What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

There are estimated 850k people in UK with undiagnosed diabetes (Diabetes UK). There are known established bidirectional links between diabetes and periodontal disease. Diabetes is a major risk factor for periodontal disease, and the presence of periodontal disease negatively impacts a diabetic patient’s glycaemic control, and there is evidence that periodontitis patients exhibit a higher chance of developing pre-diabetes with potential major public health implications. Studies have found that there is a higher association/risk between poor periodontal health and diabetes complications.

There are significant boundaries when looking at cluster working, the project will support integrated and collaborative working across the GMS and Dental collaboratives, working together for the first time, to better identify and support patients with periodontal disease, diabetes, or those at risk of developing either. Not only will the project address communication across the collaboratives, it will look to increase access to care, and improved services for patients.

What does your project aim to achieve?

NICE guidance for management of type 2 diabetes in adults was updated in June 2022 to include recommendations for periodontitis, including the need to raise awareness of the link between diseases. Recent guidance published by European Federation of Periodontology (EFP) and European arm of World Organisation of Family Doctors (WONCA) states undiagnosed pre-diabetes may significantly impact an individual’s health, and a poor response to periodontal treatment may indicate an undiagnosed metabolic condition.

Oral health professionals (OHPs) are ideally placed to help identify people at high risk of pre-diabetes or type 2 diabetes. The project aims to implement a 2-step protocol at Dental Practice Level – a validated questionnaire to identify patients at high risk of undiagnosed diabetes, followed by a POC HbA1c test and further referral if HbA1c values exceed cut-offs defined by national guidelines.

How will the project be delivered?

The project will be delivered by one Dental Practice within the cluster as a test of change which will need to:

• Working closely with GMS, the Dental Practice will establish an appropriate patient questionnaire to identify high risk patients.
• Purchase an appropriate POC machine to carry out testing/screening as necessary.
• The dental practice will carry out screening for high risk patients at the dental practice.
• Patients will be referred onwards as appropriate, if their reading exceeds cut-offs.

How is your project going to share learning?

As a part of the Accelerated Cluster Developments there are forums locally to share the learning already established and with the internal Primary and Intermediate Care Clinical Board.

The team will be more than happy to share the learning with broader community Q -members.