Diabetic Screening Performed in Dental Setting

HbA1c is widely used to test for diabetes and blood glucose measured from oral blood compare well to those from finger-stick blood where an HbA1c reading of 6.5% or more indicates a value in the diabetic range.

At the New York University (NY, USA) a nursing and dental team of scientists compared HbA1c levels in paired samples of oral gingival crevicular blood (GCB) and finger-stick blood (FSB) taken from patients with periodontal disease. The oral blood was from patients with adequate bleeding on probing and was collected on special blood collection cards.

The blood samples were analyzed for HbA1c using the BioRad Variant II Analyzer (BioRad; Hercules, CA, USA), which employs high-performance liquid chromatography, and exclusively uses BioRad Reagents. A total of 120 individuals were eligible and participated in the study and provided a FSB sample for HbA1c testing. Average FSB HbA1c readings were 6.0% ± 0.83% with 20 in the diabetes range. An additional 66 patients had FSB HbA1c test results in the prediabetes range, which is between 5.7% and 6.4%, and are at increased risk of developing diabetes in the future.

Oral blood samples were also collected from 102 of the 120 participants; no bleeding on probing or insufficient bleeding to cover adequately the tip of the blood collection wand prevented collection and/or laboratory analysis of GCB samples from the remaining 18 participants. In the case of 27 of the 102 GCB samples, an unidentified component was observed to co-elute within the elution window of HbA1c in the laboratory. The presence of a co-elution peak from this unidentified component interfered with the quantification of HbA1c and generally resulted in underestimation of true HbA1c percentages. Therefore, only 75 patients' blood samples could be compared with both tests.

Of these 75 participants, 15 had FSB HbA1c values in the diabetes range of equal to or greater than 6.5%, including 8 who indicated that they had never been told by a health care provider that they had diabetes. For these 75 participants, the correlation between FSB and GCB HbA1c values was very high. Sheila M. Strauss, PhD, the principal author said, "In light of these findings, the 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". The study was published online on November 16, 2011 in the Journal of Periodontology.

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New York University
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