Can periodontal measures assist in the identification of adults with undiagnosed hyperglycaemia? A systematic review

Abstract

Aim: The aim of this review was to answer the following question: Can periodontal measures be used to identify dental patients with undiagnosed hyperglycaemia? Materials and Methods: Systematic searches of electronic databases and the grey literature were carried out to identify studies developing and/or validating prediction models, based on any periodontal measure, to screen adults for undiagnosed hyperglycaemia (pre-diabetes and diabetes). Risk of bias was evaluated using the PRediction mOdel risk-of-Bias ASsessment Tool (PROBAST).Results: Ten studies were identified, of which eight were model development studies.The remaining two studies reported the external validation of one existing prediction model. The periodontal prediction model with some evidence of external validation showed moderate diagnostic performance in the development sample but lower performance in the external validation samples. According to PROBAST, all studies had high risk of bias mainly due to methodological limitations in data analysis, but also in the recruitment of participants, choice and measurement of periodontal predictors and diabetes.Conclusions: There is a need for more robust external validation studies of existing prediction models adhering to current recommendations. Dental professionals who see patients at risk of diabetes and routinely collect periodontal measures have an important role to play in their identification and referral.

Development and External Validation of a Multivariable Prediction Model to Identify Nondiabetic Hyperglycemia and Undiagnosed Type 2 Diabetes: Diabetes Risk Assessment in Dentistry Score (DDS)

“…A recent series of papers by Riley et al (2018Riley et al ( , 2020 highlights the importance of adequate sample sizes when developing models and outlines a novel method to calculate the required sample size and number of events per sample. Of the models developed for use in the dental setting (Appendix 12), most did not undertake external validation (Talakey et al 2022) nor report their full model, limiting the ability of external validation by others.…”

“…Several risk-assessment models for T2D exist. However, many of these models have been developed for use outside dental settings and involve collecting data that would not routinely be available to dental teams, such as waist circumference, cholesterol, and blood pressure ( Gray et al 2010 ; Collins et al 2011 ; Talakey et al 2022 ). FINDRISC is a widely used model across Europe to identify people at risk of developing T2D and has been validated for use in several European populations ( Jølle et al 2019 ; Kraege et al 2020 ).…”

aMMP-8 Oral Fluid PoC Test in Relation to Oral and Systemic Diseases

“…Given these facts, screening for these conditions, early detection, and intervention, particularly at the prediabetes stage, are critical for both patients and healthcare systems. Numerous studies have already explored the effectiveness of diabetes screening in dental clinics, applying various methods of patient selection and detection for hyperglycemia, and in this regard, a recent meta-analysis highlighted the need for additional research [91]. Furthermore, periodontitis is known to upregulate pro-inflammatory mediators such as tissue destructive matrix metalloproteinases (MMPs) in inflamed gingiva and oral fluids [92][93][94].…”