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The prevalence of potentially undiagnosed type II diabetes in patients with chronic periodontitis attending a general dental practice in London - a feasibility study

Abstract

Introduction In the UK alone, it is estimated that one in four people with type II diabetes are currently undiagnosed.

Aim To investigate the prevalence of potentially undiagnosed type II diabetes in patients with chronic periodontitis attending a general dental practice in North London.

Methods Patients aged 35 years and over, who had not been diagnosed with diabetes, attending for routine examination and diagnosed with chronic periodontitis, were offered screening for diabetes risk using the self-reporting Finnish Diabetes Risk Score (FINDRISC) questionnaire. If the score showed an increased risk of developing type II diabetes, a referral letter was sent to their general medical practitioner (GMP) for formal testing. The uptake and results of the test were recorded.

Results Over the 12-month period, a total of 51 patients were eligible to take part, with 40 agreeing to participate (78% participation rate). Nineteen participants (48%) were found to be at a significantly increased risk of developing type II diabetes based on the recommended FINDRISC cut-off point and were referred to their GMP for formal testing. Eleven participants (58%) scored above the FINDRISC cut-off point and were categorised as high-risk. A further six participants (32%) fell into the moderate-risk category and two participants (10%) fell into the slightly elevated-risk category. Of the 19 participants who were referred for formal testing, four were not found to have type II diabetes, nine were found to have intermediate hyperglycaemia (or prediabetes) and two participants were diagnosed with type II diabetes.

Conclusions This study confirmed a method of diabetes risk screening that has a good rate of uptake by patients and is practical for use in general dental practice. A moderate proportion of patients were identified as having an increased risk of developing diabetes and just under half were referred for formal testing. The study has shown an effective method for identifying undiagnosed type II diabetes and prediabetes in patients diagnosed with periodontitis who attend general dental practice.

Key points

  • This is one of the few studies of screening for systemic disease conducted in a general dental practice setting.

  • The screening method used is an effective and accepted way to identify undiagnosed type II diabetes risk.

  • The prevalence of undiagnosed type II diabetes within the population sample was 5% and the prevalence of prediabetes was 23%.

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References

  1. International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels: International Diabetes Federation, 2017.

  2. Forouzanfar M H, Afshin A, Alexander L T et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1659-1724.

  3. Diabetes UK. New diabetes prevalence figures for England. 2016.Available at https://www.diabetes.org.uk/about_us/news/new-diabetes-prevalence-figures-for-england (accessed November 2017).

  4. Office for National Statistics. Adult Dental Health Survey 2009. 2012. Available online at https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series (accessed November 2017).

  5. Casanova L, Hughes F J, Preshaw P M. Diabetes and periodontal disease: a two-way relationship. Br Dent J 2014; 217: 433-437.

  6. Simpson T C, Weldon J C, Worthington H V et al. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2015; DOI: 10.1002/14651858.CD004714.pub3.

  7. D'Aiuto F, Gable D, Syed Z et al. Evidence summary: The relationship between oral diseases and diabetes. Br Dent J 2017; 222: 944-948.

  8. Grossi S G, Zambon J J, Ho A W et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Perio 1994; 65: 260-267.

  9. Warnakulasuriya S, Dietrich T, Bornstein M M et al. Oral health risks of tobacco use and effects of cessation. Int Dent J 2010; 60: 7-30.

  10. Papapanou P N. Periodontal diseases: epidemiology. Ann Periodontol 1996; 1: 1-36.

  11. Mealey B L, Ocampo G L. Diabetes mellitus and periodontal disease. Periodontol 2000 2007; 44: 127-153.

  12. Graziani F, Gennai S, Solini A, Petrini M. A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes an update of the EFP-AAP review. J Clin Perio 2018; 45: 167-187.

  13. Taylor G W, Burt B A, Becker M P et al. Severe periodontitis and risk for poor glycaemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol 1996; 67: 1085-1093.

  14. Saremi A, Nelson R G, Tulloch-Reid M et al. Periodontal disease and mortality in type II diabetes. Diabetes Care 2005; 28: 27-32.

  15. Tsai C, Hayes C, Taylor G W. Glycaemic control of type II diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol 2002; 30: 182-192.

  16. Emerging Risk Factors Collaboration, Sarwar N, Gao P et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215-2222.

  17. Saran R, Robinson B, Abbott K C et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2017; 69(3 Suppl 1): A7-A8.

  18. Tonetti M S, Jepsen S, Jin L, Otomo-Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol 2017; 44: 456-462.

  19. Strauss S M, Russell S, Wheeler A, Norman R, Borrell L N, Rindskopf D. The dental office visit as a potential opportunity for diabetes screening: an analysis using NHANES 2003-2004 data. J Public Health Dent 2010; 70: 156-162.

  20. Howse J H, Jones S, Hungin A P S. Screening and identifying diabetes in optometric practice: a prospective study. Br J Gen Pract 2011; 61: 436-442.

  21. Holm N C R, Belstrøm D, Østergaard J A, Schou S, Holmstrup P, Grauballe M B. Identification of individuals with undiagnosed diabetes and pre-diabetes in a Danish cohort attending dental treatment. J Periodontol 2016; 87: 395-402.

  22. Wright D, Muirhead V, Weston-Price S, Fortune F. Type 2 diabetes risk screening in dental practice settings: a pilot study. Br Dent J, 2014; 216: E15.

  23. Bould K, Scott S E, Dunne S, Asimakopoulou K. Uptake of screening for type II diabetes risk in general dental practice; an exploratory study. Br Dent J 2017; 222: 293-296.

  24. Finnish Diabetes Association. Finnish Diabetes Risk Score. 2003. Available at https://www.diabetes.fi/files/502/eRiskitestilomake.pdf (accessed May 2017).

  25. Office of the Chief Dental Officer England. Commissioning Standard: Dental Care for People with Diabetes. 2019. Available at https://www.england.nhs.uk/wp-content/uploads/2019/08/commissioning-standard-dental-care-for-people.pdf (accessed July 2020).

  26. Saaristo T, Peltonen M, Lindström J et al. Cross-sectional evaluation of the Finnish Diabetes Risk Score: a tool to identify undetected type II diabetes, abnormal glucose tolerance and metabolic syndrome. Diab Vasc Dis Res 2005; 2: 67-72.

  27. Tankova T, Chakarova N, Atanassova I, Dakovska L. Evaluation of the Finnish Diabetes Risk Score as a screening tool for impaired fasting glucose, impaired glucose tolerance and undetected diabetes. Diabetes Res Clin Pract 2011; 92: 46-52.

  28. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33(Suppl 1): S62-S69.

  29. Lalla E, Kunzel C, Burkett S, Cheng B, Lamster I B. Identification of unrecognised diabetes and pre-diabetes in a dental setting. J Dent Res 2011; 90: 855-860.

  30. Herman W H, Taylor G W, Jacobson J J, Burke R, Brown M B. Screening for prediabetes and type II diabetes in dental offices. J Public Health Dent 2015; 75: 175-182.

  31. World Health Organisation. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation. Geneva: World Health Organisation, 2011.

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Acknowledgements

This study was self-funded and was performed by the first author as part of an MSc programme run by the University of Kent. Thanks are given to the first author's practice principal for his permission to perform the study in his practice and to the patients who agreed to participate.

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Contributions

G.G. designed the study, collected the data, wrote the first draft of the manuscript and agreed its final version. P.O. supervised the study and the MSc dissertation based on the study, reviewed drafts of the manuscript and agreed its final version. K.E. advised on the design of the study, monitored its progress, edited all drafts of the manuscript and agreed its final version.

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Correspondence to Gavin Goh.

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None of the authors are aware of any conflict of interest.

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Goh, G., Ower, P. & Eaton, K. The prevalence of potentially undiagnosed type II diabetes in patients with chronic periodontitis attending a general dental practice in London - a feasibility study. Br Dent J 231, 180–186 (2021). https://doi.org/10.1038/s41415-021-3223-5

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  • DOI: https://doi.org/10.1038/s41415-021-3223-5

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