| Background:Diabetes mellitus (DM) is one of most common chronic metabolic disorders characterized by hyperglycemia resulting from a defect in insulin secretion, insulin action, or both. Prolonged hyperglycemia is associated with cardiovascular diseases neuropathy, retinopathy, and nephropathy, making DM become the third chronic disease resulting in serious harm to the human health after malignant tumor and cardiovascular diseases. According to the economic data reported by America Diabetes Association, the annual healthcare costs worldwide for people with diabetes is estimated to be at least 376 billion dollars, accounting for 11.6% of total healthcare expenditure. It is felt that lifestyle, the development of economy, together with an increased longevity, are the main factors in the dramatic increase of diabetes in China. The latest national survey data have documented that almost 113.9 million nationwide, or 11.6% of the Chinese adults population currently have DM. Thus, DM is a public problem in China which not only does serious harm to human health but give a huge economic burden to the society.Periodontal disease is collectively one of the most common oral diseases, the long-term consequences of which include gum bleeding, ozostomia, tooth mobility and even tooth loss. It is the leading cause of tooth loss and highly prevalent worldwide. It is reported prevalence ranges from 20%-50% in the general population. According to the third national survey of oral health status, periodontal diseases are affecting 80%-97% of adults in China and 17% of them is estimated to have severe periodontitis. The evidence showed that periodontal diseases have multiple negative impacts on both human oral health and quality of life. Thus, The World Health Organization has pointed that oral health should be considered as one of the most important part for the human health.In recent ten years, substantive evidence has emerging supporting that periodontitis could not only have negative impacts on oral health, but is considered as a risk factor and even an independent risk factor for a variety of chronic systematic diseases. In view of the hidden features of chronic periodontitis, it is often overlooked by patients, making it become the leading cause of chronic systematic inflammation. Recently, more and more attention of scholars in the fields of endocrine and oral medicine is being given to the bidirectional relationship between DM and periodontitis. One the one hand, DM is unequivocally confirmed as a major risk factor for periodontitis. It’s indicated that the risk of suffering periodontitis among patients with DM is about 2-3 times.compared with people without DM, and the level of glycaemic control is vital to determine the risk. On the other hand, periodontis is not only related to the development of DM, but also its complication. Moreover, moderate or severe periodontitis may worsen glycaemic control when not given effective treatment. Although the results of studies are inconsistent, a meta analysis reported a reduction in HbA1c of 0.4% follow conventional periodontal therapy. Additionally, another study has also found that the improvement of DM control could be helpful for the therapy of periodontitis.Because of the accumulation of evidence revealing the two-way relationship between DM and periodontitis, more and more scholars begin to pay close attention to the bidirectional influence of them. However, what about the attitudes of endocrinologists and dentists towards the current evidence? Whether their attitudes could influence the clinical practice? Moreover, how about the patients with DM? To our knowledge, only a handful of international literatures about only endocrinologists or patients with DM were reported and there is no such scientific evidence about health professionals in the domestic.The present study aimed to survey the knowledge, awareness, behaviors of both health professionals, including endocrinologists and dentists, and patients with DM regarding the relationship between DM and periodontitis, in fields of scientific researches related to DM and periodontitis. We tried to determine whether the current scientific evidence have been transferred into clinical practice because of the development of medical science. Moreover, the results would be applied to explore a suitable and effective way for the disciplinary collaboration, which could benefit the patients in the maximum extent, and to provide useful suggestions for DM education and further the development of related policies.Part 1 Knowledge, awareness and behaviors of endocrinologists and dentists for the relationship for the relationship between diabetes and periodontitisAims:This study aimed to compare the opinions of dentists and endocrinologists regarding DM and periodontitis, and to investigate the possible effects on their practice.Subjects:The endocrinologists and dentists, who attended Guangdong society of endocrinologist 2013 annual meeting or Guangdong society of periodontologist 2013 annual meeting, were eligible and invited to participate in the investigation.Methods:Two separated questionnaires were developed respectively for endocrinologists and dentists. Evidence from the literature regarding DM and periodontitis contributed to the development of the questionnaires, and the questionnaires were then modified by a panel of professors, including a statistical expert. The final version of questionnaires consisted of 3 domains, including attitudes towards the relationship of DM and periodontitis, willingness of interdisciplinary education and collaboration, and practice behaviors. At the beginning of the meeting, the questionnaires were distributed to all the participants after verbal informed consent was obtained, and collected at the end of the meeting. The collected questionnaires were evaluated according to a unified standard. Only those data completed were analyzed.Statistical analyses:The data entry was performed independently in duplicate by two authors. All analyses were performed using SPSS, version 20. Data were described using mean and standard deviation for continuous variables frequencies for categorical variables. Student’s test or analysis of variance was carried out for continuous variables. Multivariate analysis using binary logistic regression was conducted to identify factors associated with the practice of endocrinologists and dentists. The ultimate scales were evaluated as followed, principal component factor analysis was conducted, and reliability was assessed using Cronbach’s a coefficients. A value of P <0.05 was considered statistically significant.Results:1. General informationDentists had a higher response rate at 91.8%(156/170) compared to endocrinologists with the response rate at 79.1%(317/401). The analytic data came from 431 respondents with effective data, including 297 endocrinologists and 134 dentists:158 (36.7%) men and 273(63.3%) women.29.9% of the respondents were aged less than 30 years old,47.3% aged from 30 to 40,20.2% aged form 40-50, and 2.6% aged more than 50 years old.2. Reliability and validity analysisThe internal consistency of the scales for dentists and endocrinologists was reported at 0.788 and 0.814 by Cronbach’s a coefficients, which was considered as good reliability. The results of factor analysis for the scales of dentists and endocrinologists indicated a total 3 components with eigenvalues higher than 1, which accounted for 70.7% and 71.3% of the variance, supporting a good validity.3. Knowledge, awareness and behaviors regarding DM and periodontitisCompared with endocrinologists, dentists presented more favorable attitudes for the relationship of DM and periodontitis (P<0.001). The results were shown that among endocrinologists, those with longer practicing years agreed more with the statements.61.2% of dentists reported they would frequently refer patients with severe periodontitis for DM evaluation, while only 26.6% of endocrinologists reported they would frequently advise patients with DM to visit a dentist. The logistic regression analysis exhibited that respondents with more favorable attitudes were more likely to advise a dental visit (P=0.003) or to screen for DM (P=0.006). Nearly all of the respondents (94.4%) agreed that the interdisciplinary collaboration should be strengthened.Conclusions:Endocrinologists and dentists are not equally equipped with the knowledge about the relationship between DM and periodontitis, and there is a wide gap between their practice and the current evidence, especially for endocrinologists. It’s urgent to take measures to develop the interdisciplinary education and collaboration among the health care providers to improve the oral and systematic health of patients with DM.Part 2 Knowledge, awareness, and behaviors of patients with type 2 diabetes for the relationship between diabetes and periodontitisAims:The objectives of the study were to assess the level of knowledge and awareness of patients with type 2 diabetes regarding the relationship between diabetes and periodontitis, and to determine whether they sustain good oral health through proper oral hygiene behaviors.Subjects:Participants in this study were a convenience sample of 123 in-patients with type 2 diabetes who sought treatment at the Department of Endocrinology, Zhujiang Hospital, Southern Medicine University, China from June 2013 to February 2014. Eligible participants were confirmed type 2 diabetes patients who were free from mental disabilities, cancer, hepatic failure, renal failure and any other serious diseases.Methods:The questionnaire questions were carefully selected from the third national survey of oral health status and relevant published reports in international journals, and then modified by an experienced team of health professionals and a statistical expert. The questionnaire asked about demographic characteristics, medical history about diabetes and periodontitis, habits like smoking and drinking, knowledge for diabetes and periodontitis, and oral health behaviors. The participants completed a self-report questionnaire and if necessary they received oral and written instructions on questionnaire completion. Completed questionnaires were collected and evaluated to determine whether they were considered effective according to a unified standard.Statistical analyses:The data entry was performed independently in duplicate by two authors and analyzed by SPSS, version 20. Data were described using mean and standard deviation for continuous variables and frequencies for categorical variables. A value of P<0.05 was considered statistically significant.Results:1. The general information of included participants with type 2 diabetesA total of 123 patients with type 2 diabetes were included the current study, of whom 50.4% were men and 49.6% women. The participants’age ranged from 15 to 82, with an average age of 58.6±13.0 years. Only 39.7% of the respondents reported having received diabetes education and 11.5% of them reported having been educated about oral heath knowledge.2. Knowledge, awareness, and behaviors of included participants with type 2 diabetes for the relationship between DM and periodontitisOnly 25.3% of the participants were found to have adequate knowledge of relationship between diabetes and periodontitis. The percentage of correctly answered question was generally low. Only 4.9% of the participants knew that the improvement of glycaemic control could follow effective periodontal therapy. Of the participants, only half brushed their teeth at least twice daily and,86.7% never used dental floss. Oral self-care and use of dental services were poor among participants, and less than a tenth of them have a dental visit at least twice each year.Conclusions:Almost all the patients with type 2 diabetes have little knowledge of the relationship between diabetes and periodontitis. Moreover, oral self-care and use of dental services were poor among participants. In order to improve oral and systematic health of patients with type 2 diabetes, heath professionals need to develop programs to educate the public about the relationship of diabetes and periodontitis, so that all the patients would sustain good oral health through proper oral hygiene and regular dental check-ups. |
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