Εντοπισμός αδιάγνωστου σακχαρώδους διαβήτη και προ-διαβήτη σε ασθενείς με χρόνια περιοδοντίτιδα με τη μέθοδο της μέτρησης της γλυκοζυλιωμένης αιμοσφαιρίνης στο οδοντιατρείο
Creators: name: Ματαυτσή, Μαρία Γεωργίου
Publisher: name: Aristotle University of Thessaloniki
Year: 2018
Subjects: Σακχαρώδης διαβήτης
Εντοπισμός αδιάγνωστου διαβήτη
Γλυκοζυλιωμένη αιμοσφαιρίνη
Diabetes screening
Chairside HcA1c measurement
Undiagnosed diabetes

description: Ο σακχαρώδης διαβήτης αποτελεί παγκόσμιο υγειονομικό πρόβλημα. Στα πλαίσια της προσπάθειας για έγκαιρη διάγνωσή του, η συμβολή του οδοντιάτρου αποκτά δυναμική σημασία, καθώς η επίσκεψη του ατόμου στο οδοντιατρείο είναι ιδανική ευκαιρία για τη διενέργεια τεστ ανίχνευσης για διαβήτη. Η παρούσα μελέτη προτείνει μια στρατηγική πρώιμης ανίχνευσης του διαβήτη με σκοπό τον εντοπισμό ατόμων με αδιάγνωστο διαβήτη ή με υψηλό κίνδυνο εκδήλωσής του και τη διερεύνηση του ρόλου του οδοντιάτρου στην ανίχνευση του διαβήτη. Σε 102 περιοδοντικούς ασθενείς που βρέθηκαν με υψηλό κίνδυνο εκδήλωσης διαβήτη, βάσει του ερωτηματολογίου που προτείνει το Κέντρο Ελέγχου και Πρόληψης Ασθενειών (CDC- Centre for Disease Control and Prevention), μετρήθηκε η γλυκοζυλιωμένη αιμοσφαιρίνη με τη λήψη σταγόνας αίματος από δάχτυλο του χεριού και τη χρήση του αυτοματοποιημένου αναλυτή cobas b 101 (Roche). 25 άτομα εντοπίστηκαν με αδιάγνωστη υπεργλυκαιμία (HbA1c ≥ 5.7%). Στα άτομα αυτά έγινε σύσταση για περαιτέρω εξετάσεις, ώστε να επιβεβαιωθεί η ύπαρξη ή απουσία της νόσου.
description: Diabetes mellitus represents a group of metabolic disorders characterised by marked hyperglycaemia, which derives from dysfunction in the secretion or action of insulin or both of them. Diabetes-associated chronic hyperglycaemia induces dysfunction, destruction and finally failure of several organs. Diabetes has nowadays become a pandemic, causing significant morbidity, mortility and financial healthcare issues and has a negative impact in health-related quality of life. The percentage of undiagnosed diabetes is alarming, reaching the number of 192.8 millions of adults (20-79 years old) in 2015. Pre-diabetes, defined as hyperglycaemia which is below the pathologic threshold but very close to it (HbA1c 5.7-6.4%), often precedes type 2 diabetes. Individuals with pre-diabetes are at increased risk for microvascular diseases and for developing overt diabetes, however progression to diabetes is not inevitable. Therefore early detection and timely intervention is of paramount importance. Early detection can be more efficient if the contact points of udiagnosed individuals and healthcare providers are expanded. In this context, dental professionals can play a dynamic role and contibute to the early detection of diabetes. The purpose of the present study is to propose a diabetes screening strategy that can take place in the dental office utilising chairside HbA1c measurement and to investigate the dentists’ role in identifying individuals with undiagnosed diabetes. Periodontal patients who visited the undergraduate and postgraduate clinic of the Periodontal Department of Dental School, Aristotle University, Thessaloniki, Greece, formed the sample pool. The self-assessed questionnaire proposed by the CDC (Centre for Disease Control and Prevention) was used to identify 102 patients being at high risk for developing diabetes mellitus. After giving their formal written consent, these patients were recruited for a chairside HbA1c measurement. Cobas® b101 (Roche Diagnostics) in vitro diagnostic test system was used for this purpose. Body weight, height and waist circumference of these patients were also measured by the main investigator, in order to calculate Body Mass Index (BMI) and to determine splachnic obesity. Periodontal examination included a full periodontal chart of probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP) and plaque score (Pl) in 6 surfaces of each tooth, excluding third molars, and radiographic evaluation. Patients identified with hyperglycaemia (HbA1c ≥ 5.7%) were advised to take a blood test to reject or confirm the initial measurement. The rest of the patients were given advice for lifestyle alterations regarding their weight and daily exercise and to check blood glucose level on a regular basis, as they were found to have an increased risk of developing diabetes. 25 patients out of 102 tested were found to have HbA1c ≥ 5.7%, 22 of which had HbA1c 5.7-6.4%, indicating undiagnosed pre-diabetes and 3 had HbA1c ≥ 6.5%, indicating undiagnosed diabetes. Level of HbA1c was statistically significantly associated with body mass index (BMI) and waist circumference. In accordance with similar studies, the present study further supports that the dental setting is ideal for opportunistic screening for diabetes and that point-of-care HbA1c measurement by dental professionals is convenient and effective in identifying undiagnosed pre-diabetes and diabetes.