 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Carol Kunzel, PhD, Evanthia Lalla, DDS, MS, David Albert, DDS, MPH, Hong Yin, and Ira B. Lamster, DDS, MMSc. School of Dental and Oral Surgery, Columbia University, 630 W. 168th St., New York, NY 10032, 212-304-7176, ck60@columbia.edu
The opportunity exists for dentists to identify suspected diabetic patients or poorly controlled patients in the dental office. Approximately 50% of individuals with diabetes (about 8 million people in the U.S.) remain undiagnosed. Many patients at the time of diagnosis of diabetes already have diabetic complications. It is important they be diagnosed as early as possible. In addition diabetes is an important risk factor for periodontal disease. Historically, the primary method used to diagnose diabetes and monitor blood glucose levels is the fasting blood glucose test. While valuable for making a diagnosis, this tends to be highly dependent on patient compliance, and is meaningful only for the immediate time period prior to which the test is administered. HbA1c measurement is an excellent in-office screening tool that does not rely on patient compliance, does not require fasting, and gives an indication of glucose levels over an extended time period. Pilot study data indicate that dentists' performance of diabetic screening behaviors in their offices is low. Data were collected via mail survey of active general practitioners (GP) and periodontists in the northeastern USA during fall 2002 (n=208, response rate=76%). No statistically significant difference was found between the two groups with respect to number of patients ever screened for diabetes using a finger-stick test, with 91% periodontists and 97% GP reporting none. Dentists can usefully identify suspected diabetic patients or poorly controlled patients in the dental office. According to the Theory of Planned Behavior, a change in dentists' behavior is brought about by producing changes in: Attitudes - beliefs about the consequences of performing/not performing the behavior; Norms - beliefs about whether other people approve/disapprove of performing the behavior; Perceived Behavioral Control - beliefs regarding the ease/difficulty involved in performing the behavior. These model components influence intention to perform the behavior which, along with PBC, influences behavior. Before developing interventions to change dentists' behavior, it is important to determine the degree to which the behavior is under attitudinal, normative, or behavioral control. Multiple regression analyses indicate intention to manage the diabetic patient in the office (R2=.26, p<.001) is primarily influenced by the normative component, perceived approval and support from colleagues and patients (Beta=.22, p<.01), and the extent to which the dentist routinely communicates with the patient's physician (Beta=.21, p<.01). The relative importance of the predictive components can help to shape the content and design of future interventions. Supported by NIDCR DE014898.
Learning Objectives:
Keywords: Diabetes, Screening
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.