Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes.

BACKGROUND: Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients' perspectives of their medications from hospital to two months after discharge. METHODS: Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted. RESULTS: Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence. CONCLUSIONS: The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients' difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients' needs, increase their safety, and standardize physicians', pharmacists', and nurses' roles and responsibilities.

Navigating outpatient care of patients with type 2 diabetes after hospital discharge - a qualitative longitudinal study.

BACKGROUND: The transition from hospital to outpatient care is a particularly vulnerable period for patients as they move from regular health monitoring to self-management. This study aimed to map and investigate the journey of patients with polymorbidities, including type 2 diabetes (T2D), in the 2 months following hospital discharge and examine patients' encounters with healthcare professionals (HCPs). METHODS: Patients discharged with T2D and at least two other comorbidities were recruited during hospitalization. This qualitative longitudinal study consisted of four semi-structured interviews per participant conducted from discharge up to 2 months after discharge. The interviews were based on a guide, transcribed verbatim, and thematically analyzed. Patient journeys through the healthcare system were represented using the patient journey mapping methodology. RESULTS: Seventy-five interviews with 21 participants were conducted from October 2020 to July 2021. The participants had a median of 11 encounters (min-max: 6-28) with HCPs. The patient journey was categorized into six key steps: hospitalization, discharge, dispensing prescribed medications by the community pharmacist, follow-up calls, the first medical appointment, and outpatient care. CONCLUSIONS: The outpatient journey in the 2 months following discharge is a complex and adaptive process. Despite the active role of numerous HCPs, navigation in outpatient care after discharge relies heavily on the involvement and responsibilities of patients. Preparation for discharge, post-hospitalization follow-up, and the first visit to the pharmacy and general practitioner are key moments for carefully considering patient care. Our findings underline the need for clarified roles and a standardized approach to discharge planning and post-discharge care in partnership with patients, family caregivers, and all stakeholders involved.

[Diabetes and pancreatic cancer - When diabetes indicates a pancreatic cancer]. / Diabète et cancer du pancréas - Quand le diabète est annonciateur de cancer pancréatique.

Diabetes and pancreatic cancer have an intricate relationship where each is a risk factor for developing the other. In case of type 2 diabetes, there is an increased probability of developing pancreatic cancer. Similarly, the onset of diabetes often precedes the diagnosis of pancreatic cancer. Since hyperglycemia is secondary to tumor involvement of the exocrine pancreas, diabetes is considered pancreatogenic. In the current classification, it is part of the entities belonging to type 3c diabetes. The pathophysiology is specific, characterized by a high glycemic variability and a tendency to weight loss. Early identification of inaugural type 3c diabetes would reduce diagnostic delays and could optimize oncologic management. In the absence of specific markers, the challenge for the clinician is indisputable.

Diabète et cancer du pancréas entretiennent une relation intriquée où chacun constitue un risque de développer l'autre. En cas de diabète de type 2, le risque de cancer augmente. La survenue d'un diabète précède aussi souvent le diagnostic de cancer du pancréas. L'hyperglycémie étant secondaire à l'atteinte tumorale du pancréas exocrine, ce diabète est considéré comme pancréatogénique. Dans la dénomination actuelle, il fait partie des entités appartenant au diabète de type 3c. La pathophysiologie est spécifique, caractérisée par une forte variabilité glycémique et une tendance à la perte de poids. Distinguer précocement les diabètes inauguraux de type 3c permettrait de réduire les délais diagnostiques et d'optimiser la prise en charge oncologique. En l'absence de marqueurs spécifiques, le challenge est indiscutable pour le clinicien.

Three Weeks Versus Six Weeks of Antibiotic Therapy for Diabetic Foot Osteomyelitis: A Prospective, Randomized, Noninferiority Pilot Trial.

BACKGROUND: In patients with diabetic foot osteomyelitis (DFO) who underwent surgical debridement, we investigated whether a short (3 weeks) duration compared with a long (6 weeks) duration of systemic antibiotic treatment is associated with noninferior results for clinical remission and adverse events (AEs). METHODS: In this prospective, randomized, noninferiority pilot trial, we randomized (allocation 1:1) patients with DFO after surgical debridement to either a 3-week or a 6-week course of antibiotic therapy. The minimal duration of follow-up after the end of therapy was 2 months. We compared outcomes using Cox regression and noninferiority analyses (25% margin, power 80%). RESULTS: Among 93 enrolled patients (18% females; median age 65 years), 44 were randomized to the 3-week arm and 49 to the 6-week arm. The median number of surgical debridements was 1 (range, 0-2 interventions). In the intention-to-treat (ITT) population, remission occurred in 37 (84%) of the patients in the 3-week arm compared with 36 (73%) in the 6-week arm (P = .21). The number of AEs was similar in the 2 study arms (17/44 vs 16/49; P = .51), as were the remission incidences in the per-protocol (PP) population (33/39 vs 32/43; P = .26). In multivariate analysis, treatment with the shorter antibiotic course was not significantly associated with remission (ITT population: hazard ratio [HR], 1.1 [95% confidence interval {CI}, .6-1.7]; PP population: HR, 0.8 [95% CI: .5-1.4]). CONCLUSIONS: In this randomized controlled pilot trial, a postdebridement systemic antibiotic therapy course for DFO of 3 weeks gave similar (and statistically noninferior) incidences of remission and AE to a course of 6 weeks. CLINICAL TRIALS REGISTRATION: NCT03615807; BASEC 2016-01008 (Switzerland).

Hyperinsulinism associated with GLUD1 mutation: allosteric regulation and functional characterization of p.G446V glutamate dehydrogenase.

BACKGROUND: Gain-of-function mutations in the GLUD1 gene, encoding for glutamate dehydrogenase (GDH), result in the hyperinsulinism/hyperammonemia HI/HA syndrome. HI/HA patients present with harmful hypoglycemia secondary to protein-induced HI and elevated plasma ammonia levels. These symptoms may be accompanied by seizures and mental retardation. GDH is a mitochondrial enzyme that catalyzes the oxidative deamination of glutamate to α-ketoglutarate, under allosteric regulations mediated by its inhibitor GTP and its activator ADP. The present study investigated the functional properties of the GDH-G446V variant (alias c.1496G > T, p.(Gly499Val) (NM_005271.4)) in patient-derived lymphoblastoid cells. RESULTS: The calculated energy barrier between the opened and closed state of the enzyme was 41% lower in GDH-G446V compared to wild-type GDH, pointing to altered allosteric regulation. Computational analysis indicated conformational changes of GDH-G446V in the antenna region that is crucial for allosteric regulators. Enzymatic activity measured in patient-derived lymphoblastoid cells showed impaired allosteric responses of GDH-G446V to both regulators GTP and ADP. In particular, as opposed to control lymphoblastoid cells, GDH-G446V cells were not responsive to GTP in the lower range of ADP concentrations. Assessment of the metabolic rate revealed higher mitochondrial respiration in response to GDH-dependent substrates in the GDH-G446V lymphoblastoid cells compared to control cells. This indicates a shift toward glutaminolysis for energy provision in cells carrying the GDH-G446V variant. CONCLUSIONS: Substitution of the small amino acid glycine for the hydrophobic branched-chain valine altered the allosteric sensitivity to both inhibitory action of GTP and activation by ADP, rendering cells metabolically responsive to glutamine.

[Hospital to home transition of care: challenges for patients with type 2 diabetes]. / Transition hôpital-ambulatoire : les enjeux pour les patients avec un diabète sucré.

The transition from hospital to ambulatory care is a high-risk period for patients with diabetes mellitus and is a challenge for health care professionals. Various interprofessional collaborative interventions have shown a positive impact on continuity of care at discharge. Communication and transmission of information between the hospital and ambulatory settings as well as coordination between healthcare professionals are key points to explore and to improve to ensure optimal continuity of care.

La transition entre l'hôpital et l'ambulatoire est une période à risque pour les patients avec un diabète sucré et un enjeu pour les professionnels de la santé. Différentes interventions en collaboration interprofessionnelle ont montré un impact positif sur la continuité des soins à la sortie de l'hôpital. La communication et la transmission d'informations entre les milieux hospitalier et ambulatoire ainsi qu'une coordination entre les professionnels de la santé sont des points clés à explorer et à continuer d'améliorer pour garantir une continuité des soins optimale.

[Total pancreatectomy and islet auto-transplantation: current state and new perspectives]. / Pancréatectomie totale et autotransplantation d'îlots†: état actuel et nouvelles perspectives.

Total pancreatectomy is a procedure primarily performed for chronic pancreatitis refractory to conservative therapy. It may nevertheless be indicated in the event of a malignant tumor, either as a treatment for a surgical complication or as a prevention of anastomotic leakage. If possible, islet auto-transplantation should be combined with total pancreatectomy for benign disease, in order to prevent a severe diabetes. Until recently, malignant disease was considered an absolute contraindication to islet auto-transplantation. A recent series from Milan showed promising oncological results in auto-transplantation for malignant disease, opening up new perspectives for total pancreatectomy for cancer.

La pancréatectomie totale est une procédure principalement effectuée pour une pancréatite chronique réfractaire au traitement conservateur. Elle peut néanmoins être indiquée en cas de tumeur maligne, soit comme traitement d'une complication chirurgicale, soit en prévention de fuite anastomotique. Dans la mesure du possible, une autogreffe d'îlots de Langerhans devrait être associée à une pancréatectomie totale pour maladie bénigne, dans le but de prévenir un diabète pancréatoprive. Jusqu'à récemment, une pathologie maligne était considérée comme une contre-indication absolue à une autogreffe d'îlots. Une série récente de Milan a montré des résultats oncologiques prometteurs en cas d'autogreffe pour pathologies malignes, ouvrant de nouvelles perspectives à la pancréatectomie totale pour cancer.

[Diabetes mellitus: impact of affects on self-management skills]. / Diabète sucré: impact des affects sur les compétences d'autogestion.

Diabetes self-management (DSM) is a process based on a series of complex learnings. The conceptualization of the role of the emotional dimensions that underlie and structure this process is critical to better understand why living with diabetes can become a burden. A clinical case illustrates the intertwining of the affective and cognitive dimensions of diabetes burden and its influence on DSM skills. Emotional regulation is a recognized determinant to implement effective and long-term DSM skills as well as access to DSM interventions. In order to improve DSME/S interventions efficacy, the role of emotional dimensions, new technologies and therapeutic advances needs to be considered.

L'autogestion du diabète sucré (AGDM) est un processus basé sur une série d'apprentissages complexes. La conceptualisation du rôle des dimensions affectives qui sous-tendent et structurent ce processus permet d'appréhender différemment le vécu des patients avec un diabète sucré. Une vignette clinique illustre l'intrication des dimensions affectives et cognitives et les possibles conséquences sur l'AGDM. La régulation des émotions s'avère être un des facteurs déterminants de l'AGDM, tout comme l'accès à des dispositifs d'éducation thérapeutique du patient (ETP). La prise en compte du rôle respectif des dimensions émotionnelles, des nouvelles technologies et des avancées thérapeutiques sur l'AGDM est à considérer pour développer des dispositifs d'ETP performants.

[Intensive treatment in family medicine : use of pumps and continuous glucose measurement systems]. / Traitements intensifs en médecine de famille : usage de pompes et systèmes de mesure en continu du glucose.

New technologic devices are presented: insulin pumps and continuous glucose monitoring (CGM) devices as well as morphine pumps to help general practitioners to deal different intensive situations. Insulin pumps and CGM devices are revolutionary for the management of diabetes. However, their use requires strong patient involvement, the opposite of automated diabetes management. Morphine pumps are a great help when patients in end-of-life stage cannot swallow oral morphine anymore. This article summarizes the main principles of use of these technological devices, common problems and situations at risk primary care practice.

Les dispositifs technologiques font partie de la médecine actuelle. Les pompes à insuline, la mesure en continu du glucose (MCG) ainsi que les pompes à morphine sont présentées ici pour aider le médecin de famille à gérer ces différentes situations intensives. Les pompes à insuline externes et la MCG ont révolutionné la prise en charge du diabète sucré. Pourtant, leur utilisation demande une forte implication du patient, soit l'opposé d'une gestion automatisée du diabète. Les pompes à morphine sont une grande aide lorsque le patient en fin de vie ne peut plus avaler de comprimés ou lorsque l'absorption orale est aléatoire. Cet article résume les principes de fonctionnement de ces dispositifs technologiques, les problématiques communes et les situations à risque pour la pratique du médecin de premier recours.

[Diabetes mellitus and work]. / Diabète et travail.

Diabetes mellitus (DM) affects an increasing proportion of workers, a trend that will compound with the ageing of the workforce. It is therefore important to consider DM in the workplace context. There is an interrelationship between DM and work. Indeed dysglycemia is associated with a greater risk of work accidents and long-term DM complications. On the other side work conditions can affect DM's stability. The consequences are absenteeism, presenteeism, early retirement or even disability with significant socio-economic costs. To keep patients with DM into the workforce, the evaluation of their working conditions is mandatory and ideally in collaboration with the general practitioner, diabetologist and occupational physician (OP). This article outlines some practical guidelines for the evaluation of diabetic's worker.

Le diabète sucré (DM) touche une proportion croissante de la population active et la tendance va augmenter avec le vieillissement des travailleurs. Il est donc important d'évaluer l'impact du DM sur le travail et leur interrelation. Le déséquilibre glycémique est associé à un plus grand risque d'accident de travail et les conditions de travail peuvent déséquilibrer le DM et favoriser l'émergence de complications. Les conséquences sont l'absentéisme, le présentéisme, la retraite anticipée, voire l'invalidité avec d'importants coûts socio-économiques. L'évaluation des conditions de travail en cas de DM devrait être systématique et idéalement collaborative entre médecin généraliste, diabétologue et médecin du travail (MT). Cet article résume les lignes directrices de l'évaluation du travailleur avec un DM.

[Preconception care in patients with diabetes]. / Prise en charge préconceptionnelle chez une patiente avec un diabète préexistant.

In patients with diabetes, pregnancy is associated with high maternal and fetal risks, especially in unplanned pregnancies. Current evidence confirms that timely family planning and interdisciplinary care and management starting at the preconceptional period can optimize metabolic control and significantly reduce these risks. The purpose of this article is to summarize the different aspects to consider as well as provide tools to use when preparing patients with diabetes for a pregnancy.

Chez les patientes diabétiques, la grossesse est associée à des hauts risques materno-fœtaux, notamment lorsqu'elle n'est pas planifiée. L'évidence actuelle confirme que la planification familiale opportune ainsi qu'une prise en charge interdisciplinaire depuis la période préconceptionnelle permettent d'optimiser le contrôle métabolique et de diminuer ces risques de façon significative. Le but de cet article est de résumer les différents aspects à considérer ainsi que de fournir des outils à utiliser lors de la préparation des patientes avec un diabète à une grossesse.

[Continuous glucose monitoring in clinical practice ]. / Systèmes de mesure continuedu glucose et pratique clinique.

Systems for continuous glucose monitoring (CGM) are changing the management of insulin treated patient providing dynamic glucose information. In Switzerland, CGMS are covered by the health insurance plan in case of intensive insulin therapy (> 3 injections/day) and chronic hyperglycemia, severe hypoglycemia or hypoglycaemia unawarness. The prescriptor has to be an endocrinologist. CGM technology is still expanding with a trend for new indications. Appropriate guidance is needed to keep CGMS use secure. The pillars of CGMS management are : 1) technical mastery, 2) regular reassessment of the prescription adequacy with the clinical situation, and 3) allocation of ressources dedicated to follow-up and training for both patients and caregivers.

La prise en charge des patients avec un diabète a été transformée par les systèmes permettant la mesure continue du glucose (CGMS). En Suisse, ils sont remboursés pour les patients traités par insulinothérapie intensive (> 3 injections par jour/pompe à insuline) en cas de déséquilibre glycémique, d'hypoglycémie sévère ou d'insensibilité aux hypoglycémies. L'indication doit être posée par un spécialiste. La multiplication des systèmes et la tendance à élargir les indications cliniques vont de pair avec le récent engouement suscité par ces dispositifs. L'efficacité et la sécurité d'utilisation reposent sur : 1) la maîtrise technique du système de CGM ; 2) la réévaluation régulière de l'adéquation entre la prescription et la situation clinique et 3) l'allocation de ressources pour le suivi et la formation des patients et des soignants impliqués.

[Dyslipidemia management in patients with type 1 diabetes]. / Prise en charge de la dyslipidémie chez les patients avec un diabète de type 1.

Cardiovascular diseases are the main cause of mortality in patients with type 1 diabetes (T1DM) despite modern technology and careful metabolic control. The occurrence of dyslipidemia is frequent with T1DM and affects the risk for cardiovascular disease as occur with the occurrence of micro vascular complications. Lifestyle modifications and statin treatment should be regularly evaluated in patients with T1DM. There has been extensive discussion in the media about statin but facts are statins reduce the risk of cardiovascular disease in primary and secondary prevention. In individuals with T1DM, dyslipidemia remains underdiagnosed and insufficiently treated. This article provides a summary of the knowledge about dyslipidemia and T1DM and aims to better identify the patients that should be treated.

Les maladies cardiovasculaires restent la première cause de mortalité chez les patients avec diabète de type 1 (DT1) malgré les progrès technologiques et l'attention portée au contrôle métabolique. L'occurrence d'une dyslipidémie est fréquente en cas de DT1 et constitue un facteur de risque cardiovasculaire bien identifié au même titre que l'existence de complications microvasculaires. Le renforcement des mesures hygiéno-diététiques et la prescription de statine sont à évaluer régulièrement. Les controverses médiatiques sur les statines ne devraient pas occulter leur efficacité tant en prévention secondaire que primaire, car la dyslipidémie reste sous-diagnostiquée et insuffisamment traitée dans le DT1. Cet article résume les données de la littérature et vise à mieux identifier les patients à traiter.

[Type 1 diabetes, physical activity and novel technology]. / Diabète de type 1, activité physique et nouvelles technologies.

Physical activity is recommended for all patients with diabetes, but it is important to be particularly attentive in patients with type 1 diabetes. Because of their treatment, these patients have a higher risk of hypoglycemia. The challenge for both caregivers and the patient is to find the best possible strategy to practice the desired physical activity without any significant hypo- or hyperglycemia. Thus, an adaptation of the insulin and/or nutritional treatment is necessary, depending on the type, intensity and duration of the physical activity. Moreover, many technological devices are now available that can improve patient care, but they also have some limitations to take into account. Allover, an interdisciplinary approach is highly recommended, both for a specific or a regular physical activity practice.

L'activité physique est recommandée pour tous les patients avec un diabète, mais une attention particulière est nécessaire en cas de diabète de type 1. En effet, ces patients sont à haut risque d'hypoglycémie. Le défi des soignants et du patient est donc de trouver la meilleure stratégie possible pour pouvoir pratiquer l'activité physique souhaitée, et cela sans faire d'hypo ou d'hyperglycémie. Une adaptation du traitement d'insuline et/ou de l'alimentation est nécessaire, en fonction du type, de l'intensité et de la durée de l'activité physique. Il existe désormais plusieurs outils technologiques permettant d'améliorer la prise en charge du patient, lesquels ont également des limitations. Ainsi, une prise en charge interdisciplinaire diabétologique est recommandée en vue de la pratique d'une activité physique régulière ou ponctuelle.

[Treatment of type 2 diabetes : risk and benefits of metabolic surgery]. / Traitement du diabète de type 2 : risques et bénéfices de la chirurgie métabolique.

Metabolic surgery is a serious option to treat type 2 diabetes. The latest guidelines consider surgery as one of the first option, especially in patients suffering from severe obesity or those who have uncontrolled diabetes. However, the radicality of metabolic surgery limits its prescription and is difficult to handle. Indeed, criteria of success remain insufficently understood in order to help caregivers to rigorously select the right candidates. This article proposes a review of the literature on the risks and benefits of metabolic surgery for the diabetic obese patient.

La chirurgie métabolique constitue une réelle alternative thérapeutique chez le patient avec un diabète de type 2. Les dernières recommandations prônent d'ailleurs de l'intégrer précocement parmi les options thérapeutiques à considérer, en particulier chez les patients souffrant d'une obésité sévère ou avec un diabète insuffisamment contrôlé. Dans les faits, la radicalité de la chirurgie limite sa prescription et place les soignants face à un dilemme lors de la sélection des patients candidats, les critères prédictifs de succès restant insuffisamment compris. Cet article propose une revue de la littérature relative aux risques et bénéfices de la chirurgie métabolique chez le patient obèse diabétique.

[Insulin and oral antidiabetes drugs: how associate these treatments in ambulatory care?]. / Insuline et antidiabétiques oraux: comment les associer dans la pratique ambulatoire?

Type 2 diabetes mellitus is a complex and progressive metabolic disease involving more than 400 millions of people worldwide. The treatments need to be constantly managed to maintain appropriate glycemic control and avoiding complications. There is a wide variety of therapeutic option including oral antidiabetes drugs or new insulin on the market. The initiation of insulin treatment seems a mandatory step for a large panel of patients. Therefore, it is important to know the indications to initiate insulin treatment and the best way to associate it with antidiabetes drugs.

[News in diabetology]. / Diabétologie.

News on the front of diabetes have revealed the remarkable results of multifactorial treatment of type 2 diabetes on morbidity and mortality. Micro and macro-angiopathic complications have markedly decreased during the last 20 years. However, intervention trials on glycemic control alone show a slight or no benefit on cardiovascular complications or mortality when intensive treatment aims at HbA1c below 7.0-7.5%. Life adaption remains a critical part of diabetes treatment to decrease cardiovascular risk. Recent knowledge on nutrition and meal frequency has taught us to distrust old dogmas.

Assessing the use of sodium-glucose cotransporter 2 inhibitor in patients with type 2 diabetes mellitus and chronic kidney disease in tertiary care: a SwissDiab Study.

INTRODUCTION: The overall aim of this study was to evaluate the implementation of sodium-glucose cotransporter 2 inhibitors (SGLT2i) among patients in tertiary care with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS: The cross-sectional analysis was based on outpatients in tertiary diabetes care enrolled in the Swiss Diabetes Registry with T2DM and a study visit January 1, 2020-March 31, 2021. Prevalence of CKD was ascertained as an estimated glomerular filtration rate <60 mL/min/1.73 m2 and/or persistent albuminuria as defined by Kidney Disease Improving Global Outcomes, and the proportion of patients prescribed SGLT2i was determined. Documented reasons for non-treatment with SGLT2i were extracted by a retrospective review of the medical records. RESULTS: Of 368 patients with T2DM, 1.1% (n=4) were excluded due to missing data. Of the remaining 364 patients, 47.3% (n=172) had CKD of which 32.6% (n=56) were prescribed SGLT2i. The majority (75%) of these patients were on treatment already in 2018, before the renoprotective effects of SGLT2i were established. Among the 116 patients without SGLT2i, 19.0% had known contraindications, 9.5% stopped treatment due to adverse events, 5.2% had other reasons, and no underlying reason for non-treatment could be identified for 66.4%. CONCLUSIONS: A divergence between recommended standard of care and implementation in daily clinical practice was observed. Although treatment should always consider patient-specific circumstances, the results highlight the need to reinforce current treatment recommendations to ensure patients benefit from the best available care.

Knowledge and practice attitudes regarding the relationship between diabetes and periodontitis: a survey among Swiss endocrinologists and general physicians.

BACKGROUND: The objective of the present survey is to assess the knowledge about the relationship between oral health and diabetes and to identify the practice behaviors of Swiss endocrinologists and general practitioners regarding oral health in diabetic patients. METHODS: A thirty- item questionnaire was mailed to 428 internists and 99 endocrinologists working in the French speaking part of Switzerland. Participants were asked about their awareness of the relationship between diabetes and periodontal disease, their practice behaviors as well as their willingness for an interdisciplinary education and collaboration with oral health professionals. The questions were answered according to a three-point or five-point Likert scale. RESULTS: The response rate was 23%. All participants were aware of the inflammatory and infectious nature of periodontal disease. They all agreed that good periodontal health is important for overall health. However, most of the practitioners responded that only rarely received information during their education curricula on the link between systemic and oral health or concerning periodontal problems in diabetic patients (60.9% for endocrinologists and 54.1% for general physicians); thus, only a minority of health practitioners addresses oral health care to their patients (13% and 15.3%, respectively). Both endocrinologists and general health physicians agreed that an oral health screening could be included in their practice (79% for both groups). CONCLUSIONS: An interdisciplinary education and collaboration among medical and dental health providers should be established to effectively prevent, manage, and control both diabetes and periodontal disease in diabetic patients.