Diabetes has reached epidemic proportions in the US, with 7 million people as yet undiagnosed, preventing them from adopting disease management strategies that could improve their quality of life and decrease morbidity.
Among those at great risk are persons with periodontal disease, many of whom may see a dentist but not a primary care provider annually. This suggests the potential and importance of screening for diabetes at dental visits.
"In our previous pilot study, whose findings were published in the Journal of Periodontology in 2012, we found that a dental visit could be a useful opportunity to conduct an initial diabetes screening - an important first step in identifying those patients who need further testing to determine their diabetes status," said Dr. Shiela Strauss, associate professor of nursing and co-director of the Statistics and Data Management Core for New York University's Colleges of Nursing and Dentistry.
Dr. Strauss' team conducted a pilot study (N=120) at a Periodontics Clinic to examine a potentially useful intra-oral approach to blood testing for diabetes using hemoglobin A1c (HbA1c) levels. The team collected samples of both finger stick blood (FSB) and gingival crevicular blood (GCB) from periodontal patients (the latter occurring naturally on probing their periodontal pockets).
Results of the pilot study showed high specificity (.900) and sensitivity (.933) of the GCB HbA1c values relative to the FSB HbA1c values. It also demonstrated patient and provider preference for the GCB approach, as they were more comfortable with the provider collecting blood samples in the patient's mouth.
The current two-year interdisciplinary, mixed methods study builds on the unique organizational partnership between the New York University College of Nursing (NYUCN) and its College of Dentistry (NYUCD) to assess the accuracy, acceptability, feasibility, and consequences of a novel approach using oral blood to screen patients with periodontal disease for diabetes in general dental practices.
The study will be recruiting 500 patients with periodontal disease who seek care at 14 general practice clinics at NYUCD over a 15-month period, addressing the following specific aims:
- Assess the accuracy of patients' HbA1c test results using GCB relative to FSB HbA1c readings;
- Examine patient and provider views on the GCB diabetes screening approach's acceptability and feasibility;
- Assess the psychological impact to patients of participating in screening for diabetes at dental visits; and
- Compare socio-demographic and clinical characteristics of patients with a positive screening result who follow up with a health care provider within 3 months and those who do not, thereby illuminating potential barriers and facilitators to follow up.
If results demonstrate that the GCB HbA1c screening is accurate, feasible, and acceptable, with minimal psychological impact on patients, and leads to timely follow-up with a health care provider, Dr. Strauss intends to seek additional funding to further examine its usefulness on a broader scale.
"Expanding the types, venues and approaches for diabetes screening may enable many medically underserved persons to learn of their condition sooner, thereby enabling them to prevent or delay major diabetes-related complications," Dr. Strauss said.
Co-investigators on the study include:
Mary Rosedale, PhD, PMHNP-BC, Assistant Professor NYUCN; Mark Wolff, DDS, PhD, Professor and Chair, Associate Dean for Pre-doctoral Clinical Education, Department of Cariology and Comprehensive Care, NYUCD; Ann Danoff, MD, New York University School of Medicine, (NYUSOM); Dolores Malaspina, MD, NYUSOM. Consultants: David Rindskopf, PhD, Professor of Educational Psychology at the Graduate School and University Center of the City University of New York; Janet Tuthill, RDH,MA, Clinical Instructor and Program Administrator, School of Dental Medicine, Stony Brook University.
The grant was made possible by the National Institute of Dental & Craniofacial Research of the National Institutes of Health under Award Number R15DE023201.
About the New York University College of Nursing:
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing; Master of Arts and Post-Master's Certificate Programs; a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit www.nyu.edu/nursing.
About New York University College of Dentistry:
Founded in 1865, New York University College of Dentistry (NYUCD) is the third oldest and the largest dental school in the US, educating more than 8 percent of all dentists. NYUCD has a significant global reach and provides a level of national and international diversity among its students that is unmatched by any other dental school.