Identification of Individuals With Undiagnosed Diabetes and Pre-Diabetes in a Danish Cohort Attending Dental Treatment.
Holm NR1, Belstrøm D1, Østergaard JA2,3, Schou S4, Holmstrup P1, Bay Grauballe MC1.
BACKGROUND AND OBJECTIVE:
It is estimated that 3.6% and 13.6% of the Danish population suffer from undiagnosed type 2 diabetes and pre-diabetes, respectively. Periodontitis is an established complication to diabetes. Identification of individuals with diabetes and pre-diabetes is important to reduce diabetes-related complications including periodontitis. The objective of the study was to identify individuals with undiagnosed diabetes or pre-diabetes among individuals attending a dental setting for diagnosis and treatment.
291 adults with no history of diabetes were included in the study (periodontitis patients n=245, non-periodontitis control individuals n=46). Participants answered questionnaires concerning general health, including family history of diabetes. BMI, waist circumference, fat percentage, and glycated hemoglobin level (HbA1c) were recorded chair-side. Periodontal examination was performed and radiographic bone level measured. All individuals were informed about the HbA1c result, and referred to their physician if HbA1c levels were above those of the American Diabetes Association guidelines.
A total of 9 (3.1%) and 79 (27.1%) subjects were identified with HbA1c levels corresponding to guideline values for diabetes and pre-diabetes respectively. Higher proportions of patients with undiagnosed diabetes and pre-diabetes were observed in the periodontitis group (32.7%) than in the control group (17.4%) (p=0.054). Identification of diabetes and pre-diabetes based on a diagnosis of periodontitis yielded a sensitivity of 0.91 and specificity of 0.19.
This study confirms that individuals with undiagnosed diabetes and pre-diabetes can be identified in the dental office by chair-side HbA1c recordings. Routine measurement of HbA1c in dental offices, eventually restricted to risk subjects, may help identification of individuals with diabetes and pre-diabetes at early stages of disease, which may prevent future complications.
J Periodontol. 2016 Jan 8:1-12. [Epub ahead of print]