Link to gum disease suggests that it would flag patients otherwise undiagnosed
• by Jeff Minerd
Contributing Writer, MedPage Today February 22, 2017
• This article is a collaboration between MedPage Today® and:
Action Points

• Patients with mild-to-severe periodontitis had significantly higher mean HbA1c values than a control group without periodontitis; using the American Diabetes Association (ADA) cutoff of 6.5%, diabetes was identified in 23% of patients with severe periodontitis, 14% with moderate/mild periodontitis, and 10% of control patients without gum disease.
• Note that the data suggest that a dental office treating patients with severe periodontitis is suitable for screening for (pre)diabetes and diabetes, and a considerable number of suspected new cases can be identified, indicating that periodontitis can be an early sign of diabetes mellitus.
Screening periodontitis patients in the dentist’s office with a glycated hemoglobin (HbA1c) test may help identify undiagnosed cases of diabetes and prediabetes, according to a Dutch study.
Patients with severe periodontitis had significantly higher mean HbA1c values compared with a control group without periodontitis (6.3% ± 1.3% versus 5.7% + 0.7%; P=0.003). The mean HbA1c of patients with moderate/mild periodontitis was also significantly higher (6.1% ± 1.4%; P=0.003), reported Bruno Loos, MSc, of the University of Amsterdam in the Netherlands, and colleagues.
Using the American Diabetes Association (ADA) cutoff of 6.5%, the researchers identified diabetes in 23% of the patients with severe periodontitis, 14% of those with moderate/mild periodontitis, and 10% of control patients without gum disease (P=0.01 for comparison), according to the study in BMJ Open Diabetes Research and Care.
After adjusting for patients with a diagnosis of diabetes, the team found undiagnosed diabetes in 18.1% of the severe periodontitis group, 9.9% of the moderate/mild group, and 8.5% of the control group (P=0.024 for comparison).
When the ADA definition of prediabetes was used (HbA1c of 5.7%-6.4%), prediabetes was identified in 47% of the severe periodontitis group, 46% of the moderate/mild group, and 37% of the control group (P=0.01).
“The early identification of subjects at high risk for (pre)diabetes mellitus or with undiagnosed diabetes mellitus is crucial to implement measures that may prevent or delay progression from pre-diabetes to overt diabetes mellitus and reduce the incidence of chronic complications,” Loos and colleagues wrote. “Here, we show that periodontitis is an early sign of diabetes mellitus and may therefore serve as a valuable risk indicator.
“A dental office that treats patients with periodontitis is a suitable location for screening for diabetes by a simple finger stick and validated HbA1c dry spot analysis.”
However, one expert not involved with the study was not entirely convinced by the findings: “This method of screening has never been validated, and this method of measuring HbA1c is not standardized in the way blood tests are rigorously validated,” Vivian Fonseca, MD, chief of the Section of Endocrinology at Tulane University in New Orleans, said in an email to MedPage Today, when asked for his opinion.
“Screening of the whole population may not be cost effective, so targeted screening of high-risk populations is recommended. Patients with periodontitis do not necessarily fall into that category unless they have other features that make them high risk,” said Fonseca, acting as a spokesperson for the American Association of Clinical Endocrinologists (AACE).
The study included 313 adult participants seen at a university dental clinic. Of these, 78 had severe periodontitis, 126 had moderate/mild periodontitis, and 109 did not have periodontitis and served as the control group. The investigators measured HbA1c values by laboratory analysis of dry blood spots. Blood was collected by finger stick and spotted on Whatman 903 paper collection cards. The cards were mailed to a laboratory, where HbA1c was measured on an Abbott ci8200 clinical chemistry analyzer.
The main outcome measures of the study were differences in HbA1c values and the prevalence of diabetes and prediabetes in the periodontitis groups versus the control group.
The investigators also measured the height and weight of the participants. The mean body-mass index was significantly higher in patients with periodontitis versus controls (27 versus 24.9; P=0.008).
When the higher cutoff HbA1c of 7% was used to identify cases of diabetes, the team found a trend that bordered on significance: 12.8% in the severe periodontitis group, 7.1% in the moderate/mild group, and 3.7% in the control group (P=0.061).
“The early diagnosis and intervention of (pre)diabetes prevent the common microvascular and macrovascular complications and are cost-effective. In addition, it can be suggested that the early diagnosis and treatment of (pre)diabetes may also benefit the treatment of periodontitis,” Loos and colleagues concluded.
“A dental office that treats patients with severe periodontitis is a suitable location for screening for (pre)diabetes; a considerable number of suspected new diabetes cases were identified and indicated that periodontitis is an early sign of diabetes mellitus.”