Identification of Diabetes Risk in Dental Settings: Implications for Physical and Mental Health.

The risk for diabetes risk is significantly elevated in persons who are older, overweight and have serious mental illness. However, primary care practitioners (PCP) tend to underestimate this risk. Although there are few opportunities for early detection of diabetes, blood exuded during routine oral exams in dental settings can be used to assess glycated hemoglobin (HbA1c) levels. The current study sought to understand how primary care practitioners would react to patients who screened positive for elevated HbA1c, how they estimated risk, and whether they provided treatment recommendations or counseling. Method: Semi-structured telephone interviews were conducted on 61 subjects three months after demonstrating elevated HbA1c levels from dental screenings. Data were transcribed and analyzed using content analysis. Results: Qualitative analyses revealed four themes according to patients: (1) "Being told I needed to make lifestyle changes" (41%); (2) Realizing I needed a new health care provider or medication change" (10%); (3) "Being told of the need for monitoring but no counseling/treatment change" (16%); and (4) "Being told everything is fine and there is nothing to worry about" (31%). Conclusions: Only half of the 61 cases reporting elevated HbA1C levels at screening experienced their PCP's as responding with counseling or medication changes. Almost a third of cases perceived that their PCP's dismissed the results, making no recommendations, and the rest perceived no counseling or interventions being proposed. Based on subjects' perceptions of their PCP's responses to their elevated HbA1c values, the impact of this intervention is substantially reduced over expectations.

Predictors of Depression Among Adult Women With Diabetes in the United States: An Analysis Using National Health and Nutrition Examination Survey Data From 2007 to 2012.

PURPOSE: The purpose of the study was to identify the sex-specific characteristics that predict depression among adult women with diabetes. METHODS: Data from the 2007-2012 National Health and Nutrition Examination Survey in the United States were used to identify the predictors of depression in a large sample of women ages 20 years and older with diabetes (n = 946). RESULTS: When extrapolated to almost 9 million women in the United States ≥ 20 years of age with diabetes, 19.0% had depression. Female-specific significant predictors of depression included younger age (< 65 years old), less than high school graduation, self-rated fair or poor health, inactivity due to poor health, and pain that interferes with usual activities. Marital status and diabetes-related factors (years living with diabetes, use of insulin, parent or sibling with diabetes) were not significant predictors of depression in adult women with diabetes. CONCLUSION: When educating and counseling women with diabetes, diabetes educators should be aware that some of the predictors of depression in women with diabetes differ from those of populations that include both sexes. Depression screening, although important for all women with diabetes, should especially be performed among women with female-specific depression predictors.

The potential for glycemic control monitoring and screening for diabetes at dental visits using oral blood.

OBJECTIVES: We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes. METHODS: In 2013 and 2014, we performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired "gold-standard" HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients. RESULTS: About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits. CONCLUSIONS: Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients.

Illness perceptions among adults at risk for diabetes.

PURPOSE: The purpose of this study is to examine diabetes illness perceptions among a sample of at-risk adults according to specific characteristics that make them vulnerable to diabetes. METHODS: At-risk adults (N = 372) participated in a study investigating the potential to screen them for diabetes at a large urban dental college. Sociodemographic and individual-level diabetes risk-related characteristics, A1C measures, diabetes-related symptoms, diabetes knowledge, diabetes illness perceptions, and perceived causes of diabetes were collected and reported for the study sample; t tests were then used to determine whether there were statistically significant differences in each of 8 dimensions of diabetes illness perceptions according to the presence or absence of 6 diabetes risk factors. RESULTS: Average A1C values were 5.6% (38 mmol/mol), and 46% of the study sample had A1C values in the prediabetes or diabetes range. Participants had various diabetes knowledge gaps and misperceptions, and there were differences in dimensions of diabetes illness perceptions depending on specific diabetes-related risk factors. CONCLUSIONS: In view of differences in the diabetes-related illness perceptions of persons at risk for diabetes, it is important for diabetes educators and other health care providers to personalize their diabetes-related education, management, and support to the specific needs and vulnerabilities of at-risk patients.

Enhancing Drug Treatment Program Staff's Self-Efficacy to Support Patients' HCV Needs.

To increase HCV-related support for patients in substance abuse treatment programs, we implemented an on-site staff training in 16 programs throughout the United States. It aimed to increase participants' self-efficacy in assisting patients with their HCV-related needs. Findings indicate that participants' self-efficacy increased both 1- and 3-months post-training, resulting in providers' perceptions that they were better able to support patients regarding HCV. Implementing an engaging and interactive HCV training for social workers and other substance abuse treatment program staff has the potential to increase their HCV knowledge, self-efficacy, and the HCV-related assistance provided to patients both in the short- and longer-term.

How persons with chronic hepatitis C in residential substance abuse treatment programs think about depression and interferon therapy.

OBJECTIVE: This secondary analysis of existing qualitative descriptive data is the first to specifically report on how persons undergoing residential treatment for substance abuse think about depression and the risks of neuropsychiatric side effects associated with interferon (IFN) treatment for hepatitis C virus (HCV) infection. METHOD: Krippendorff 's method for qualitative content analysis was used to describe patient perspectives about psychiatric symptoms and potential side effects of IFN treatment. Transcripts from face-to-face, semistructured interviews with 20 patients in 3 residential substance abuse treatment programs were analyzed. RESULTS: Themes included patients' powerlessness and their evaluation of risk and confidence. Participants commented that residential substance abuse treatment programs offered a unique opportunity to undergo antiviral treatment because they capitalized on a patient's heightened readiness for change. Barriers to treatment included perceived obstacles, such as compulsory waiting periods before treatment initiation, fear that neuropsychiatric treatment side effects would sabotage addiction recovery, and concern that psychiatric providers lacked sufficient HCV knowledge. However, when patients perceived clinicians as knowledgeable and genuinely caring, they were amenable to considering antiviral treatment. CONCLUSION: Increasing HCV-specific psychiatric education and staff training, exploring combined psychiatric and antiviral treatment combinations, and therapeutically supporting patient decision making are needed to better use substance abuse residential treatment programs as sites for treating HCV infection. Novel antidepressant treatment approaches are required in this population. Advanced practice psychiatric nurses are well-positioned to develop new integrative models of care addressing the medical, psychiatric, and substance abuse comorbidities in this highly vulnerable group.