Screening of hyperglycaemia in dental settings

Background + Aims

• Diabetes mellitus (DM) is a prevalent chronic condition, often undiagnosed, and associated with significant morbidity. Periodontitis is a chronic gum disease linked to systemic inflammation, and dental settings have been proposed as a location for screening undiagnosed DM and prediabetes.
• The DiabetRisk study aimed to evaluate the efficacy of screening protocols combining diabetes risk questionnaires, periodontal examinations, and point-of-care HbA1c tests to detect undiagnosed hyperglycaemia in dental clinics.

Materials + Methods

• This study involved 1,143 individuals ≥40 years old with no prior diagnoses of DM or prediabetes.
• Patients completed the FINDRISC questionnaire (Finnish Diabetes Risk Score).
  • FINDRISC is a validated self-reported questionnaire designed to estimate an individual’s risk of developing type 2 diabetes within 10 years. It is a widely used, non-invasive tool that considers major diabetes risk factors.
  • It considers the following domains:
    • Age
    • Body Mass Index (BMI)
    • Waist circumference
    • Daily physical activity
    • Consumption of fruits/vegetables
    • History of high blood glucose
    • Current/past use of blood pressure medications
    • Family history of diabetes
  • Patients are then scored with each factor contributing to a total risk score, with higher scores indicating greater risk. A score ≥12 typically suggests a moderate or high risk of diabetes and prompts further evaluation.
• Periodontal examination were undertaken using a basic screening exam – Examen Periodontal Básica (EPB)
• Patients with moderate FINDRISC scores (≥12) received a point-of-care HbA1c test.
• Patients with HbA1c ≥5.7% were referred to their physician for confirmatory diagnosis.
• Receiver operating characteristic (ROC) curves were used to assess the performance of various predictive models with confirmed hyperglycaemia as an outcome.

Results

• 5% of participants were newly diagnosed with hyperglycaemia (6.0% prediabetes; 2.5% diabetes).
• Screening Protocol Performance:
  • FINDRISC alone: Area under the curve (AUC) = 0.866
  • FINDRISC + EPB: AUC = 0.876 (slight improvement versus FINDRISC alone, p = 0.042).
  • FINDRISC + HbA1c: AUC = 0.961 (demonstrated the highest diagnostic capability, sensitivity: 86%, specificity: 94%).
• Adding periodontal parameters did not significantly improve the diagnostic value.
• The FINDRISC questionnaire combined with a chairside HbA1c test was an efficient and cost-effective method for identifying patients with undiagnosed diabetes or prediabetes.

Limitations