INtroducing DIabetes Checks in A denTal practice Environment: INDICATE
Research type
Research Study
Full title
Introducing Diabetes Checks in A denTal practice Environment: INDICATE
IRAS ID
277583
Contact name
Zehra Yonel
Contact email
Sponsor organisation
University of Birmingham
Duration of Study in the UK
1 years, 9 months, 31 days
Research summary
Type 2 diabetes is a growing problem, predicted to account for 17% of money spent in the NHS by 2035(10). Almost 4 million people in the UK are currently diagnosed with diabetes, but it is thought another 1 million have undiagnosed diabetes(11) and another 12 million are at high risk of developing it(12). People may remain undiagnosed for years because diabetes often has no symptoms in its early stages(13).
The UK National Screening Committee (NSC) recognises benefits to earlier identification of people at high risk of developing diabetes or with undiagnosed diabetes(3) including reducing the risk of complications like heart-attacks, stroke and blindness(14, 15). It is suggested that 1-in-5 diabetes patients already have developed complications at the time they are diagnosed (16). Evidence also shows that diabetes is preventable in those at high risk(17). The NHS has developed the Diabetes Prevention Programme, a service to which GPs (general practitioners) can refer patients and which help patients reduce their risk. New approaches to identify people with undiagnosed diabetes or who are at high-risk of developing diabetes may result in better health, improved quality of life for patients, and reduced NHS costs.
In the UK, most people only see their GP when they feel unwell. However, most people visit a dentist for regular check-ups, even when they think themselves healthy(18).
This research aims
1) To determine the feasibility and acceptability of using UK dental practices to identify patients at high risk of diabetes or with undiagnosed type 2 diabetes.2) To determine the accuracy of the risk assessment process in identifying those who are at high risk or who unknowingly have type 2 diabetes.
Dental settings provide a unique opportunity to check large proportions of the population for the condition. Importantly, diabetes has known associations with periodontal disease (gum disease); dentists therefore also need to be aware if their patients have diabetes such that they can manage their oral health appropriately.
Summary of results
The study met all, documented objectives as per protocol.
- The main findings include:
o “This exploratory clinical study demonstrates the potential for utilising dental practice teams (DPTs) to develop their role and become an integral part of future diabetes management. Given the strong and well-established relationship between periodontitis and diabetes in addition to the current guidelines advocating improved collaborative working between dental teams and physicians. This study highlights how dental teams can identify new cases of non-diabetic hyperglycaemia (NDH) and type 2 diabetes (T2D) using the DDS/LRA (validated risk-assessment tools) especially when used in conjunction with point of care testing, provide brief interventions, signpost patients to reputable resources and potentially delay and prevent the onset of diabetes.
o In our sample:
10% of participants had a HbA1c (≥6% & <6.5%) = Non-Diabetic Hyperglycaemia
3% of participants had a HbA1c >6.5%) = T2D
o Key findings from the qualitative aspect of the study demonstrates that patients within NHS dental practices are in broad support of utilising OHPs to case-find NDH/T2D. Several key themes emerged from the interviews including: the relationship patients have with OHPs being key to success, the convenience of single visit testing, tangible testing and documentation, privacy and sensitivity around specific measures, aftercare and GP linkage, digital interface and clearer communication pathways with IT system linkage and improved IT infrastructure, Equity and measures to tackle health inequalities.REC name
London - Bromley Research Ethics Committee
REC reference
21/LO/0654
Date of REC Opinion
25 Oct 2021
REC opinion
Further Information Favourable Opinion