Wright D, Muirhead V, Weston-Price S, Fortune F
Dental Public Health, Public Health England, 151 Buckingham Palace Road, London, SW1W 9SZ.
Dental Public Health, Centre for Clinical and Diagnostic Oral Sciences, UK.
Br Dent J. 2014 Apr;216(7):E15. doi: 10.1038/sj.bdj.2014.250.
Dental surgeries are highlighted in the 2012 NICE guidance Preventing type 2 diabetes: risk identification and interventions for individuals at high risk as a suitable setting in which to encourage people to have a type 2 diabetes risk assessment.
To assess the feasibility of implementing a type 2 diabetes risk screening pathway in dental settings using the NICE guidance tool.
The study was carried out over two weeks in June 2013. The validated tool in the NICE guidance was used to determine risk. This included a questionnaire and BMI measurement used to determine a risk score. Patients were rated low, increased, moderate or high risk. All patients were given written advice on healthy lifestyle. Patients who were moderate or high risk were referred to their general medical practitioners for further investigation. Participating dental teams were asked to nominate a member who would be responsible for overseeing the screening and training the other team members.
A total of 166 patients took part in the pilot (58% male, 75% aged 49 years or younger and 77% were from BME groups). Twenty-six low risk patients (15.7%), 61 increased risk patients (36.7%), 49 moderate-risk patients (29.5%) and 30 high-risk patients (18.1%) were identified during the pilot. Fifteen of the 49 patients (30.6%) identified as moderate-risk and 6 of the 30 high-risk patients (20%) had visited their GP to discuss their type 2 diabetes risk in response to the screening.
The pilot suggests that people at risk of developing type 2 diabetes could be identified in primary, community and secondary dental care settings. The main challenges facing dental staff were time constraints, limited manpower and the low number of patients who visited their GP for further advice.
2012年英国国家卫生与临床优化研究所（NICE）发布的指南《预防2型糖尿病：高危个体的风险识别与干预》强调，牙科手术是鼓励人们进行2型糖尿病风险评估的合适场所。
使用NICE指南工具评估在牙科环境中实施2型糖尿病风险筛查路径的可行性。
该研究于2013年6月进行了两周。采用NICE指南中经过验证的工具来确定风险。这包括一份问卷和用于确定风险评分的体重指数（BMI）测量。患者被评定为低风险、风险增加、中度风险或高风险。所有患者都收到了关于健康生活方式的书面建议。中度或高风险患者被转介给他们的全科医生进行进一步检查。参与的牙科团队被要求指定一名成员负责监督筛查并培训其他团队成员。
共有166名患者参与了该试点（58%为男性，75%年龄在49岁及以下，77%来自少数族裔群体）。在试点期间，识别出26名低风险患者（15.7%）、61名风险增加患者（36.7%）、49名中度风险患者（29.5%）和30名高风险患者（18.1%）。在被识别为中度风险的49名患者中，有15名（30.6%），在30名高风险患者中有6名（20%）因筛查结果而去看全科医生讨论他们的2型糖尿病风险。
该试点表明，在初级、社区和二级牙科护理环境中可以识别出有患2型糖尿病风险的人群。牙科工作人员面临的主要挑战是时间限制、人力有限以及去看全科医生寻求进一步建议的患者数量较少。
