Oral Health and Diabetes: Effects of Health Coaching

ayse_basak_cinarMedicalResearch.com Interview with:
Ayse Basak Cinar, Assistant Professor
The Department of Odontology
The Faculty of Medical and Health Resources
2200 Copenhagen N Denmark

MedicalResearch.com:  What are some of the unique or enlightening findings of this study that haven’t been published before?

Answer:  To our knowledge, this is the first randomized controlled intervention study comparing the impact of individualized Health Coaching (HC) to formal Health Education (HE); applying HC as a holistic intervention for management of more than one specific type of chronic disease, namely oral health and diabetes management.

The present study has two phases [the Turkish Phase, Turkey (2010-2012) and the Danish Phase, Denmark (2012- …)]. The unique/enlightening figures from the Turkish phase as follows:

The HC group compared to the HE group had significantly higher improvement at;

HbA1c* (reduction: 0, 8% vs. 0%), and Periodontal Attachment Loss (PAL) (56% vs. 26%), (p≤0.01)

Tooth Brushing Self-Efficacy (TBSE) (increase: 61% vs.25%) and stress (reduction: 16% vs. 1%), (p≤0.01).
Among the high risk group patients (HbA1c≥8%), the reduction at HbA1c (-1.5%) and PAL (- 63%) was highly significant in the HC group compared to those at the HE group (-0-5% vs. -18%), (p≤0.03).

The impact of HC on HbA1c  was significant  (p=0.002) but  the impact of HE on HbA1c was not significant (p=0.68).

Improvement of Community Periodontal Need Index (CPI) from baseline to post intervention i. the HC group  was 73% and it was 20.8% for HE group, (p=0.001).

This improvement at CPI had a higher significant impact on reduced HbA1c in the HC group compared to the HE group (p=0.02).

Improved TBSE was correlated with favourable HbA1c levels (HbA1c<6.5%, p<0.05) and quality of life (p<0.01) in the HC group.

Among the patients brushing their teeth at least once a day, the HC group patients compared to those in the HE group were more likely to be physically active (89% vs. 60%) and to have higher self-efficacy (≥ mean: 71% vs.43%), (p<0.01).

Feeling stressed was significantly reduced only in the HC group.

MedicalResearch.com:  Were you surprised by any of the findings?

Answer: Some results that we are surprised are as follows:

  •     The degree of reduction at HbA1c levels and improvement at periodontal health
  •     The impact of HC on HbA1c among high risk patients
  •     The association between toothbrushing frequency and physical activity

Toothbrushing self-efficacy scale used in the present research is originally designed by AB Cinar et al.**and its validity and reliability were tested by earlier studies. It is exciting to find out how this scale works, in terms of its significant interrelation with toothbrushing frequency and HbA1c. That may show that the scale may be used to assess the toothbrushing frequency and also one of the health promotion tools to improve HbA1c levels.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answers: Clinicians from different disciplines such as dentistry and medicine, in particular, could try to integrate HC in their practice. In HC, patients are the expert and reliable resource of information regarding personal strategies for oral-related and diabetes-related behavior/lifestyle changes. This differs somewhat from traditional oral health/diabetes education where the dentist/physician by definition is the expert who provides information. In coaching, education is provided in line with the patient’s goals, and information must be meaningful in the context of the patient’s needs and expectations. Coaches elicit ideas and resource from patients, encouraging them to explore and to understand about their health problems in the framework of their daily life routines and social environment.

While dentists, physicians, and diabetes educators undergo extensive education and training to learn “what is best” for patients, the education/training mostly misses “how” to achieve that best. “How” is implied in the patient’s motivation and patient’s needs to find out his/her motivators with support and encouragement of health care providers who take off their “medical profession” shoes and put on “HC” shoes. It is vital that patients learn to connect their health goals and lifestyle to a vision of health in a greater picture, which is a critical step in developing the best strategies for lasting behavior change 499 thereby to maintain better oral health and diabetes management.

Toothbrushing Self-efficacy may be a practical start point for empowerment and toothbrushing can be used as an effective and practical behavior to observe personal success in diabetes management; so dentists may use these as a practical point to improve diabetes management skills of their patients or patients can start adjust healthy behaviors/lifestyles by adopting regular toothbrushing. For example, the success of a coaching group patient at adoption of healthy behaviors in the Turkish phase of the research from baseline to post-intervention can be given an example: A 60 year old obese lady who has could never adopt regular physical exercise in her daily life practice, was used to brush her teeth 3-5 times a week. She preferred to be coached first for regular toothbrushing behavior so she was coached for this particular type of behavior for few sessions and then she set up a goal with the coach for adoption of regular physical activity. After 6 months, she told that she was starting her daily physical exercises while she was brushing her teeth in the morning and then by that `start` she was going out for regular walks. Another coaching patient has found that it is better for him to brush his teeth after he ate dinner as he was falling asleep on the sofa after dinner. By the time when he experienced that he could come over his laziness to brush his teeth during the night, he started eating healthier. Another patient started to be socially active by believing in herself that she could do something positive and healthy for her life such as regular toothbrushing. Clinical parameters of these patients (periodontal health and HbA1c) showed significant improvement in line with these personal success stories.

Regular toothbrushing cannot be always the entry point, of course, for adopting other healthy behaviors but it can act most of the time as an initial motivator for activating positive beliefs  in one`s self and can be a very effective initial behavior to adopt  other positive healthy lifestyles.  Every positive change starts when a person believes himself/herself that he/she `can` succeed a specific type of behavior. Patients with diabetes type two need to be motivated; not to be told; for action/performance to unlock their potential to adopt healthy lifestyles and to overcome challenges; that is the point where physicians need to integrate HC as a communication tool in their practice.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: The findings of the present study highlights that there is a need for further research to assess the impact of similar interventions on diabetes and oral health management, so that a common HC -based health promotion strategy can be set up for patients with diabetes type 2 to improve their quality of life. Additionally toothbrushing self-efficacy may be a practical start point for empowerment of patients with diabetes type 2; and further studies may bring new insights and more effective  outcomes for health promotion for diabetes patients.


“Smile healthy to your diabetes”: health coaching-based intervention for oral health and diabetes management.

Cinar AB, Oktay I, Schou L.
Clin Oral Investig. 2013 Dec 21. [Epub ahead of print]

Last Updated on February 25, 2014 by Marie Benz MD FAAD