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Harcke K, Lindunger A, Kollinius E, Gebreslassie M, Ugarph Morawski A, Nylén C, Peterson M, Yucel-Lindberg T, Östenson CG, Skott P, Saleh Stattin N. Observational study of selective screening for prediabetes and diabetes in a real-world setting: an interprofessional collaboration method between public dental services and primary health care in Sweden. Scand J Prim Health Care 2024; 42:170-177. [PMID: 38214672 PMCID: PMC10851808 DOI: 10.1080/02813432.2023.2299114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Describe a method in a real-world setting to identify persons with undiagnosed prediabetes and type 2 diabetes through an interprofessional collaboration between Public Dental Services and Primary Health Care in Regions Stockholm. DESIGN A descriptive observational study. SETTING The study was conducted at seven sites in the region of Stockholm, Sweden. Each collaborating site consisted of a primary health clinic and dental clinic. SUBJECTS Study participants included adults over 18 years of age who visited the Public Dental Services and did not have a medical history of prediabetes or type 2 diabetes. MAIN OUTCOME MEASURES Selective screening is conducted in accordance with a risk assessment protocol at the Public Dental Services. In the investigated method, DentDi (Dental and Diabetes), adults diagnosed with caries and/or periodontitis over a cut-off value are referred to the Primary Health Care clinic for screening of prediabetes and type 2 diabetes. RESULTS DentDi, introduced at seven sites, between the years 2017 and 2020, all of which continue to use the method today. A total of 863 participants from the Public Dental Services were referred to the Primary Health Care. Of those 396 accepted the invitation to undergo screening at the primary health care centre. Twenty-four individuals did not meet the inclusion criteria, resulting in a total of 372 persons being included in the study. Among the 372 participants, 27% (101) had elevated glucose levels, of which 12 were diagnosed with type 2 diabetes and 89 with prediabetes according to the study classification. CONCLUSIONS DentDi is a feasible method of interprofessional collaboration where each profession contributes with the competence included in everyday clinical practice for early identification of persons with prediabetes and type 2 diabetes with a complete chain of care. The goal is to disseminate this method throughout Stockholm County and even other regions in Sweden.
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Affiliation(s)
- Katri Harcke
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Anders Lindunger
- Department of Dental Medicine, Karolinska Institutet, Sweden
- Public Dental Services, Region Stockholm, Sweden
| | | | | | - Anna Ugarph Morawski
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Charlotta Nylén
- Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Peterson
- Department of Public Health and Caring Sciences, Section General Medicine, Uppsala University, Sweden
- Academic Primary Health Care, Region Uppsala, Sweden
| | | | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Pia Skott
- Department of Dental Medicine, Karolinska Institutet, Sweden
- Public Dental Services, Region Stockholm, Sweden
| | - Nouha Saleh Stattin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
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Yonel Z, Kocher T, Chapple I, Dietrich T, Völzke H, Nauck M, Collins G, Gray L, Holtfreter B. Development and External Validation of a Multivariable Prediction Model to Identify Nondiabetic Hyperglycemia and Undiagnosed Type 2 Diabetes: Diabetes Risk Assessment in Dentistry Score (DDS). J Dent Res 2023; 102:170-177. [PMID: 36254392 PMCID: PMC9893389 DOI: 10.1177/00220345221129807] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to develop and externally validate a score for use in dental settings to identify those at risk of undiagnosed nondiabetic hyperglycemia (NDH) or type 2 diabetes (T2D). The Studies of Health in Pomerania (SHIP) project comprises 2 representative population-based cohort studies conducted in northeast Germany. SHIP-TREND-0, 2008 to 2012 (the development data set) had 3,339 eligible participants, with 329 having undiagnosed NDH or T2D. Missing data were replaced using multiple imputation. Potential covariates were selected for inclusion in the model using backward elimination. Heuristic shrinkage was used to reduce overfitting, and the final model was adjusted for optimism. We report the full model and a simplified paper-based point-score system. External validation of the model and score employed an independent data set comprising 2,359 participants with 357 events. Predictive performance, discrimination, calibration, and clinical utility were assessed. The final model included age, sex, body mass index, smoking status, first-degree relative with diabetes, presence of a dental prosthesis, presence of mobile teeth, history of periodontal treatment, and probing pocket depths ≥5 mm as well as prespecified interaction terms. In SHIP-TREND-0, the model area under the curve (AUC) was 0.72 (95% confidence interval [CI] 0.69, 0.75), calibration in the large was -0.025. The point score AUC was 0.69 (95% CI 0.65, 0.72), with sensitivity of 77.0 (95% CI 76.8, 77.2), specificity of 51.5 (95% CI 51.4, 51.7), negative predictive value of 94.5 (95% CI 94.5, 94.6), and positive predictive value of 17.0 (95% CI 17.0, 17.1). External validation of the point score gave an AUC of 0.69 (95% CI 0.66, 0.71), sensitivity of 79.2 (95% CI 79.0, 79.4), specificity of 49.9 (95% CI 49.8, 50.00), negative predictive value 91.5 (95% CI 91.5, 91.6), and positive predictive value of 25.9 (95% CI 25.8, 26.0). A validated prediction model involving dental variables can identify NDH or undiagnosed T2DM. Further studies are required to validate the model for different European populations.
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Affiliation(s)
- Z. Yonel
- Periodontal Research Group, School of
Dentistry, College of Medical and Dental Science, University of Birmingham,
Edgbaston, Birmingham, UK
| | - T. Kocher
- Department of Restorative Dentistry,
Periodontology, Endodontology, and Preventive and Paediatric Dentistry, University
Medicine Greifswald, Greifswald, Germany
| | - I.L.C. Chapple
- Periodontal Research Group, School of
Dentistry, College of Medical and Dental Science, University of Birmingham,
Edgbaston, Birmingham, UK
| | - T. Dietrich
- Periodontal Research Group, School of
Dentistry, College of Medical and Dental Science, University of Birmingham,
Edgbaston, Birmingham, UK
| | - H. Völzke
- German Centre for Cardiovascular
Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Department of Study of Health in
Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine,
University Medicine Greifswald, Greifswald, Germany
| | - M. Nauck
- German Centre for Cardiovascular
Research (DZHK), Partner Site Greifswald, Greifswald, Germany
- Institute for Laboratory Medicine and
Clinical Chemistry, University Medicine Greifswald, Greifswald, Germany
| | - G. Collins
- Centre for Statistics in Medicine,
University of Oxford, Oxford UK
| | - L.J. Gray
- Department of Health Sciences,
University of Leicester, University Road, Leicester, UK
| | - B. Holtfreter
- Department of Restorative Dentistry,
Periodontology, Endodontology, and Preventive and Paediatric Dentistry, University
Medicine Greifswald, Greifswald, Germany
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Priede A, Lau P, Darby I, Morgan M, Mariño R. Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10102020. [PMID: 36292467 PMCID: PMC9601736 DOI: 10.3390/healthcare10102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals’ (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals’ referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.
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Affiliation(s)
- Andre Priede
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
- Correspondence:
| | - Phyllis Lau
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - Ivan Darby
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - Mike Morgan
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand
| | - Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
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Yonel Z, Kuningas K, Sharma P, Dutton M, Jalal Z, Cockwell P, Webber J, Narendran P, Dietrich T, Chapple ILC. Concordance of three point of care testing devices with clinical chemistry laboratory standard assays and patient-reported outcomes of blood sampling methods. BMC Med Inform Decis Mak 2022; 22:248. [PMID: 36138408 PMCID: PMC9493167 DOI: 10.1186/s12911-022-01999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Point of care testing (POCT) devices have been developed to facilitate immediate results with the potential to aid screening for new disease and enable patients to self-monitor their disease. Non-communicable diseases (NCDs) are the major cause of mortality globally and are increasing in prevalence as the population ages. Allied health care professionals (AHPs) are skilled in undertaking risk assessment and delivering preventative advice, providing opportunities to access large proportions of the population who may not visit their doctor, within non-traditional community settings. There is evidence of high levels of support from public, patients and health professionals for engaging AHPs in risk-targeted early case detection of certain NCDs. Thus, POCT devices offer a potential alternative to traditional venous blood collection, as novel care pathways for increasing early case detection and access to preventative care. The objectives of this study were to: (i) determine the concordance of the specific POCT devices with laboratory-based standard assays employed within clinical biochemistry laboratories. (ii) compare the sampling experience of both methods via patient-reported experiences. Methods A prospective, two-centre study was undertaken involving 158 participants who provided informed consent. Venous blood was collected for traditional assays of HbA1c, creatinine/ estimated Glomerular-Filtration-Rate (eGFR) and vitamin-D. Capillary blood was collected by finger prick test and also assayed for the same biochemical indices (Nova StatSensor (creatinine/eGFR); Siemens DCA-Vantage (HbA1C); CityAssays (vitamin-D)). All users were provided with device training. Participants reported any discomfort experienced by each simultaneously applied method (randomised in order) via a 100 mm Visual-Analogue-Scale. Results Results for each POCT device and the laboratory standard were analysed by Bland-Altman plots to determine assay concordance. POCT devices demonstrated good concordance with laboratory testing, with at least 95% of all samples being within two standard deviations, for each of the devices tested. The majority of participants reported less discomfort with POCT than venepuncture, with the average reported discomfort being 17/100 mm less for POCT compared to venous blood sample collection on the visual analogue scale. Conclusions The POCT devices demonstrated acceptable concordance with laboratory-based assays, and patients reported lower levels of discomfort compared to traditional means of blood collection. This study demonstrates the potential of using these devices as acceptable methods for opportunistic testing of “at-risk” individuals within non-traditional community care settings.
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Affiliation(s)
- Z Yonel
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK.
| | - K Kuningas
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P Sharma
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - M Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Z Jalal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - P Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - J Webber
- Diabetes Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P Narendran
- Diabetes Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - T Dietrich
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - I L C Chapple
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
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Borgnakke WS, Poudel P. Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.709831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.
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Yonel Z, Cerullo E, Kröger AT, Gray LJ. Use of dental practices for the identification of adults with undiagnosed type 2 diabetes mellitus or non-diabetic hyperglycaemia: a systematic review. Diabet Med 2020; 37:1443-1453. [PMID: 32426909 DOI: 10.1111/dme.14324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/14/2022]
Abstract
AIM Type 2 diabetes is a growing global challenge. Evidence exists demonstrating the use of primary care (non-hospital based) dental practices to identify, through risk assessments, those who may be at increased risk of type 2 diabetes or who may already unknowingly have the condition. This review aimed to synthesize evidence associated with the use of primary care dental services for the identification of undiagnosed non-diabetic hyperglycaemia or type 2 diabetes in adults, with particular focus on the pick-up rate of new cases. METHOD Electronic databases were searched for studies reporting the identification of non-diabetic hyperglycaemia/type 2 diabetes in primary care dental settings. Returned articles were screened and two independent reviewers completed the data-extraction process. A descriptive synthesis of the included articles was undertaken due to the heterogeneity of the literature returned. RESULTS Nine studies were identified, the majority of which utilized a two-stage risk-assessment process with risk score followed by a point-of-care capillary blood test. The main barriers cited were cost, lack of adequate insurance cover and people having previously been tested elsewhere. The pick-up rate of new cases of type 2 diabetes and non-diabetic hyperglycaemia varied greatly between studies, ranging from 1.7% to 24% for type 2 diabetes and from 23% to 45% for non-diabetic hyperglycaemia, where reported. CONCLUSION This review demonstrates that although it appears there may be benefit in using the dental workforce to identify undiagnosed cases of non-diabetic hyperglycaemia and type 2 diabetes, further high-quality research in the field is required assessing both the clinical and cost effectiveness of such practice. (Prospero Registration ID: PROSPERO 2018 CRD42018098750).
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Affiliation(s)
- Z Yonel
- University of Birmingham, Birmingham School of Dentistry, Birmingham, UK
| | - E Cerullo
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A T Kröger
- University of Birmingham, Birmingham School of Dentistry, Birmingham, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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Prevalence of Undiagnosed Diabetes and Prediabetes in the Dental Setting: A Systematic Review and Meta-Analysis. Int J Dent 2020; 2020:2964020. [PMID: 32908510 PMCID: PMC7468655 DOI: 10.1155/2020/2964020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background With the close link between diabetes mellitus (DM) and periodontal disease (PD), dentists have an unrealized opportunity to make a chance discovery of a patient's medical condition. Unlike in the medical setting, information on the point of care (PoC) and opportunistic screening for DM in the dental setting is limited. To make a reliable estimate on the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) and prediabetes among dental patients in the dental setting and to assist healthcare planners in making an informed decision, information on the disease frequency and strategies employed to address this issue is of paramount importance. Objectives To summarize the data on the prevalence of undiagnosed T2DM and prediabetes amongst dental patients and further explore the effectiveness of the PoC screening and its implication for use in the dental setting. Methods A MEDLINE-PubMed, EMBASE, Web of Science, and Cochrane Library search was conducted with no time specification. Information on study characteristics and diagnostic parameters was retrieved for meta-analysis. All the studies were assessed for methodological quality using the QUADAS-2 tool. Proportions were presented in tables and forest plots. All statistical analysis was performed using the MedCalc software. Results Nine studies met the inclusion criteria. The proportion of dental patients identified to be at a risk of hyperglycaemia with the PoC screening using random blood glucose (RBG) and HbA1 was 32.47% and 40.10%, whilst the estimated proportion with undiagnosed T2DM and prediabetes was identified as 11.23% and 47.38%. Conclusion A significant proportion of dental patients can be identified as undiagnosed T2DM and prediabetes. Targeted opportunistic screening is a feasible approach and can help reduce the prevalence of undiagnosed T2DM and prediabetes.
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Kocher T, König J, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 2000 2018; 78:59-97. [DOI: 10.1111/prd.12235] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Jörgen König
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor Michigan
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Peter Meisel
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
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Ziebolz D, Reiss L, Schmalz G, Krause F, Haak R, Mausberg RF. Different views of dentists and general medical practitioners on dental care for patients with diabetes mellitus and coronary heart diseases: results of a questionnaire-based survey in a district of Germany. Int Dent J 2017; 68:197-203. [PMID: 29274083 DOI: 10.1111/idj.12353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this questionnaire-based study was to evaluate the views of dentists (Ds) and general medical practitioners (GPs) on different aspects of dental care for patients with diabetes mellitus (DM) or coronary heart disease (CHD). METHODS Reliable and comparable questionnaires for Ds and GPs, with 23 questions, were sent to 1,000 randomly selected Ds and 1,000 randomly selected GPs. Questions were asked about patients with DM or CHD regarding their dental care and potentially related issues (e.g. antibiotic prophylaxis). The responses received within 12 weeks were evaluated and statistically analysed using chi-square and Mann-Whitney U tests (P < 0.05). RESULTS The response rate was 39% (n = 391) for Ds and 18% (n = 181) for GPs. Both groups stated that they used the medical history as well as patient interviews to assess patients. However, only 55% of Ds assumed correct identification of every at-risk patient compared with 100% of GPs (P < 0.01). Furthermore, Ds speculated that they inform their patients more often about their at-risk status than do GPs (P < 0.01). Neither Ds nor GPs appeared to be confident in their knowledge about adequate antibiotic prophylaxis. Interdisciplinary collaboration was considered insufficient, although Ds had a higher rate of regular collaboration (68% for Ds vs. 40% for GPs; P < 0.01). CONCLUSION Ds and GPs have differing views on dental care of patients with DM or CHD, and Ds showed more interest in this issue. These results might partially explain the insufficient collaboration between Ds and GPs.
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Affiliation(s)
- Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Lucie Reiss
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Felix Krause
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer F Mausberg
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Goettingen, Goettingen, Germany
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Olafsdottir E, Andersson DKG, Dedorsson I, Svärdsudd K, Jansson SPO, Stefánsson E. Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy. Acta Ophthalmol 2016; 94:232-9. [PMID: 26855250 DOI: 10.1111/aos.12954] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/09/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care. METHODS A total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination. RESULTS Among the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p < 0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10 years' follow-up and onwards (p = 0.0002). CONCLUSIONS Among patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.
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Affiliation(s)
- Eydis Olafsdottir
- Department of Ophthalmology; The National University Hospital; Reykjavik Iceland
- University of Iceland; Reykjavik Iceland
- Department of Ophthalmology; Orebro University Hospital; Orebro Sweden
| | - Dan K. G. Andersson
- Family Medicine and Preventive Medicine Section; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Inger Dedorsson
- Department of Ophthalmology; Orebro University Hospital; Orebro Sweden
| | - Kurt Svärdsudd
- Family Medicine and Preventive Medicine Section; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Stefan P. O. Jansson
- Family Medicine and Preventive Medicine Section; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Family Medicine Research Centre; Orebro County Council; School of Health and Medical Sciences; Orebro University; Sweden
| | - Einar Stefánsson
- Department of Ophthalmology; The National University Hospital; Reykjavik Iceland
- University of Iceland; Reykjavik Iceland
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11
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Creanor S, Millward BA, Demaine A, Price L, Smith W, Brown N, Creanor SL. Patients' attitudes towards screening for diabetes and other medical conditions in the dental setting. Br Dent J 2015; 216:E2. [PMID: 24413142 DOI: 10.1038/sj.bdj.2013.1247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 01/09/2023]
Abstract
AIM To determine the attitudes of patients attending routine appointments at primary care dental clinics and general dental practices towards the possibility of chair-side screening for medical conditions, including diabetes, in the dental setting. METHODS A brief, anonymous, self-administered questionnaire distributed to adult patients (≥18 years) attending 2 primary care dental clinics and 16 general dental practices in South-West England. RESULTS One hundred and ninety-seven completed questionnaires were received from patients at primary care dental clinics and 429 from general dental practice patients. Overall, 87% of respondents thought that it was important or very important that dentists screened patients for medical conditions such as diabetes; 79% were very willing to let a dental team member carry out screening. The majority indicated willingness to be screened for various medical conditions during a visit to the dentist, with significantly higher proportions of respondents in the primary care clinics indicating willingness (hypertension: 83% vs 74%; heart disease: 77% vs 66%; diabetes 82% vs 72% [all p <0.02]). Nearly two thirds of primary care clinic respondents and over half of general practice patients indicated that they would be willing to discuss test results with the dental team. Overall, 61% had never knowingly been screened or tested for diabetes; 20% reported that they had been tested within the previous 12 months. CONCLUSION The majority of respondents supported the concept of medical screening in a dental setting and were willing both to have screening tests and discuss their results with the dental team. Patient acceptance is paramount for successful implementation of such screening programmes.
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Affiliation(s)
- S Creanor
- Centre for Medical Statistics and Bioinformatics, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - B A Millward
- Plymouth Diabetes Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - A Demaine
- Peninsula Medical School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - L Price
- Research Design Service South West, ITTC Building, Tamar Science Park, Plymouth, UK
| | - W Smith
- Peninsula Dental Social Enterprise CIC, Plymouth, UK
| | - N Brown
- Peninsula Dental Social Enterprise CIC, Plymouth, UK
| | - S L Creanor
- Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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12
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Strauss SM, Rosedale MT, Pesce MA, Rindskopf DM, Kaur N, Juterbock CM, Wolff MS, Malaspina D, Danoff A. The potential for glycemic control monitoring and screening for diabetes at dental visits using oral blood. Am J Public Health 2015; 105:796-801. [PMID: 25713975 DOI: 10.2105/ajph.2014.302357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes. METHODS In 2013 and 2014, we performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired "gold-standard" HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients. RESULTS About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits. CONCLUSIONS Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients.
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Affiliation(s)
- Shiela M Strauss
- At the time of this study, Shiela M. Strauss, Mary T. Rosedale, and Navjot Kaur were with the College of Nursing, New York University, New York, NY. Michael A. Pesce was with the Columbia University Medical Center, New York. David M. Rindskopf was with the Graduate School and University Center of the City of New York. Caroline M. Juterbock, Dolores Malaspina, and Ann Danoff were with the NYU Langone Medical Center, New York University. Mark S. Wolff was with the College of Dentistry, New York University
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13
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Lalla E, Cheng B, Kunzel C, Burkett S, Ferraro A, Lamster IB. Six-month outcomes in dental patients identified with hyperglycaemia: a randomized clinical trial. J Clin Periodontol 2015; 42:228-35. [DOI: 10.1111/jcpe.12358] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Evanthia Lalla
- Division of Periodontics; College of Dental Medicine; Columbia University; New York NY USA
| | - Bin Cheng
- Department of Biostatistics; Mailman School of Public Health; Columbia University; New York NY USA
| | - Carol Kunzel
- Division of Community Health; College of Dental Medicine; Columbia University; New York NY USA
| | - Sandra Burkett
- Division of Periodontics; College of Dental Medicine; Columbia University; New York NY USA
| | - Andrew Ferraro
- Division of Community Health; College of Dental Medicine; Columbia University; New York NY USA
| | - Ira B. Lamster
- Division of Periodontics; College of Dental Medicine; Columbia University; New York NY USA
- Department of Health Policy and Management; Mailman School of Public Health; Columbia University; New York NY USA
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14
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Engström S, Borgquist L, Berne C, Gahnberg L, Svärdsudd K. Can costs of screening for hypertension and diabetes in dental care and follow-up in primary health care be predicted? Ups J Med Sci 2013; 118:256-62. [PMID: 23957310 PMCID: PMC4192423 DOI: 10.3109/03009734.2013.818599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The purpose was to assess the direct costs of screening for high blood pressure and blood glucose in dental care and of follow-up in primary health care and, based on these data, arrive at a prediction function. Study population. All subjects coming for routine check-ups at three dental health clinics were invited to have blood pressure or blood glucose measurements; 1,623 agreed to participate. Subjects screening positive were referred to their primary health care centres for follow-up. METHODS Information on individual screening time was registered during the screening process, and information on accountable time, costs for the screening staff, overhead costs, and analysis costs for the screening was obtained from the participating dental clinics. The corresponding items in primary care, i.e. consultation time, number of follow-up appointments, accountable time, costs for the follow-up staff, overhead costs, and analysis costs during follow-up were obtained from the primary health care centres. RESULTS The total screening costs per screened subject ranged from €7.4 to €9.2 depending on subgroups, corresponding to 16.7-42.7 staff minutes. The corresponding follow-up costs were €57-€91. The total resource used for screening and follow-up per diagnosis was 563-3,137 staff minutes. There was a strong relationship between resource use and numbers needed to screen (NNS) to find one diagnosis (P < 0.0001, degree of explanation 99%). CONCLUSIONS Screening and follow-up costs were moderate and appear to be lower for combined screening of blood pressure and blood glucose than for separate screening. There was a strong relationship between resource use and NNS.
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Affiliation(s)
- Sevek Engström
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, UppsalaSweden
| | - Lars Borgquist
- Department of Medical and Health Sciences, Family Medicine, Linköping University, Linköping, Sweden
| | - Christian Berne
- Department of Medical Sciences, University Hospital, Uppsala, Sweden
| | - Lars Gahnberg
- Department of Behavioural and Community Dentistry, Institute of Odontology, University of Gothenburg, Göteborg, Sweden
| | - Kurt Svärdsudd
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, UppsalaSweden
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