Glurich Ingrid, Berg Richard, Panny Aloksagar, Shimpi Neel, Steinmetz Annie, Nycz Greg, Acharya Amit
Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States.
Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI, United States.
Front Oral Health. 2021 May 26;2:670355. doi: 10.3389/froh.2021.670355. eCollection 2021.
Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments. POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset ( = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored. Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures. POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.
糖尿病/糖尿病前期的发病率持续上升，不同人群受到的影响差异显著。以往的现场试验将牙科诊所作为额外的初级保健场所，推广即时(point-of-care, POC)血糖筛查，以识别需要综合护理干预的潜在高危个体。本研究观察了社区卫生中心(CHC)牙科诊所(DC)进行POC糖化血红蛋白(HbA1c)筛查的结果，以及在牙科就诊的高危患者对纵向综合护理管理的依从性。在DC环境中使用美国食品药品监督管理局(FDA)批准的仪器进行POC HbA1c筛查，并对之前未诊断为糖尿病/糖尿病前期且在过去6个月内未进行血糖检测的高危牙科患者进行牙周评估。对2017年10月24日至2018年9月24日期间在威斯康星州的4个CHC-DC就诊的患者进行筛查，这些诊所服务的人群差异代表性较高。符合高危特征的受试者接受了POC HbA1c筛查。糖化血红蛋白(HbA1c)测量值处于糖尿病/糖尿病前期范围的个体被建议寻求进一步的医学评估，并在3个月后再次联系以记录其依从性。对一部分(n = 44)有可用临床、医疗和牙科数据的受试者，在电子健康记录中纵向记录血糖测量长达2年。监测纵向血糖状态以及随访护理的医疗和牙科就诊频率。风险评估确定，在经过两级风险筛查后，224/915 (24.5%)的患者符合纳入标准，其中127/224 (57%)的患者有资格进行POC HbA1c筛查。在接受检测的患者中，62/127 (49%)的患者表现出血糖升高：55例处于糖尿病前期范围，7例处于糖尿病范围。与血糖测量值在正常范围的个体相比，糖尿病前期/糖尿病患者中中重度牙周炎更为普遍。3个月时参与者的随访依从率为90%。纵向随访记录显示，糖化血红蛋白(HbA1c)筛查测量值异常的个体在24个月内对综合医疗/DC环境的持续就诊率较高(分别为100%和89%)。POC血糖筛查显示，近一半的高危CHC-DC患者糖化血红蛋白(HbA1c)测量值升高。观察到在24个月期间对综合医疗/牙科管理的强烈依从性，证明患者在牙科环境中对POC筛查的良好接受度以及高危患者对综合护理随访的依从性。
