Dental Tribune USA

Dentists can help identify diabetes

By Dental Tribune
June 13, 2011

NEW YORK, NY, USA: Researchers at the Columbia University College of Dental Medicine found that dental visits represent a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition. The study sought to develop and evaluate an identification protocol for high blood sugar levels in dental patients.

“Periodontal disease is an early complication of diabetes, and about 70 per cent of US adults see a dentist at least once a year,” Dr Ira Lamster, dean of the College of Dental Medicine and senior author on the paper, said. “Prior research focused on identification strategies relevant to medical settings. Oral healthcare settings have not been evaluated before, nor have the contributions of oral findings ever been tested prospectively.”

For the study, which was supported by a research grant from Colgate-Palmolive, the researchers recruited about 600 individuals visiting a dental clinic in Northern Manhattan. The subjects were 40-years-old or older (if non-Hispanic white) and 30-years-old or older (if Hispanic or non-white), with no prior diagnosis of diabetes or pre-diabetes.

Approximately 530 patients with at least one additional self-reported diabetes risk factor (family history of diabetes, high cholesterol, hypertension, or overweight/obesity) received a periodontal examination and a fingerstick, point-of-care hemoglobin A1c test. In order for the investigators to assess and compare the performance of several potential identification protocols, patients returned for a fasting plasma glucose test, which indicates whether an individual has diabetes or pre-diabetes.

Researchers found that, in this at-risk dental population, a simple algorithm composed of only two dental parameters (number of missing teeth and percentage of deep periodontal pockets) was effective in identifying patients with unrecognised pre-diabetes or diabetes. The addition of the point-of-care A1c test was of significant value, further improving the performance of this algorithm.

“Early recognition of diabetes has been the focus of efforts from medical and public health colleagues for years, as early treatment of affected individuals can limit the development of many serious complications,” Dr Evanthia Lalla, an associate professor at the College of Dental Medicine, and the lead author on the paper, explained. “Relatively simple lifestyle changes in pre-diabetic individuals can prevent progression to frank diabetes, so identifying this group of individuals is also important,” she added. “Our findings provide a simple approach that can be easily used in all dental-care settings.”

According to the Centers for Disease Control and Prevention, one in four people affected with type 2 diabetes in the United States remains undiagnosed. Additionally, those with pre-diabetes are at an increased risk for type 2 diabetes and also for heart disease, stroke and other vascular conditions typical of individuals with diabetes.

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