Abstract
Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments.Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored.Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures.Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.
Highlights
Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected
Results of hemoglobin A1c (HbA1c) shown in Table 2 found that 62/127 (49%) of the subset of potentially at-risk patients had POC screening HbA1c values ≥ 5.7%, with 55/62 (89%) and 7/62 (11%), exhibiting measures in the prediabetic and diabetic ranges, respectively
Re-evaluation of our health-care delivery models has been advocated with emphasis on evolution of improved integrated medical–dental care delivery models supported by systematic examination to show evidence that such models are cost-effective and leverage improved patient outcomes [21]
Summary
Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Between 2015 and 2030, diabetes prevalence in the USA is projected to increase by 54%, annual diabetes-associated mortality by 38%, and annual overall cost associated with diabetes to exceed $620 billion [3]. These data project that diabetes remains on track for continued escalation of its epidemic status. Because recent systematic review and meta-analysis of the evidence base surrounding bidirectional associations between PD and diabetes continues to support potential interactions between these conditions [5], there is an increased need to expand and promote integration of interdisciplinary efforts across primary dental and medical settings to identify and manage high-risk individuals
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