Early Screening Strategies for Diabetes Mellitus by Leveraging Dental Visits Using Optimal Screening Tools Available Onsite

Abstract

Diabetes mellitus (DM) continues to be a major health concern in the Western hemisphere, and the management of type 2 DM (T2DM) is an ongoing challenge for the American healthcare system despite major advances in DM research. T2DM imparts a massive economic burden, and a major challenge in managing T2DM continues to be timely screening. Adults are more likely to visit a dentist than a primary care physician. This study was designed to compare current screening standards recommended by the American Diabetes Association with the use of gingival-crevicular blood and its compatibility with traditional methods using a fingerstick. Patients routinely presenting to the dental clinic were offered participation in the trial and, after informed consent, checked for blood glucose levels using the fingerstick method as a control. The control values were compared to the results of the gingival-crevicular blood glucose test obtained during the dental procedure from the same patient (i.e., patients were their own controls). A total of 226 study participants were included. Of these, 127 (56.1%) participants were women, whereas 99 (43.9%) participants were men. The sample size was derived using the Slovin’s equation (Power = 80%) statistical test. We used the Pearson coefficient test to measure the statistical difference between the two tests. We found no significant difference in glucose readings between the fingerstick method and the gingival methods of collection (t = -1.134, P = 0.258). A small sample was also tested for glycosylated hemoglobin (HbA1c) using the same sample collecting methods. However, due to the cost restraints involved in using HbA1c kits, a statistically significant cohort could not be collected. By incorporating this interdisciplinary approach, testing for DM during routine dental visits can be a vital resource for the early diagnosis of DM, potentially leading to significant savings in future healthcare costs.

Use of dental practices for the identification of adults with undiagnosed type 2 diabetes mellitus or non‐diabetic hyperglycaemia: a systematic review

“…1); all were observational in nature. Five studies were based in the USA [22,26,27,37,39] with one study in each of the UK [35], Germany [38], Sweden [25] and Japan [36]. Two of the included studies were based solely in one primary care dental practice [37,38].…”

“…In five of these studies, the second stage of the risk‐assessment process was a point‐of‐care fingerstick blood sample, with one study choosing to refer participants for venous blood sample HbA 1c and an OGTT [38]. One study used a sequential screening strategy, initially using a point‐of‐care fingerstick and gingival crevicular blood sample, followed by a venous HbA 1c test in the event of an abnormal point‐of‐care random blood glucose level [39]. Of the studies that utilized point‐of‐care fingerstick blood samples, three used HbA 1c devices as part of their risk assessment; the remaining studies utilized random blood glucose measurements, with one opting for an additional HbA 1c test if the random blood glucose level was elevated [39].…”

“…Nine studies met the eligibility criteria [22,25–27,35–39] and were included in the systematic review (Table 1 and Fig. 1); all were observational in nature.…”

“…Two of the included studies were based solely in one primary care dental practice [37,38]. A further two recruited participants from two dental practices [35,39]. The remaining studies involved three [25], 11 [22], 13 [26] and 28 [27] practices, with one study not reporting the number of dental practices used to recruit participants [36].…”

“…All studies had a ‘fair’ risk of bias according to the NIH study quality assessment tool [34]. Using United States Preventative Task Force criteria to assess internal validity, one study was deemed to have a high risk of bias [37], whereas three studies were deemed to have a lower risk of bias than the others [22,36,39]. The remaining studies were deemed to be ‘fair’ (Table ).…”