Periodontitis has been identified as the sixth complication of diabetes. Advanced glycation end-products, altered lipid mechanisms, oxidative stress, and systemically elevated cytokine levels in patients with diabetes and periodontitis suggest that dental and medical care providers should coordinate therapies.

In addition to periodontitis and dental caries, other oral conditions commonly occur commonly in patients with diabetes. These include fungal infections, salivary gland dysfunction, neuropathy, and mucosal disorders. Many of these lesions can be easily examined and documented by non-dental providers.

Inadequate coordination of care between dentists and medical doctors presents a barrier to comprehensive management of patients with diabetes. New technologies for managing and exchanging health data hold a promise of improved transfer of clinical information between specialties. The authors present a model of how information technology can be used to support standardized workflows in medicine and dentistry to optimize care coordination for patients with diabetes.

Methods. The study included 35 subjects followed in a pharmacist-managed insulin titration and 35 matched control subjects. Control subjects were followed under standard procedures within the same clinic and were matched for age, titration time frame, and insulin regimen. The primary outcome was change in A1C between the two groups at 6 months. Secondary outcomes included change in A1C within groups at 3, 6, 9, and 12 months, as well as the proportion of subjects attaining a goal A1C of < 7% and adhering to preventive care recommendations.

Results. Between-group comparison demonstrated a significant absolute difference in mean change in A1C at 6 months favoring pharmacist management (0.9%, 95% CI 0.2–1.6, P = 0.009). Within-group comparisons demonstrated significant A1C reduction from baseline at 6 months (–1.1%, 95% CI –1.7 to –0.4, P = 0.002), 9 months (–1.4%, 95% CI –2.0 to –0.7, P < 0.001), and 12 months (–1.3%, 95% CI –2.0 to –0.5, P = 0.001) in the pharmacist-managed group with no significant changes observed in the control group.

Conclusion. Pharmacist-managed insulin titration resulted in significant improvement in glycemic control compared to standard care in an indigent population.

Research design and methods. We retrospectively evaluated 526 patients who were screened for DR in the first year of a newly implemented telemedicine program (July 2009 to June 2010). Through this program, a total of 139 patients were diagnosed with DR, whereas 387 patients were not and then served as the comparator group. Multivariate logistic regression was used to determine the predictors of DR in this cohort of patients.

Results. After multivariate analysis, four positive predictors of DR were found: insulin use (adjusted odds ratio [AOR] 1.94 [1.17–3.22]), years with diabetes (AOR 1.22 [1.16–1.28]), A1C (AOR 1.15 [1.02–1.29]), and kidney disease (AOR 5.11 [2.33–11.20]). No variables were found to decrease the odds of DR.

Conclusion. Among patients with diabetes, use of insulin therapy, longer duration of diabetes, presence of kidney disease, and higher A1C values increase the odds of DR. These preliminary data may suggest patients who are at higher risk of DR to further prioritize screening for DR with a newly implemented telemedicine program.