Screening of hyperglycaemia in dental settings

Background + Aims

• Diabetes mellitus (DM) is a significant global health challenge, with Type 2 diabete mellitus (T2DM) often going undiagnosed for years. It is estimated that 46% of diabetes cases worldwide remain undiagnosed, contributing to delayed treatment and increased complications.
• Pre-diabetes, a precursor to diabetes, also frequently goes undetected, leaving individuals at risk for metabolic and vascular diseases. Research highlights the importance of early identification and primary prevention in improving outcomes.
• Periodontitis is thought to be a common early complication of diabetes, underscoring the need for integrated healthcare approaches. Dental settings could provide an opportunity for screening undiagnosed diabetes through simple algorithms based on risk factors and oral findings.
• This study investigates whether providing detailed screening information and follow-up reminders to dental patients, with previously unaware possible diabetes or pre-diabetes, improves health outcomes compared to basic notification of the findings alone.

Materials + Methods

• This randomised clinical trial (RCT) evaluated two interventions for dental patients identified with hyperglycaemia.
• Participants were recruited if they met the inclusion criteria:
  • ≥40 years old if non-Hispanic White (or ≥30 years old for minority groups or Hispanic)
  • ≥1 self-reported diabetes risk factor (diabetes in a first degree blood relative, hypertension, hypoercholesterolaemia or overweight/ obese
• Baseline assessments included:
  • Blood tests for glycated haemoglobin (HbA1c) levels
  • Periodontal assessments
• Individuals with HbA1c levels ≥5.7% (pre-diabetes or diabetes as per American Diabetes Association) were randomised to a control or test group.
• Participants of the control group were informed:
  • Of their diabetes risk factors
  • Of their HbA1c result and told to see a physician for further assessment
  • Of their periodontal status and advised to see a dentist if needed
• Participants of the test group received:
  • A detailed explanation of their findings and modifiable risk factors, along with brief advice on weight management, healthier eating, physical activity, and managing hypertension and hypercholesterolaemia.
  • A written report for their physician, detailing the link between diabetes and periodontitis, their risk factors, and HbA1c results, urging further medical evaluation.
  • Follow-up calls at 2 and 4 months to ensure patients sought medical care, emphasising the importance of timely follow-up.
• At 6 months, participants were re-evaluated for medical follow-up, glycaemic levels, lifestyle changes, and periodontal health. Statistical analyses compared outcomes between groups, with a linear mixed-effects model assessing glycaemic and periodontal changes.

Results

• The study included 101 participants with abnormal HbA1c levels (7 with potential diabetes and 94 with pre-diabetes), randomised to the control (n=50) or test (enhanced interventions (n=51)) groups.
• At 6 months, 73 participants (41 for the control and 32 in the test groups) returned for follow-up, with a higher retention rate in the control group (82% vs. 63%, p=0.04).
• The main findings demonstrated:
  • 80% of the control group (basic intervention) and 88% of the test group (enhanced intervention) visited a physician following the intervention, with no significant difference in timing or frequency of physician visits between groups (p=0.34).
  • HbA1c reductions were observed in both groups, with a significant decrease in participants identified with potential diabetes (mean reduction 1.46%, p<0.01). HbA1c reduction was not significant in the possible pre-diabetes cohort.
  • HbA1c changes did not significantly differ between intervention groups (p=0.41).
  • Lifestyle changes were reported by 49% of participants, including efforts to control weight (26%), improve diet (22%), and increase physical activity (42%), with no significant differences between groups.
  • Physician advice regarding weight control, diet, and blood pressure did not demonstrate a statistically significant difference between groups
  • Physician advised on physical activity did differ between groups with more being advised of this in the enhanced interventions group (85% vs. 52%, p<0.01).
  • Dental follow-up occurred in 71% of participants, with similar rates between groups.
  • Improvements in periodontal health, including reduced deep and bleeding pockets, were observed but were not significantly different between interventions.

Limitations