Title: Diabetes and periodontitis: developing and piloting a novel oral health intervention to enable improved glycaemic control.
Funder: Department of Health and Social Care

Abstract: Background: Diabetes is a major risk factor for periodontitis (increasing the risk of periodontitis approximately 3-fold), and, importantly, evidence supports a two-way' relationship between diabetes and periodontitis with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. This bi-directional relationship between diabetes and periodontitis is now widely accepted by periodontal researchers and dental clinicians all over the world. However, the evidence linking diabetes and periodontitis has had limited impact on the organization of diabetes care, and, as my previous research in the Tyne & Wear region has shown, diabetes care providers are generally not aware of the links between the two conditions. Objectives: I will conduct a 3-phased project to develop and pilot an oral health intervention to improve awareness of patients and clinicians of the links between periodontitis and diabetes, and of the importance of managing periodontal health as part of overall diabetes management. Design: In Phase 1, I will develop a questionnaire to ascertain knowledge, current practices and barriers and facilitators relating to oral health and diabetes among healthcare professionals (HCPs) who manage people with diabetes (PWD) in the North East and North Cumbria (NE&NC) and the South West Peninsula (SWP) regions of England. This wider geographical spread will allow me to more comprehensively identify the barriers and facilitators that exist for HCPs when considering the oral health of their PWD, as well as any exemplars of good practice that I can draw upon. I will survey GPs, diabetes nurse specialists, dieticians and diabetologists (n=336 in total) who manage PWD in primary and secondary care. I will liaise with the Diabetes Research Networks in NE&NC and SWP to gain access to PWD through their PPI lay groups and to HCPs via their research facilitators in the North East Commissioning Support (NECS) unit and SWP Primary Care Research Network (PCRN). In Phase 2, I will work with focus groups of HCPs and PWD, utilising the information derived from Phase 1 and from my field notes and observations of centres of excellence in the UK/USA/Canada, to design potential oral health interventions that could be implemented within the context of the NHS. The key factor here is that I will work with the HCPs and PWD to develop oral health intervention(s) that would work for them, in the context of their own health management and working environments. There will be iterative cycles of development and refinement of the oral health interventions undertaken by the focus groups. Finally, in Phase 3, those interventions (likely n=1-3) deemed to be the most suitable by the HCPs and PWD (i.e. those delivering the intervention and those receiving it), will be piloted to assess their feasibility and acceptability.Expected outcomes and possible benefits: It is understood that knowledge alone is not sufficient to enable the delivery of healthcare interventions; investment potential on the behalf of the HCPs and health system changes are vital; that is why my research is focused on working with HCPs and PWD; the very people who will deliver and receive the intervention(s). The expected outcome of this research is, by working with HCPs and PWD, to develop an oral health intervention that they feel would work for them in the context of their own environment. Longer term, I would take this forward into a future funding application to conduct an RCT to evaluate the incorporation of the oral health intervention into diabetes screening systems in the UK.

Lay abstract: Gum disease (periodontitis) is a lesser known complication of diabetes. Furthermore, gum disease makes diabetes control more difficult, and it has also been shown that treating gum disease results in improved diabetes control. These facts are generally not known to most people with diabetes or by the medical teams who treat them. The aim of my research is to reduce the gap that currently exists between evidence and clinical practice by working with patients and clinicians to develop and pilot intervention(s) to increase awareness of the importance of managing periodontal health as part of overall diabetes management.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL