Pilot Test of Diabetes Screening and Referral to Primary Care Within an Alaska Native Dental Clinic: Protocol for a...

Recognizing the bidirectional relationship between oral health and diabetes mellitus (DM) and integrating DM screening and referrals to primary care into routine dental hygiene visits has strong potential to expand access to diabetes prevention and early detection services.

This paper describes methods used in an academic-Tribal partnership to co-design, coimplement, and pilot-test a DM screening and referral process within a Tribal health care setting.

The project uses implementation science frameworks and applies a 4-step iterative, participatory planning approach. Project implementation steps include (1) conducting key informant interviews with dental and primary care staff and administrators and surveying dental care recipients to assess the context for implementation and receptivity toward the proposed innovation; (2) forming and engaging a multidisciplinary planning team comprising dental, primary care, informatics, and care improvement personnel, care recipients, and researchers; (3) applying survey and interview findings and internal knowledge of clinic procedures and processes to develop a feasible dental DM screening service model to pilot test with iterative data collection; and (4) refining and disseminating the innovation.

Key informant interviews and patient surveys were completed in September 2023. The planning team then developed the pilot process based on these findings in combination with lived experience. Study enrollment for the pilot began in April 2025 and was completed in July 2025. Data analysis is underway.

Offering DM screening during dental appointments aligns dental and primary care services to prevent or delay DM onset. This paradigm shift has the potential to facilitate communication between dental and primary care providers, improve the coordination of care across dental and medical services, capitalize on opportunities to reach individuals in need of DM screening while they are accessing other services, and expand health system capacity to identify individuals at risk and offer them appropriate DM services.