IDF2022-0987 Development of a Clinical Risk Model for Targeted Screening of Undiagnosed Diabetes in Asian Dental Settings

Studies show that Asians are at higher risk of developing type 2 DM compared to non-Asians. In Singapore, 11.6% of residents aged 20–79 years have diabetes and 50.4% of these have undiagnosed diabetes, UD posing significant morbidity and mortality. The link between periodontitis and diabetes and the feasibility of dental settings for opportunistic health screening suggest the potential of detecting accurately patients at risk of DM by using data obtained during the dental visit. To develop a clinical risk model that easily allows targeted optimal screening of UD in dental patients diagnosed with periodontitis according to current or former classifications. The study included 1074 adult patients with no known DM. Patients’ socio-demographic characteristics, general health status, and periodontal status were recorded as potential predictors. Full periodontal examination and point-of-care (POC) HbA1c analysis were performed. The POC HbA1c was considered the outcome, grouped as normoglycemic, at-risk of PreDM, or at-risk of UD. The best model was chosen using univariable analysis of DM by logistic regression followed by multi-variable logistic regression analysis. 66(6.1%) and 386(35.9%) individuals had POC HbA1c levels indicative of DM and PreDM, respectively. BMI, family history of diabetes, smoking status and advanced periodontitis were significantly associated with the glycemic status of the patients. The final clinical risk model for UD in patients with Stage-3 or 4 Periodontitis had a sensitivity of 80.3%, specificity of 54.6%, and AUC of 0.72(95% CI: 0.656, 0.783). The final clinical risk model for UD in patients with Severe Periodontitis had a sensitivity of 78.8%, specificity of 62.1%, and AUC of 0.735(95% CI: 0.674, 0.796). Patient BMI, family history of diabetes, smoking status and advanced periodontal disease could be used reliably in clinical risk models to screen patients in Asian dental settings for UD, facilitating early diagnosis and management of DM.