Implementation and analysis of an enhanced screening and testing protocol for prediabetes in a dental school patient population

Abstract

Objectives: This project aimed to enhance the identification of patients at-risk for prediabetes or diabetes within a dental school patient population by introduction of a modified screening tool and related training of dental residents and students.

Methods: The American Diabetes Association Risk Tool (ADART) was modified by addition of three diabetes-linked oral health questions. Of the 1477 dental patients screened, 551 (37.3%) indicated an at-risk status using the modified tool. A subset of 138 patients received follow-up chairside HbA1c blood testing conducted by dental residents and students. Data was analysed to determine a) the influence of the modifications on the tool's discrimination strength and b) change in the tool's predictive value.

Results: The addition of the 3 oral health questions to the 7-item ADART resulted in a 9.4% increase in identification of patients at-risk for pre-diabetes/diabetes. The predictive value of the tool remained stable. Residents and students successfully incorporated the new screening activities within their assigned clinics.

Conclusions: This project demonstrates that screening for risk for prediabetes/diabetes is both prudent and practical in the dental setting. Dental personnel, including trainees, can successfully incorporate enhanced screening methods within their traditional activities. Further, screening tools used in the dental setting might be enhanced by inclusion of certain oral health variables associated with diabetes. These findings add to emerging knowledge on the importance of screening for prediabetes/diabetes in dental settings and have particular relevance and application to institutional practice.

Keywords: comprehensive dental care; diabetes mellitus; interprofessional practice; practice transformation; primary health care; risk assessment; scope of practice; type 2.