A qualitative examination of patient awareness and understanding of type 2 diabetes and oral health care needs Melissa A. Valerio a, *, Preetha P. Kanjirath b , Christine P. Klausner b , Mathilde C. Peters c a Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1450 Washington Hts., Ann Arbor, MI, United States b Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States c Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States 1. Introduction Approximately 23.6 million Americans have diabetes, with type 2 diabetes mellitus accounting for 90% of diagnosed cases [1,2]. Type 2 diabetes risk is associated with obesity, family history of diabetes, physical inactivity, and race/ethnicity. African Americans, Hispanics and Native Americans are at highest risk for diabetes and its complications [2]. In 2007, the estimated cost of diabetes in the U.S. was $174 billion [3]. In addition to medical costs, diabetes imposes high costs on society in terms of reduced quality of life, activity limitations and burden to families, friends and caregivers [2,3]. A diabetes related complication that is less often empha- sized and discussed with patients is the high risk of oral disease. Researchers have identified a bidirectional adverse relationship between diabetes and oral disease; diabetes significantly amplifies the destruction of periodontal ligament and gums, which in turn have negative effects on glycemic control [4–8]. Patients with poorly controlled diabetes are consequently at risk for a spectrum of oral diseases including acute oral infections, salivary dysfunction, periodontitis, and caries leading to loss of teeth [1–3,9–11]. Tooth loss is especially important to evaluate in patients with type 2 diabetes as those with diabetes may be at higher risk for loss of teeth and those with complete edentulism have been found to d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 9 3 ( 2 0 1 1 ) 1 5 9 – 1 6 5 a r t i c l e i n f o Article history: Received 16 November 2010 Received in revised form 21 March 2011 Accepted 28 March 2011 Published on line 22 April 2011 Key words: Type 2 diabetes Oral health Health literacy Qualitative research a b s t r a c t Aims: The study examined awareness and understanding of the bidirectional relationship between type 2 diabetes and oral health care in adult patients with type 2 diabetes. Methods: Focus groups were held with 30 participants with type 2 diabetes. Groups were comprised of African Americans (n = 16), Hispanics (n = 6), and Caucasians (n = 8). A ground- ed theory approach was used to analyse and interpret findings. Results: Participants were unaware of the relationship between type 2 diabetes and oral health but were concerned about the influence of poor oral health on quality of life. Having diabetes was reported as a potential challenge for the coordination and receipt of dental care. Patient-provider communication of diabetes and oral health needs were perceived to be inadequate. Conclusions: Patients with type 2 diabetes are at-risk for poor oral health, yet have limited awareness and understanding of the specific oral health care needs and risks associated with type 2 diabetes. This lack of awareness and understanding of the relationship between diabetes and oral health may be an indicator of inadequate oral health literacy. Addressing the relationship between diabetes and oral health with patients may improve dental out- comes, increase quality of life, and promote oral health literacy in at-risk populations. # 2011 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +1 734 763 0673; fax: +1 734 763 7379. E-mail address: mvalerio@umich.edu (M.A. Valerio). C o n t e n t s l i s t s a v a i l a b l e a t S c i e n c e D i r e c t Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres 0168-8227/$ – see front matter # 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2011.03.034