Novel Interdisciplinary Intra-Oral Diabetes Screening in Dental Patients

牙科患者的新型跨学科口腔内糖尿病筛查

• 批准号: 8433603
• 负责人: SHIELA M STRAUSS
• 金额: $ 33.64万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-12-05 至 2015-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8433603
• 关键词: 20 year old; Address; Adopted; Adult; Affect; American; Anxiety; Area; Attention; Behavioral Research; Biomedical Research; Blood; Blood Screening; Blood Tests; Blood specimen; Build-it; Caring; Characteristics; Clinic; Clinical; Collaborations; Complications of Diabetes Mellitus; Coupled; Dental; Dental General Practice; Dental Offices; Dentistry; Dentists; Diabetes Mellitus; Diagnosis; Discipline of Nursing; Disease; Disease Management; Disorder by Site; Early treatment; Ensure; Environment; Epidemic; Ethnic Origin; Fingers; Funding; General Practices; Gingiva; Glycosylated hemoglobin A; Health; Health Expenditures; Health Personnel; Hemorrhage; Individual; Insurance; Interdisciplinary Study; Laboratories; Learning; Measures; Methods; Morbidity - disease rate; Nurses; Nursing Students; Oral; Oral cavity; Patient-Centered Care; Patients; Periodontal Diseases; Periodontal Pocket; Periodontic specialty; Persons; Pilot Projects; Primary Health Care; Provider; Psychological Impact; Public Health; Quality of life; Reading; Recruitment Activity; Relative (related person); Research; Research Methodology; Research Personnel; Risk; Risk Factors; Sampling; Savings; Screening Result; Secondary Prevention; Source; Specificity; Students; Test Result; Testing; Time; Translating; United States National Institutes of Health; Visit; Work; abstracting; base; care seeking; college; diabetes management; follow-up; improved; innovation; medically underserved; mortality; next generation; novel; novel strategies; population health; preference; prevent; psychologic; public health relevance; racial difference; response; screening; social cognitive theory

DESCRIPTION (provided by applicant): Project Summary/Abstract This interdisciplinary, mixed methods R15 application builds on the unique organizational partnership between the NYU College of Nursing (NYUCN) and its College of Dentistry (NYUCD) to assess the accuracy, acceptability, feasibility, and consequences of a novel approach using oral blood to screen patients with periodontal disease for diabetes in general dental practices. Diabetes has reached epidemic proportions in the US, with 7 million people as yet undiagnosed, preventing them from adopting disease management strategies that could improve their quality of life and decrease morbidity. Among those at great risk are persons with periodontal disease, many of whom may see a dentist but not a primary care provider annually. This suggests the potential and importance of screening for diabetes at dental visits. Facilitated by the American Diabetes Association's promotion of blood testing for diabetes using hemoglobin A1c (HbA1c) levels, we conducted a pilot study (N=120) at a Periodontics Clinic to examine a potentially useful intra-oral approach to this screening. To do so, we collected samples of both finger stick blood (FSB) and gingival crevicular blood (GCB) from periodontal patients (the latter occurring naturally on probing their periodontal pockets). We then sent the dried blood samples for laboratory testing, and examined the accuracy of the GCB relative to the FSB readings. The laboratory, not the dentist, shared FSB test results with the patient, thus eliminating scope of practice concerns for the dentist. Results of this pilot study showed high specificity (.900) and sensitivity (.933) of the GCB HbA1c values relative to the FSB HbA1c values. It also demonstrated patient and provider preference for the GCB approach, as they were more comfortable with the provider collecting blood samples in the patient's mouth. However, before recommending widespread implementation of this promising diabetes screening approach, research is needed to replicate and expand this pilot study with a larger patient sample and to translate it to general dental practice settings, while ensuring that the screening does not generate excess patient anxiety or other psychological harms. After recruiting 500 patients with periodontal disease who seek care at 14 general practice clinics at NYUCD over a 15-month period, we will address the following specific aims: (1) Assess the accuracy of patients' HbA1c test results using GCB relative to FSB HbA1c readings; (2) Examine patient and provider views on the GCB diabetes screening approach's acceptability and feasibility; (3) Assess the psychological impact to patients of participating in screening for diabetes at dental visits; and (4) Compare socio-demographic and clinical characteristics of patients with a positive screening result who follow up with a health care provider within 3 months and those who do not, thereby illuminating potential barriers and facilitators to follow up. If results demonstrate that the GCB HbA1c screening is accurate, feasible, and acceptable, with minimal psychological impact on patients, and leads to timely follow-up with a health care provider, we will seek funding to further examine its usefulness on a broader scale.

描述（由申请人提供）： 项目摘要/摘要这个跨学科的混合方法R15应用程序建立在纽约大学护理学院（NYUCN）和牙科学院（NYUCD）之间独特的组织合作关系的基础上，以评估一种新方法的准确性、可接受性、可行性和后果，该方法使用口腔血液在一般牙科实践中筛查牙周病患者的糖尿病。糖尿病在美国已达到流行病的程度，有700万人尚未确诊，这使他们无法采取可以改善生活质量和降低发病率的疾病管理策略。牙周病患者的风险很大，他们中的许多人可能每年都去看牙医，但不是初级保健提供者。这表明在牙科就诊时筛查糖尿病的潜力和重要性。在美国糖尿病协会推广使用血红蛋白A1 c（HbA 1c）水平进行糖尿病血液检测的促进下，我们在牙周病诊所进行了一项试点研究（N=120），以检查一种潜在有用的口腔内方法进行这种筛查。为此，我们收集了牙周病患者的手指针刺血（FSB）和龈沟血（GCB）样本（后者在探测牙周袋时自然发生）。我们 然后将干燥的血液样本送去实验室检测，并检查GCB相对于FSB读数的准确性。实验室，而不是牙医，与患者分享FSB测试结果，从而消除了牙医的实践范围。该初步研究的结果显示，GCB HbA 1c值相对于FSB HbA 1c值具有较高的特异性（0.900）和灵敏度（0.933）。它还证明了患者和提供者对GCB方法的偏好，因为他们对提供者在患者口中收集血液样本更满意。然而，在建议广泛实施这种有前途的糖尿病筛查方法之前，需要进行研究，以复制和扩大这项试点研究，并将其转化为一般的牙科实践环境，同时确保筛查不会产生过度的患者焦虑或其他心理伤害。在招募了500名在纽约大学CD的14个全科诊所寻求治疗的牙周病患者15个月后，我们将解决以下具体目标：（1）评估患者的HbA 1c检测结果使用GCB相对于FSB HbA 1c读数的准确性;（2）检查患者和提供者对GCB糖尿病筛查方法的可接受性和可行性的看法;（3）评估在牙科就诊时参与糖尿病筛查对患者的心理影响;以及（4）比较在3个月内与医疗保健提供者进行随访的筛查结果为阳性的患者和未进行随访的患者的社会人口统计学和临床特征，从而阐明随访的潜在障碍和促进因素。 如果结果表明GCB HbA 1c筛查是准确的，可行的，可接受的，对患者的心理影响最小，并导致与医疗保健提供者及时随访，我们将寻求资金进一步研究其在更广泛范围内的有用性。