Fasting plasma glucose screening should begin at age 30–45 and be repeated at least every three years. Earlier and more frequent screening should be conducted in at-risk individuals. The risk factors for which are listed below: * Family history (parent or sibling) * Dyslipidemia (triglycerides > 200 or HDL 25) * History of gestational diabetes or infant born with birth weight greater than * High risk ethnic group (such as of being of African American, Hispanic, Native American, Asian American or Pacific Islander heritage) * Hypertension (systolic blood pressure >140 mmHg or diastolic blood pressure > 90 mmHg) * Prior fasting blood glucose > 99 * Known vascular disease * Markers of insulin resistance (PCOS, acanthosis nigricans)<unk>  Screening in a Dental Setting Screening The United States Preventative Services Task Force (USPSTF) recommends adults who are overweight/obese and aged 40–70 years old to get screened during visits to their regular physician. The American Diabetes Association (ADA) recommends normal testing repeated every three years and recommends a larger range of people get tested: anyone over the age of 45 regardless of risk; an adult of any age who is obese or overweight and has one or more risk factors, which includes hypertension, a first degree relative with diabetes, a physical inactivity, high risk race/ethnicity, Asian Americans with BMI of ≥23 kg/m2, HDL 250 mg/dL, women who have delivered child >9 lbs or with gestational diabetes, A1c ≥ 5.7%, impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). It’s been found that people will visit their dentist more regularly than their primary physician for checkups, so the dentist’s office becomes a very useful place for potentially checking for diabetes. For people who are unaware of their diabetes risk and fall into the non-White, obese, or ≥45 y old category, screening at the dentist’s would have the highest odds of getting identified as someone at risk. Studies have been done to evaluate the overall effectiveness and value of<unk>  testing in the dental setting, usually at dental schools. One study has looked at screening through dental visits followed up by intervention programs such as the commercial Weight Watchers and found it a cost-effective means to identify and treat affected people in the long term. Cost is a factor people at risk might need to consider, since, on average, people diagnosed with diabetes have approximately 2.3 times higher medical expenditure that what expenditures would be in its absence. A simple test may be instituted at the dentist’s office, in which an oral blood sample is taken during a normal visit to the dentist’s. This sample tests for glycated hemoglobin (HbA1c) levels; HbA1c gives healthcare professionals an idea of blood glucose levels and is the most reliable form of testing for diabetes in asymptomatic patients. Fasting and “acute perturbations” are not needed for HbA1c test and it reveals average glycemic control over 3 month period. HbA1c less than 5.6% is considered normal. Glucose status can also be tested through fasting blood sugar (FBS) and requires a blood sample after a patient has fasted for at least eight hours, so it might not be as convenient. Patients who have gotten oral blood samples taken say it feels as if part of a normal procedure, and dentists say it is convenient. In a study that analyzed data from 10,472 adults from 2013 to 2014 and 2015 to 2016, it was revealed that screening for risk of<unk>  in the dental setting has the potential to alert an estimated 22.36 million adults. Diabetes may be asymptomatic for a long time, but since it would be wasteful to test every patient at the dental office, utilizing known risk factors may guide who is ideal for testing. Since a history is already taken at a dental office, a few additional questions would help guide a dentist on narrowing down who the test is recommended for. For example, people with high BMI are at higher risk for diabetes. A study done by the School of Dentistry, Diabetes Research Centre, Mazandaran University of Medical Sciences in Sari, Iran found a relation between periodontitis and the prediabetic condition, and this could be another tool to help guide who might be recommended to take the test. Periodontal disease occurs when a number of anaerobic bacteria living on the tooth surface cause infections, which leads to a potentially sustained immune response. Diabetes is a type of condition in which infections are easier to get, and hyperglycemia contributes to the mechanism causing oral complications. Early Detection and Management Over half the people who are diagnosed with<unk>  eventually develop type 2 diabetes and once diagnosed with<unk> , people experience a range of emotions: distress and fear; denial and downplay of risks; guilt and self-criticism; and self-compassion. While<unk>  is a reversible condition, it requires diet change and exercise, which may be more difficult for people diagnosed<unk>  because facing the risk of a chronic condition is associated with negative emotions, which further hinder the self-regulation that is required in reversing a<unk>  diagnosis. Still, without taking action, 37% of individuals with<unk>  will develop diabetes in only 4 years, and lifestyle intervention may decrease the percentage of prediabetic patients in whom diabetes develops to 20%. The National Diabetes Prevention Program (DPP) has a Center of Disease Control (CDC)-recognized lifestyle change program that showed prediabetic people following the structured program can cut their risk of developing type 2 diabetes by 58% (71% for people over 60 years old). Considering the possibility to recover from the prediabetic status but also this emotional struggle upon diagnosis, it is encouraged for higher risk patients to get tested early. Having an additional screening option in the dental setting may offset some of the emotional struggle because it is more regularly visited and therefore has the potential to initiate earlier recognition and intervention.
Prediabetes
Metabolic syndrome
Prehypertension
Diabetes
Obesity
Type 2 diabetes
Normal weight obesity
Premorbidity