HbA1c Screening in the Dental Setting

Objectives: Epidemiological evidence supports increased global prevalence of dysglycemia and periodontal disease, and growing need for development of alternative integrated medical-dental delivery care models to prevent, delay and manage these chronic diseases. A point-of-care risk screening protocol was developed and piloted in four Wisconsin-based dental centers located in rural and metropolitan areas to identify dysglycemia among patients whose status was unknown.
Methods: Participants over the age of 21 with scheduled dental appointments at participating dental centers, who met eligibility criteria, were approached to complete a risk screening questionnaire. If responses indicated potential risk status, a point-of-care HbA1c screening was completed using a Siemens DCA Vantage Analyzer. Any patients with HbA1c values of ≥5.7% were referred to their primary care provider for additional follow-up. Participants were contacted telephonically one month post their dental encounter to determine compliance with follow-up and outcome of their medical evaluation. For a subset of patients, the dysglycemia diagnosis was prospectively tracked for validation in the electronic health record to capture further diagnostic glycemic measures.

Results: A total of 915 participants were screened over a period of 12 months. 219 participants were enrolled, and 127 individuals underwent HbA1c screening. Individuals at high-risk (62/126 (49%)) were advised to follow-up with their primary provider. Among high risk participants 48%, 2% and 22% respectively attended one of three rural dental clinics while 28% attended the metropolitan clinic. Follow-up was achieved for 56/62 (90.3%) of the participants. For a small subset, follow-up diagnosis data was validated in the electronic health record.

Conclusions: In order to achieve higher follow-up rates, a coordinated hand-off with dental providers has the potential to be more effective for follow-up care. Point-of-care screening in the dental setting offered a feasible option for detecting undiagnosed dysglycemia and patients can be directed for appropriate care.