The Role of the Oral Healthcare Team in Identification of Type 2 Diabetes Mellitus: A Systematic Review

Abstract

Abstract Purpose of Review Type 2 diabetes (T2DM) presents a growing global health and economic burden. Dental settings have been employed to identify individuals who may be at high risk of diabetes, who exhibit non-diabetic hyperglycaemia (NDH – also termed “prediabetes”) and who already unknowingly have the condition, through the use of targeted risk-assessments. This review aims to synthesize the existing literature supporting dental teams’ identification of individuals at an increased risk of or suffering from undiagnosed NDH or T2DM in dental specialist care settings. Recent Findings Electronic databases were searched for studies reporting the identification of NDH and or T2DM, in specialist care dental settings. Screening of returned articles and data extraction were completed by two independent reviewers (RJ, ZY). A descriptive synthesis of the included articles was undertaken. Due to heterogeneity of the literature, a meta-analysis could not be performed. The search yielded 52 eligible studies, of which 12 focused primarily on stakeholder opinions. Opinions of patients, dentists, dental hygienists, dental students and physicians on case identification of T2DM by oral health professionals were generally positive. The main barriers cited were time, cost, inadequate training and low follow-up of participants by primary care physicians. The risk assessment processes varied, with most studies using a combination of methods consisting of a questionnaire followed by a chairside blood sample. Methods utilizing questionnaires, gingival crevicular blood (GCB), fingerstick blood (FSB) and urine samples have all been evaluated. Summary This review demonstrates that there may be benefit in engaging the dental workforce to identify cases of NDH and undiagnosed T2DM and that such a care pathway has the support of multiple stakeholders. Further high-quality research is required to assess both the clinical and cost-effectiveness of such practice in order to optimize protocols and patient care pathways. Studies should include a comparison of methods, health economic analyses and protocols to ensure those identified as high-risk go on to receive appropriate follow-up care.