INDICATE [INtroducing DIabetes Checks in A denTal sEtting]: estimating prevalence of undiagnosed pre-diabetes/type 2 diabetes in primary dental care

Abstract

Aims Non-diabetic hyperglycaemia (NDH; pre-diabetes) and type 2 diabetes (T2D) represent an increasing health and economic burden. Oral healthcare professionals may support early identification of undiagnosed disease, particularly in patients with periodontitis. This study estimated the prevalence of undiagnosed NDH/T2D in NHS dental settings and evaluated the performance of two validated diabetes risk-prediction tools in primary dental care. Methods This cross-sectional study was conducted in 13 NHS dental practices. Adults aged ≥40 years without a prior diagnosis of NDH/T2D were recruited. Participants (n = 803) completed two validated risk questionnaires and underwent point-of-care HbA1c testing irrespective of risk score. Individuals with HbA1c ≥42 mmol/mol (6.0%) received preventive advice and were advised to consult their general practitioner. Results Sixty one percent of participants self-identified as women, 85% as white British; and mean body mass index was 27.4 kg/m². NDH prevalence (HbA1c 42–47 mmol/mol) was 10.0%, and previously undiagnosed T2D (≥48 mmol/mol) was 3.0%. Using UK/ADA diagnostic thresholds as the reference standard, both risk tools showed good sensitivity (>80%) but low specificity (<55%). Conclusions This large UK primary care dental study demonstrates that NDH and undiagnosed T2D are common in dental attendees. Both questionnaires showed acceptable sensitivity, while point-of-care HbA1c testing improved specificity within a two-step dental risk-assessment pathway.