Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latif, Kuala Lumpur, 56000, Malaysia.
Department of Family Oral Health, Faculty of Dentistry, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia.
BMC Health Serv Res. 2022 Aug 13;22(1):1034. doi: 10.1186/s12913-022-08429-w.
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.
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.
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.
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.
尽管人们已经意识到糖尿病对口腔健康的影响,并了解相关知识,但将糖尿病患者转介至牙医进行治疗的做法仍然很差。同样,治疗接受糖尿病治疗的患者的牙医很少了解患者的血糖状况,因此错过了共同管理这些患者的机会。本研究旨在提供一种标准化的护理途径,该途径将从牙科诊所开始对糖尿病进行筛查,并将患者与初级保健机构联系起来,以便为他们提供优化的血糖控制护理。
采用改良德尔菲技术,根据现有证据和最佳护理实践,就牙周炎患者就诊牙科诊所时筛查糖尿病的建议达成共识。采用滚雪球技术招募专家组成员,专家包括家庭医学专家(5 名)、牙周病专家(6 名)、内分泌专家(3 名)和临床药剂师(4 名),他们参与管理公共和私人医疗保健机构的糖尿病患者。根据现有的公共医疗保健服务设计了护理算法。
CODAPT 专家组建议,如果诊断为牙周炎的患者空腹毛细血管血糖水平≥5.6mmol/L,则转介至初级保健以进一步评估血糖状况。列出了针对前驱糖尿病的干预治疗方案,并特别强调向牙科医疗团队反馈。
CODAPT 护理途径有可能将牙科诊所与初级保健联系起来,以便对接受牙周炎治疗的患者进行糖尿病/前驱糖尿病的诊断和/或优化治疗。