Screening for prediabetes and type 2 diabetes in dental offices

Abstract

ObjectivesMost Americans see dentists at least once a year. Chair‐side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c ≥5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices.MethodsWe recruited 1,033 adults ≥30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population ≥30 years of age.ResultsIndividuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self‐reported body mass index ≥35 kg/m2 (severe obesity) or random capillary glucose ≥110 mg/dl. We estimate that 30 percent of patients ≥30 years of age seen in these general dental practices had dysglycemia.ConclusionsThere is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair‐side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high‐risk patients.Practical implicationsFurther studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost‐effectiveness of chair‐side screening.

2. Classification and Diagnosis of Diabetes

“…Because periodontal disease is associated with diabetes, the utility of chairside screening and referral to primary care as a means to improve the diagnosis of prediabetes and diabetes has been explored (39-41), with one study estimating that 30% of patients $30 years of age seen in general dental practices had dysglycemia (41). Further research is needed to demonstrate the feasibility, effectiveness, and cost-effectiveness of screening in this setting.…”

Screening for diabetes in dental settings

“…A sample of participants then went on to receive a definitive diagnosis using A1c information. The results showed that patients at risk of prediabetes or diabetes could be identified rapidly using the risk questions alone or with the random capillary glucose test (Herman, Taylor, Jacobson, Burke, & Brown, 2015). This study did not go beyond identifying those at risk of diabetes and the HbA1c test was not administered during the dental visit.…”

Embracing Change In Dental Practice To Deliver Better Health Outcomes- A Type 2 Diabetes Screening and Oral Health Pilot Program

“…Herman et al [27] suggested many Americans see a dentist at least once a year, which is not the case in our community dental clinic patients, who often have to wait a considerable amount of time on the waiting list for any dental procedures including initial dental examination (up to 2 years). Herman et al [27] introduced dysglycemia screening in 13 general dental practices using a questionnaire similar to the AUSDRISK tool and identified 30% of patients in a high risk diabetes category, considerably lower than our 52% at a high risk.…”

“…Studies in the USA report a prediabetic HbA1c range as 5.7% to 6.4% and suggest people with HbA1c > 6.4% on more than one reading has diabetes [27,28]. Genco et al [28] investigated the utility of screening for diabetes in dental settings and concluded forty percent had an HbA1c level of greater than 5.7% and were referred on for further diagnosis with 12% confirmed and 23% with prediabetes.…”

“…Herman et al [27] introduced dysglycemia screening in 13 general dental practices using a questionnaire similar to the AUSDRISK tool and identified 30% of patients in a high risk diabetes category, considerably lower than our 52% at a high risk.…”