Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 2:25:e46381.
doi: 10.2196/46381.

Evaluation of a Digital Decision Support System to Integrate Type 2 Diabetes Mellitus and Periodontitis Care: Case-Vignette Study in Simulated Environments

Affiliations

Evaluation of a Digital Decision Support System to Integrate Type 2 Diabetes Mellitus and Periodontitis Care: Case-Vignette Study in Simulated Environments

Olivier Kalmus et al. J Med Internet Res. .

Abstract

Background: As highlighted by the recent World Health Organization Oral Health Resolution, there is an urgent need to better integrate primary and oral health care. Despite evidence and guidelines substantiating the relevance of integrating type 2 diabetes mellitus (T2DM) and periodontitis care, the fragmentation of primary and oral health care persists.

Objective: This paper reports on the evaluation of a prototype digital decision support system (DSS) that was developed to enhance the integration of T2DM and periodontitis care.

Methods: The effects of the prototype DSS were assessed in web-based simulated environments, using 2 different sets of case vignettes in combination with evaluation surveys among 202 general dental practitioners (GDPs) and 206 general practitioners (GPs). Each participant evaluated 3 vignettes, one of which, chosen at random, was assisted by the DSS. Logistic regression analyses were conducted at the participant and case levels.

Results: Under DSS assistance, GPs had 8.3 (95% CI 4.32-16.03) times higher odds of recommending a GDP visit. There was no significant impact of DSS assistance on GP advice about common risk factors for T2DM and periodontal disease. GDPs had 4.3 (95% CI 2.08-9.04) times higher odds of recommending a GP visit, 1.6 (95% CI 1.03-2.33) times higher odds of giving advice on disease correlations, and 3.2 (95% CI 1.63-6.35) times higher odds of asking patients about their glycated hemoglobin value.

Conclusions: The findings of this study provide a proof of concept for a digital DSS to integrate T2DM and periodontal care. Future updating and testing is warranted to continuously enhance the functionalities of the DSS in terms of interoperability with various types of data sources and diagnostic devices; incorporation of other (oral) health dimensions; application in various settings, including via telemedicine; and further customization of end-user interfaces.

Keywords: decision support; diabetes; diagnostic device; digital health; evaluation; hemoglobin; integrated care; oral care; oral health; periodontitis; survey; telemedicine; type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
General dental practitioner vignette example with decision support system hint in green. The patient is male, aged 58 years, and slightly overweight; he is coming for a dental checkup. He does not report any concerns. The picture gives an overview of his dental situation. The text in green is only shown when decision support system assistance is active; all the text in black is shown with and without decision support system assistance.
Figure 2
Figure 2
General practitioner vignette main evaluation question with decision support system hints in green. Participants were asked to choose their next steps from a multiple choice list including anamnesis, examination, therapy, referral, and “no further steps.” The text in green is only shown when decision support system assistance is active; all the text in black is shown with and without decision support system assistance.

Similar articles

References

    1. Resolution WHA74/5. Oral health. World Health Organization. 2021. [2023-01-31]. https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_R5-en.pdf .
    1. Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, Weyant RJ, Mathur MR, Guarnizo-Herreño Carol C, Celeste RK, Peres MA, Kearns C, Benzian H. Ending the neglect of global oral health: time for radical action. Lancet. 2019 Jul 20;394(10194):261–272. doi: 10.1016/S0140-6736(19)31133-X.S0140-6736(19)31133-X - DOI - PubMed
    1. Holmstrup P, Damgaard C, Olsen I, Klinge B, Flyvbjerg A, Nielsen CH, Hansen PR. Comorbidity of periodontal disease: two sides of the same coin? An introduction for the clinician. J Oral Microbiol. 2017;9(1):1332710. doi: 10.1080/20002297.2017.1332710. https://europepmc.org/abstract/MED/28748036 1332710 - DOI - PMC - PubMed
    1. Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006 Sep;94(1):10–21. doi: 10.1007/s10266-006-0060-6. https://europepmc.org/abstract/MED/16998613 - DOI - PMC - PubMed
    1. Kocher T, König Jörgen, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 2000. 2018 Oct;78(1):59–97. doi: 10.1111/prd.12235. http://hdl.handle.net/2027.42/146293 - DOI - PubMed

Publication types

-