This interdisciplinary, mixed methods R15 application builds on the unique organizational partnership between the NYU College of Nursing (NYUCN) and its College of Dentistry (NYUCD) to assess the accuracy, acceptability, feasibility, and consequences of a novel approach using oral blood to screen patients with periodontal disease for diabetes in general dental practices. Diabetes has reached epidemic proportions in the US, with 7 million people as yet undiagnosed, preventing them from adopting disease management strategies that could improve their quality of life and decrease morbidity. Among those at great risk are persons with periodontal disease, many of whom may see a dentist but not a primary care provider annually. This suggests the potential and importance of screening for diabetes at dental visits. Facilitated by the American Diabetes Association's promotion of blood testing for diabetes using hemoglobin A1c (HbA1c) levels, we conducted a pilot study (N=120) at a Periodontics Clinic to examine a potentially useful intra-oral approach to this screening. To do so, we collected samples of both finger stick blood (FSB) and gingival crevicular blood (GCB) from periodontal patients (the latter occurring naturally on probing their periodontal pockets). We then sent the dried blood samples for laboratory testing, and examined the accuracy of the GCB relative to the FSB readings. The laboratory, not the dentist, shared FSB test results with the patient, thus eliminating scope of practice concerns for the dentist. Results of this pilot study showed high specificity (.900) and sensitivity (.933) of the GCB HbA1c values relative to the FSB HbA1c values. It also demonstrated patient and provider preference for the GCB approach, as they were more comfortable with the provider collecting blood samples in the patient's mouth. However, before recommending widespread implementation of this promising diabetes screening approach, research is needed to replicate and expand this pilot study with a larger patient sample and to translate it to general dental practice settings, while ensuring that the screening does not generate excess patient anxiety or other psychological harms. After recruiting 500 patients with periodontal disease who seek care at 14 general practice clinics at NYUCD over a 15-month period, we will address the following specific aims: (1) Assess the accuracy of patients'HbA1c test results using GCB relative to FSB HbA1c readings;(2) Examine patient and provider views on the GCB diabetes screening approach's acceptability and feasibility;(3) Assess the psychological impact to patients of participating in screening for diabetes at dental visits;and (4) Compare socio-demographic and clinical characteristics of patients with a positive screening result who follow up with a health care provider within 3 months and those who do not, thereby illuminating potential barriers and facilitators to follow up. If results demonstrate that the GCB HbA1c screening is accurate, feasible, and acceptable, with minimal psychological impact on patients, and leads to timely follow-up with a health care provider, we will seek funding to further examine its usefulness on a broader scale.
This study addresses an issue of critical public health importance and urgency: the need to increase opportunities for diabetes screening for at-risk patients with periodontal disease by using an innovative intra- oral screening approach in dental practices. Expanding the types, venues and approaches for diabetes screening may enable many medically underserved persons to learn of their condition sooner, thereby enabling them to prevent or delay major diabetes-related complications.
