Identification of diabetes risks in periodontitis patients and their compliance to referral for shared care interventions

Abstract

The reciprocal bidirectional link between diabetes mellitus and periodontitis denoted a call for voluntary diabetes screening among periodontitis patients. To date, opportunistic screening for diabetes in dental clinics in Malaysia has never been documented and little is known about patients’ compliance to referral for diabetes management. Referral non-compliance could delay the diagnosis and treatment of diabetes and thus lead to poorer health outcomes. This study aims to identify diabetes risks among periodontitis patients in private dental clinics using the Finnish Diabetes Risk Score (FINDRISC) and glycaemic assessment with capillary Fasting Blood Glucose (cFBG), and patients’ compliance to referral for diabetes management at health clinics. Private general dental practitioners (GDPs) were invited to participate in this study and were given training for periodontal health and diabetes risk screening prior to patients’ recruitment. Periodontitis patients with no prior history of diabetes were classified with increased risk of diabetes if their FINDRISC score ≥ 11 and/or cFBG≥5.6 mmol/L. Subsequently, patients were referred to health clinics for further diabetes evaluation and their compliance to referral was assessed based on verified patients’ reports by the medical practitioners. A total of 142 voluntary patients recruited by 20 GDPs were included in this study. In relation to FINDRISC, 36.4% (n=47/142) of patients presented with increased risk of diabetes (mean 7.7±4.5). Out of all patients, 129 (90.8%) returned for glycaemic assessment and 26.3% (n=34/129) had cFBG≥5.6mmol/L (mean 5.64±1.46). Fifty-four patients (41.8%) were referred to health clinics and 33 (61.1%) received diabetes assessment: 16 (29.6%) patients were diagnosed with non-diabetes, 10 (18.5%) prediabetes and 7 (12.9%) diabetes respectively, and the remaining 21 (38.9%) did not report back (non-compliance). In conclusion, this study identified 41.8% periodontitis patients to be at risk for diabetes, and one-third of the referred patients were eventually diagnosed with prediabetes or diabetes. Patients' compliance to referral was high and encouraging. These findings emphasized the significance of shared care intervention in the identification of diabetes risk in periodontitis patients in private dental clinics for improvement of patients’ overall wellness