Zehra Yonel won the first joint National Institute for Health Research NIHR / Diabetes UK Doctoral Research Fellowship (NIHR300171), for her project titled “INDICATE: INtroducing DIabetes Checks in A denTal practice Environment”. This grant is a culmination of five years’ work as part of The School of Dentistry’s Periodontology Research Group led by Iain Chapple.
Zehra joined the University of Birmingham in February 2015 as a clinical lecturer and rapidly developed a strong interest in the field of periodontitis and systemic diseases, with a particular focus on the associations between periodontitis and type two diabetes (T2DM). In her five years in the department she worked on a number of research projects in the associated area, including collaborations with the Diabetes and the Renal Research Groups at the Queen Elizabeth Hospital, Birmingham, in addition to collaborations with other departments within the wider University and with industry partners.
In October 2018, the NIHR announced that they would be partnering with several leading UK health and social care research charities for the first time, offering jointly funded partnership awards. These aim to harness the strengths and expertise of both partners; adding value and quality in order to make the greatest impact.
Zehra decided to apply for funding to move her project forward and with the support of her supervisors; Professors Iain Chapple, Thomas Dietrich and Laura Gray applied for the NIHR Diabetes UK partnership fellowship. After a competitive and rigorous application process. She reached the interview stage and had a gruelling interview, defending her ideas and proposal to a national panel of medical experts. She was thrilled to win one of the very first NIHR Charity Partnership fellowships and started her exciting work in February 2020.
Zehra’s project consists of several programmes of work investigating the feasibility of dental teams undertaking targeted risk-assessments for patients at high risk of T2DM or those who may unknowingly already have the condition. Evidence exists demonstrating that different populations visit different healthcare professionals. Many people visit their dentist when they perceive themselves to be healthy, yet only visit their doctor when they are symptomatic. In addition, many people who haven’t seen their GP for many years do see their dentist regularly. This in addition to the strong association between periodontitis and T2DM and the fact dental teams are highly skilled in risk-assessing patients and delivering preventative advice, may mean that dental teams are ideally placed to help identify T2DM early. Earlier identification and referral to appropriate care pathways may facilitate earlier instigation of management programmes. This approach may result in improved health and wellbeing for the individual but also economic savings for the NHS through reductions in diabetes complications and complex interventions required when T2DM is detected later.
Zehra’s work will initially undertake a statistical analysis of large datasets to determine whether dental parameters such as tooth loss and periodontal status can be used in addition to known risk-factors for T2DM such as: waist to hip ratio, ethnicity, age, first degree relative with T2DM amongst others, to correctly identify those at high risk. If this is the case it may lead the way for Zehra to develop a prediction model and risk-assessment tool for specific use in the dental setting as part of her future work.
A further element of work Zehra will be conducting will be to work with five UK dental practices that have an NHS component. She will work with the teams to establish the impacts that undertaking these risk assessments for T2DM in a dental setting could have on the dental team, their day-to-day work, and what the benefits and limitations to the dental team undertaking such risk-assessments are. This programme of work will first involve identifying interested dental practices within the West-Midlands that are interested to participate in research. The practice staff will be trained in the techniques required to undertake the risk-assessments. The teams will be given autonomy to undertake the T2DM risk-assessments, then Zehra will undertake focus groups with the practice teams to determine barriers and facilitators to the process, and she will undertake interviews with a sample of the patients to determine their views relating to the process. If you feel you or your practice team may wish to be involved in her research Zehra is happy to be contacted (Z.Yonel@bham.ac.uk)