Point-of-care Screening For (Pre)Diabetes Risk In A Tertiary Dental Institution

Objectives: Among developed countries, Singapore ranks second-highest for diabetes prevalence, accounting 11.3% for those aged 18-69 years. Half of them (51.4%) were unaware of their condition at the time of diagnosis. Undiagnosed diabetes is associated with significant morbidity and mortality. The bi-directional relationship between periodontitis and diabetes suggests that dental settings may be a potential opportunity to identify patients with undiagnosed diabetes. The aim of this study was to identify patients with risk of undiagnosed (pre)diabetes during dental visits in a tertiary healthcare setting.
Methods: 890 participants with no history of diabetes were recruited. Questionnaires assessing demographics, medical history, and diabetes risk test adapted from the American Diabetes Association (ADA) were administered. All patients underwent periodontal examination and staged according to the new EFP/AAP classifications. Glycated haemoglobin (HbA1c) levels were recorded using a point-of-care (POC) device (Abbott Afinion^TM 2) on a finger-prick blood sample. Patients were informed about their HbA1c results immediately and if it was above 6.0%, they were referred to a medical physician to rule out undiagnosed (pre)diabetes.
Results: 54(6.1%) and 322(36.2%) were identified with HbA1c levels corresponding to diabetes and pre-diabetes, respectively. Patients with Stage III/IV Periodontitis were more likely detected with undiagnosed diabetes than those with Stage II Periodontitis [p<0.001]. They also had significantly higher mean number of pockets and percentage of pockets >3mm, and more likely to not have received periodontal treatment compared to the control(healthy), Stage 1 or Stage II Periodontitis groups [p<0.001].
Conclusions:
Approximately 1 in 17 and 1 in 3 dental patients was detected to be at risk of diabetes and prediabetes respectively. Findings demonstrate that screening for risk of undiagnosed (pre)diabetes during dental visits using a chairside point-of-care HbA1c device is feasible. This may especially be relevant in Stage III/IV Periodontitis patients, to increase early referral and confirmation of undiagnosed (pre)diabetes, thereby reducing disease burden.