摘要：Objectives. We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes. Methods. In 2013 and 2014, we performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired “gold-standard” HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients. Results. About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits. Conclusions. Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients. Although diabetes has reached epidemic proportions in the United States, 1 many diabetes complications could be mitigated by early detection coupled with lifestyle modification and therapeutic interventions to optimize glycemic control. 2 Unfortunately, 8.1 million of the 29.1 million persons in the United States who have diabetes are undiagnosed, 3 and among those diagnosed with diabetes, many are not likely to have received regular testing to monitor their glycemic control. 4 An additional 86 million US adults have prediabetes, a condition that often progresses to diabetes, but only 11.1% of these persons have been told of their condition. 3 Importantly, early identification and treatment of prediabetes can interrupt its progression. 5,6 Thus, more opportunities are needed to screen for prediabetes and diabetes and to monitor glycemic control in those already diagnosed. Because many persons in the United States visit a dental provider but not a primary care provider (PCP) each year, 7 the dental visit may serve as an opportune site for diabetes screening and monitoring blood glucose. 8–10 However, both dental patients and dental providers are accustomed to having dental providers only administer care in the mouth. In an earlier pilot study, we therefore investigated and demonstrated the acceptability and feasibility of using oral blood to screen for diabetes in persons with bleeding on dental probing. 11,12 Many patients appreciated the use of oral blood for this screening, indicating that its collection felt like a routine dental cleaning, and most dental providers felt that the oral blood collection was fast and easy. 12 In the current study, we refined our examination of the use of oral blood to screen for diabetes by implementing a laboratory-based approach to diabetes testing that enabled definitive and accurate analysis of all of the samples for which sufficient blood was collected. We included a large sample of patients (n = 408) at risk for diabetes or its complications who presented for regular dental visits at a dental college’s comprehensive care clinics. We analyzed the sociodemographic and diabetes risk–related characteristics of the sample, and compared the results of diabetes screening and glycemic control monitoring with dried blood samples of gingival crevicular blood (GCB) and gold-standard finger-stick blood (FSB) to determine the validity of using GCB for this purpose. This screening and monitoring was performed by testing the samples for hemoglobin A1c (HbA1c), a test promoted by the American Diabetes Association for diabetes diagnostic purposes and glycemic control monitoring. 2 By providing an average measure of glycemic control over a 3-month period, this test is especially advantageous because fasting is not needed for HbA1c assessment, and no acute perturbations (e.g., stress, diet, exercise) affect HbA1c. 2 Finally, we examined the potential benefits of this approach to diabetes screening and glycemic control monitoring according to whether study participants had previous-year tests for blood glucose and previous-year visits to PCPs and dental providers.
