Diabetes screening at dental surgeries?
PD Dr. Kristina Bertl, PhD MSc MBA
The bidirectional links between periodontitis and diabetes are undisputed, and a big problem associated with diabetes is the relatively high number of unreported cases. To improve this number and to identify patients with pre-diabetes and diabetes sooner, the potential role of the dental surgery has been discussed more and more in recent years. The rationale for this is as follows: many of our patients attend dental check-ups relatively often (at least once every 1–2 years), but they visit their general practitioner much less frequently, particularly if they do not have any symptoms. Consequently, dentists see potential patients much more often than general practitioners do.
So, what might diabetes screening at the dentist surgery look like? It is very easy to screen for pre-diabetes and diabetes by using what is known as a point-of-care system. An easily performed finger stick procedure can produce enough blood for an easy-to-use test strip, and the patient’s HbA1c level (= long-term blood sugar value) can be determined immediately. A medical examination is recommended for patients with a value of 5.7% and above.
Several studies have already addressed this topic. The example discussed below is from the USA (Genco et al. 2014). In this study, the HbA1c of more than 1000 patients was measured, and almost 50% of patients had an HbA1c of ≥ 5.7%. These 416 patients were advised to visit their general practitioner; however, only 146 patients in this study followed this recommendation. Nonetheless, the numbers of newly diagnosed cases of pre-diabetes and diabetes among these 146 patients were shocking: 23% of cases were classified as pre-diabetes, and 12% were actually classified as manifest diabetes.
Figure. Rate of newly diagnosed cases of pre-diabetes and diabetes in the study by Genco et al. (2014).
Accordingly, this screening method could be a very valuable tool in dental practices – particularly from a general medical point of view.
The HbA1c value indicates the patient’s blood glucose level in the past 8–12 weeks. It is therefore an important measurement in diabetes management for monitoring blood sugar levels, which our patients should also be aware of. To achieve an acceptable blood sugar level, a person with diabetes should aim to keep this value below 7.5% or 58 mmol/mol; as a comparison, the value in a non-diabetic is approx. 5% or 30 mmol/mol.
- Genco RJ, Schifferle RE, Dunford RG, Falkner KL, Hsu WC, Balukjian J. Screening for diabetes mellitus in dental practices: a field trial. J Am Dent Assoc. 2014 Jan;145(1):57-64. doi: 10.14219/jada.2013.7.