Integrated Diabetes and Oral Health Care in Oman

Type 2 diabetes mellitus (T2DM) is an important public health problem in Oman. Periodontal disease is common among people with diabetes, and the relationship between diabetes and periodontal disease is bidirectional. Poor glycaemic control may contribute to periodontal inflammation, while periodontal inflammation may adversely affect metabolic control. Despite this relationship, diabetes education commonly focuses on glycaemic control and general diabetes self-management, with limited structured integration of oral-health education and behavioural approaches. This study is a multicentre, two-arm randomized controlled trial designed to evaluate the effectiveness and cost-effectiveness of an integrated diabetes-oral health educational intervention based on the Health Belief Model (HBM). The study will recruit 290 adults with T2DM (145 participants per group) from participating diabetes clinics in Oman. Participants will be allocated to either the intervention group or the control group. Participants assigned to the intervention group will receive six structured, individual HBM-based educational sessions, approximately 30 minutes each, delivered over 12 weeks. The intervention addresses diabetes and oral-health risk awareness; the severity and consequences of periodontal disease in people with T2DM; benefits of glycaemic control and oral hygiene; barriers to oral-health self-care and practical solutions; toothbrushing, interdental cleaning, and self-monitoring skills; and maintenance planning and relapse prevention. Sessions will include structured educational material, individualized advice, and goal-setting. Participants in the control group will continue to receive standard diabetes care and education. Data will be collected at baseline and at 3, 6, and 12 months, as appropriate for each outcome. The primary outcome is change in HbA1c from baseline to 12 months. Secondary outcomes include periodontal clinical indicators, diabetes and oral-health self-management behaviours, HBM constructs, oral health-related and general health-related quality of life, psychological well-being, diabetes distress, healthcare utilization, and direct medical costs. An economic evaluation will assess the cost-effectiveness of the intervention. As an exploratory component, participants will undergo periodontal assessment to estimate the prevalence of previously undiagnosed periodontal disease and examine its association with glycaemic control. The study will also explore associations between changes in periodontal status and oral microbiome profiles.