential to link dental clinics with primary care for diagnosis and/or optimised treatment of prediabetes/diabetes among patients receiving periodontitis treatment.

Nerve growth factor enhances the therapeutic effect of mesenchymal stem cells on diabetic periodontitis

Patients with diabetes frequently suffer from periodontitis, which progresses rapidly and is difficult to cure. Mesenchymal stem cell (MSC) transplantation may effectively treat periodontitis, but high glucose limits its therapeutic effect in diabetes. Nerve growth factor (NGF) has the functions of cell protection, anti-apoptosis and immune regulation, and may have potential application in diabetic periodontitis. In the present study, flow cytometry indicated that NGF inhibited MSC apoptosis induced by high glucose. Of note, high glucose promoted the transformation of MSCs into the proinflammatory type. NGF inhibited this transformation of MSCs under diabetic conditions and further decreased the proportion of T cells and monocytes/macrophages among lymphocytes. An animal model of diabetic periodontitis was constructed and MSC transplantation was demonstrated to reduce alveolar bone loss caused by diabetes. NGF enhanced the therapeutic effect of MSCs and maintained transplanted MSC survival in periodontal tissue of diabetic mice. Immunohistochemical analysis of periodontal tissues suggested that in the NGF group, infiltration of T cells and macrophages was reduced. Neurotrophic receptor tyrosine kinase 1 was indicated to have a key role in these effects of NGF. In conclusion, NGF may enhance the therapeutic effect of MSCs on diabetic periodontitis by protecting the cells and promoting the transformation of MSCs into the immunosuppressive type.

The integration of oral health-related best practice recommendations in the management of patients with diabetes: a cross-sectional survey of primary care physicians

OBJECTIVE

To determine whether best practice recommendations are being followed by primary care physicians (PCPs) by examining the integration of oral health-related practices in their management of patients with diabetes.

METHODS

A cross-sectional study design was used to examine PCPs' knowledge of the bidirectional link between diabetes and periodontal disease (PD), their adherence to international best practice recommendations, and their experience of interprofessional collaboration with dentists via an online survey.

RESULTS

In total, 79 of 173 PCPs completed the online survey. Almost 90 percent of PCPs neither inform patients with diabetes about the link with PD nor advise dental care. Approximately, one-third of PCPs (32 percent) felt confident facilitating access to dentists. However, 93 percent of PCPs do not refer patients with diabetes to dentists as part of diabetes management.

CONCLUSION

PCPs tend not to inform their patients with diabetes of the bidirectional link with PD, or provide advice or referral to attend dental care as part of diabetes management.