A Novel Intraoral Diabetes Screening Approach in Periodontal Patients: Results of a Pilot Study
Corresponding Author
Shiela M. Strauss
College of Nursing, New York University, New York, NY.
Correspondence: Shiela M. Strauss, New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003. Fax: 212-995-3143; e-mail: [email protected].Search for more papers by this authorJanet Tuthill
State University of New York at Stony Brook, Stony Brook, NY.
Search for more papers by this authorDavid Rindskopf
Department of Educational Psychology, Graduate Center of the City University of New York, New York, NY.
Search for more papers by this authorMary Rosedale
College of Nursing, New York University, New York, NY.
Search for more papers by this authorCorresponding Author
Shiela M. Strauss
College of Nursing, New York University, New York, NY.
Correspondence: Shiela M. Strauss, New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003. Fax: 212-995-3143; e-mail: [email protected].Search for more papers by this authorJanet Tuthill
State University of New York at Stony Brook, Stony Brook, NY.
Search for more papers by this authorDavid Rindskopf
Department of Educational Psychology, Graduate Center of the City University of New York, New York, NY.
Search for more papers by this authorMary Rosedale
College of Nursing, New York University, New York, NY.
Search for more papers by this authorAbstract
Background: This pilot study examines whether a novel diabetes screening approach using gingival crevicular blood (GCB) could be used to test for hemoglobin A1c (HbA1c) during periodontal visits.
Methods: Finger-stick blood (FSB) samples from 120 patients and GCB samples from those patients with adequate bleeding on probing (BOP) were collected on special blood collection cards and analyzed for HbA1c levels in a laboratory. The Pearson correlation coefficient was used to measure correlation between FSB and GCB HbA1c values for 75 paired FSB and GCB samples. A receiver–operator characteristic curve (ROC) analysis was performed to determine an optimal GCB HbA1c criterion value for a positive diabetes screen.
Results: For the 75 paired samples, the Pearson correlation coefficient was 0.842. The ROC analysis identified a criterion value of 6.3% for the GCB HbA1c test with high sensitivity (0.933) and high specificity (0.900), corresponding to FSB HbA1c values ≥6.5% (in the diabetes range). Using this GCB HbA1c criterion value for 27 additional paired samples, in which there was an unidentified component observed to coelute within the elution window of GCB HbA1c in the laboratory, there was agreement between FSB and GCB values for 24 of the pairs according to whether both were within or outside of the diabetes range.
Conclusion: Using a criterion value of 6.3%, GCB samples are acceptable for HbA1c testing to screen for diabetes in most persons with BOP at the GCB collection site.
REFERENCES
- 1 Centers for Disease Control and Prevention. National diabetes fact sheet, 2011. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed June 24, 2011.
- 2 Diabetes Prevention Program Research Group. The prevalence of retinopathy in impaired glucose tolerance and recent-onset diabetes in the Diabetes Prevention Program. Diabet Med 2007; 24: 137–144.
- 3Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M. The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology 2003; 60: 108–111.
- 4Herman WH. Diabetes epidemiology: Guiding clinical and public health practice: The Kelly West Award Lecture, 2006. Diabetes Care 2007; 30: 1912–1919.
- 5Barrett-Connor E, Ferrara A. Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. The Rancho Bernardo Study. Diabetes Care 1998; 21: 1236–1239.
- 6Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229–234.
- 7Adler AI, Neil HA, Manley SE, Holman RR, Turner RC. Hyperglycemia and hyperinsulinemia at diagnosis of diabetes and their association with subsequent cardiovascular disease in the United Kingdom prospective diabetes study (UKPDS 47). Am Heart J 1999; 138: S353–S359.
- 8 The DECODE Study Group on Behalf of the European Diabetes Epidemiology Group. Glucose tolerance and mortality: Comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 1999; 354: 617–621.
- 9Nathan DM, Cleary PA, Backlund JY, et al; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353: 2643–2653.
- 10Barr ELM, Zimmet PZ, Welborn TA, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 2007; 116: 151–157.
- 11Borch-Johnsen K, Lauritzen T, Glümer C, Sandbaek A. Screening for Type 2 diabetes — Should it be now? Diabet Med 2003; 20: 175–181.
- 12 American Diabetes Association. Standards of medical care in diabetes — 2007. Diabetes Care 2007; 30 (Suppl. 1) : S4–S41.
- 13Alberti KG. Zimmett PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1. Diagnosis and classification of diabetes mellitus Report of a WHO Consultation. Diab Med 1998; 15: 539–553.
- 14Diabetes UK. Position statement. Early identification of people with type 2 diabetes, 2008. Available at: http://www.diabetes.org.uk/About_us/Our_Views/Position_statements/Early_identification_of_people_with_Type_2_diabetes/. Accessed April 29, 2012.
- 15 Diabetes Australia. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Part 3. Case detection and diagnosis, 2001. Available at: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/di9.pdf?q=publications/synopses/_files/di9.pdf. Accessed April 29, 2012.
- 16Wareham NJ, Griffin SJ. Should we screen for type 2 diabetes? Evaluation against National Screening Committee criteria. BMJ 2001; 322: 986–988.
- 17Hein C, Cobb C, Iacopino A. Report of the Independent Panel of Experts of the Scottsdale Project, 2007. Available at: http://downloads.pennnet.com/pnet/gr/scottsdaleproject.pdf. Accessed June 24, 2011.
- 18Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: A two-way relationship. Ann Periodontol 1998; 3: 51–61.
- 19Mealey BL, Rethman MP. Periodontal disease and diabetes mellitus. Bidirectional relationship. Dent Today 2003; 22: 107–113.
- 20Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc 2006; 137 (Suppl.) : 26S–31S.
- 21Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: An epidemiologic perspective. Ann Periodontol 2001; 6: 99–112.
- 22Southerland JH, Taylor GW, Offenbacher S. Diabetes and periodontal infection: Making the connection. Clin Diabetes 2005; 23: 171–178.
- 23Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999; 70: 13–29.
- 24Strauss SM, Russell S, Wheeler AJ, Norman R, Borrell LN, 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.
- 25Vernillo AT. Dental considerations for the treatment of patients with diabetes mellitus. J Am Dent Assoc 2003; 134 (Spec. No., Suppl. 1) : 24S–33S.
- 26Lalla E, Kunzel C, Burkett S, Cheng B, Lamster IB. Identification of unrecognized diabetes and pre-diabetes in a dental setting. J Dent Res 2011; 90: 855–860.
- 27Li S, Williams PL, Douglass CW. Development of a clinical guideline to predict undiagnosed diabetes in dental patients. J Am Dent Assoc 2011; 142: 28–37.
- 28Borrell LN, Kunzel C, Lamster I, Lalla E. Diabetes in the dental office: Using NHANES III to estimate the probability of undiagnosed disease. J Periodontal Res 2007; 42: 559–565.
- 29Strauss SM, Wheeler AJ, Russell SL, et al. The potential use of gingival crevicular blood for measuring glucose to screen for diabetes: An examination based on characteristics of the blood collection site. J Periodontol 2009; 80: 907–914.
- 30Parker RC, Rapley JW, Isley W, Spencer P, Killoy WJ. Gingival crevicular blood for assessment of blood glucose in diabetic patients. J Periodontol 1993; 64: 666–672.
- 31Beikler T, Kuczek A, Petersilka G, Flemmig TF. In-dental-office screening for diabetes mellitus using gingival crevicular blood. J Clin Periodontol 2002; 29: 216–218.
- 32Khader YS, Al-Zu'bi BN, Judeh A, Rayyan M. Screening for type 2 diabetes mellitus using gingival crevicular blood. Int J Dent Hyg 2006; 4: 179–182.
- 33Müller HP, Behbehani E. Screening of elevated glucose levels in gingival crevice blood using a novel, sensitive self-monitoring device. Med Princ Pract 2004; 13: 361–365.
- 34Horowitz AM, Siriphant P, Sheikh A, Child WL. Perspectives of Maryland dentists on oral cancer. J Am Dent Assoc 2001; 132: 65–72.
- 35Greenberg BL, Glick M, Frantsve-Hawley J, Kantor ML. Dentists’ attitudes toward chairside screening for medical conditions. J Am Dent Assoc 2010; 141: 52–62.
- 36Khan AI, Vasquez Y, Gray J, Wians FH Jr, Kroll MH. The variability of results between point-of-care testing glucose meters and the central laboratory analyzer. Arch Pathol Lab Med 2006; 130: 1527–1532.
- 37Ahmed M, Gannon MC, Nuttall FQ. Postprandial plasma glucose, insulin, glucagon, and triglyceride responses to a standard diet in normal subjects. Diabetologia 1976; 12: 61–67.
- 38Bonora E, Calcaterra F, Lombardi S, et al. Plasma glucose levels throughout the day and HbA(1c) interrelationships in type 2 diabetes. Implications for treatment and monitoring of metabolic control. Diabetes Care 2001; 24: 2023–2029.
- 39American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2010;33(Suppl. 1):S11-S61.
- 40Mobile Exam Center Components Descriptions. Available at: http://www.cdc.gov/nchs/data/nhanes/meccomp.pdf. Accessed June 24, 2011.
- 41American Diabetes Association. ADA Diabetes Risk Test. Available at http://www.diabetes.org/diabetes-basics/prevention/diabetes-risk-test/. Accessed June 24, 2011.
- 42National Glycohemoglobin Standardization Program (NGSP). Available at: http://www.ngsp.org/docs/methods.pdf. Accessed April 29, 2012.
